Clerking Patients With Stroke: A Step-By-Step Guide

Knowing how to clerk a patient with a stroke involves understanding the signs and symptoms of a stroke, the immediate steps to take, and the long-term care required. It is crucial to act quickly and call for emergency medical assistance if you suspect someone is having a stroke, as prompt treatment can significantly improve the patient's outcome. Strokes occur when the blood supply to the brain is blocked or limited, resulting in a lack of oxygen and essential nutrients, and subsequent damage to the affected areas of the brain. The effects of a stroke can vary, with some patients experiencing mild effects and others facing significant limitations requiring around-the-clock care.

Recognising the signs of a stroke

Face Drooping

Check if one side of the person's face is drooping or numb. Ask them to smile and observe if their smile is uneven. This could be a sign of muscle weakness or paralysis, often occurring on just one side of the body.

Arm Weakness

Ask the person to raise both arms. If they are unable to lift one or both arms due to weakness or numbness in one arm, it could be a sign of a stroke. Pay attention to whether one arm drifts or drops downward.

Speech Difficulty

Listen for slurred speech or strange speech patterns. Ask the person to say a short phrase and check for any abnormalities. Stroke victims may also experience difficulty in choosing their words or understanding speech.

Time to Call Emergency Services

If you observe any of the above signs, it is crucial to act fast. Call the emergency services immediately and note the time when any of the symptoms first appeared. Every minute counts in stroke treatment, and early treatment leads to higher survival rates and lower disability rates.

In addition to the F.A.S.T. checklist, there are other signs and symptoms that may indicate a stroke:

• Numbness or weakness, especially on one side of the body
• Confusion, disorientation, or memory loss
• Trouble speaking or understanding speech
• Blurred vision or loss of sight in one or both eyes
• Dizziness, loss of balance, or falling over
• Severe headache with no known cause
• Clumsiness or poor coordination
• Difficulty walking

Calling emergency services

If you suspect someone is having a stroke, it is imperative that you act quickly and call for emergency services. Time is of the essence as human nerve tissue is rapidly lost as the stroke progresses, and the longer the delay in treatment, the more damage can occur in the brain. Here are some detailed steps to follow when calling for emergency assistance:

Recognize the signs of a stroke: Use the acronym FAST to help you remember:

• F = Face: Check for any changes in the person's face, such as drooping on one side or an uneven smile.
• A = Arms: Ask the person to raise both arms and observe if they can hold them up or if the arms drift down.
• S = Speech: Assess their speech by asking them to repeat a simple sentence. Listen for slurred speech or difficulty in understanding.
• T = Time: If you observe any of the above signs, don't hesitate to call 911 or your local emergency number immediately.

• Ensure the person's safety: Make sure the surrounding area is safe and there are no imminent dangers, such as moving vehicles, that could cause further harm to the person.
• Talk to the person: Engage with the person and ask them their name and other questions. If they are unable to speak, request that they squeeze your hand in response. If there is no response, they are likely unconscious.
• Position the person comfortably: If the person is conscious, gently place them in a comfortable position. Ideally, they should be lying on their side with their head and shoulders slightly raised and supported. Avoid moving them unnecessarily after this.
• Loosen restrictive clothing: Loosen any tight clothing, such as shirt collars or scarves, to help the person breathe more easily. Be careful to not pull or strain any weakened limbs.
• Keep them warm: If the person feels cold, use a blanket or coat to maintain their body temperature.
• Check their airway: Ensure the person's airway is clear and unobstructed. If there are objects or substances, such as vomit, in the mouth that may hinder breathing, carefully place the person on their side in the recovery position.
• Reassure the person: Let the person know that help is on the way. Stay with them and provide comfort until emergency services arrive.
• Do not give food or liquids: Refrain from giving the person any food or liquids, as stroke can impair muscle control, including the ability to swallow.
• Monitor symptoms and note the time: Pay close attention to the person's symptoms and look for any changes in their condition. Note the time the symptoms started, as this information is crucial for emergency personnel. If possible, refer to a clock rather than estimating the time, as it can be challenging to gauge time accurately in a stressful situation.
• Check for breathing and pulse: If the person is unconscious, check for breathing and pulse. Place a cheek over their mouth to feel for breath and listen for breathing sounds. If there are no signs of breathing or pulse, immediately begin CPR (cardiopulmonary resuscitation) and continue until emergency services arrive.
• Place the person in the recovery position: If the person is unconscious or their airway is not completely clear, follow the steps to place them in the recovery position:

• Take the arm that is farthest away and place it at a right angle to their body.
• Place the other arm across their chest.
• Keep the leg that is farthest away straight and bend the other knee.
• Support their head and neck, and carefully roll them onto their side so that their bottom leg is straight and their top leg is bent at the knee, with the knee touching the ground.
• Tilt their head slightly forward and down to allow for any vomit to drain out of the airway.

• Clear the person's mouth: If necessary, manually clear out any substances or objects from the person's mouth to maintain a clear airway.
• Perform CPR if needed: If the person is not breathing, perform CPR until emergency services arrive. For those untrained in CPR, the American Heart Association (AHA) recommends initiating hands-only CPR for teenagers and adults by pushing hard and fast in the center of the chest.
• Use an automated external defibrillator (AED) if available: If there is an AED device nearby, use it to check the person's heart rhythm and deliver an electric shock to the chest if necessary.

Remember, calling for emergency services promptly is crucial when dealing with a stroke. The faster the person receives medical attention, the better the chances of a positive outcome.

Placing the patient in the recovery position

Placing a stroke patient in the recovery position is a crucial step in ensuring their safety and promoting optimal recovery. Here are some detailed instructions on how to place a stroke patient in the recovery position:

Step 1: Understanding the Recovery Position

The recovery position is used when a person is unconscious but breathing and has no other life-threatening conditions. It helps keep their airway clear and open and prevents choking in case of vomiting or fluid accumulation.

Step 2: Prepare the Patient's Position

Kneel on the floor next to the patient, who should be lying on their back. This position will give you leverage and stability as you adjust their body.

Step 3: Position the Arms

Extend the arm nearest to you at a right angle to their body, ensuring the palm faces up. This will help maintain a clear airway. Now, take their other arm and gently fold it so that the back of their hand rests on the cheek closest to you. Hold it in place to stabilise their head and neck.

Step 4: Bend the Far Knee

Use your free hand to carefully bend the patient's knee farthest from you, also at a right angle. This will facilitate rolling them onto their side and ensure stability in the recovery position.

Step 5: Roll the Patient onto Their Side

Gently pull the bent knee towards you, carefully rolling the patient onto their side. Ensure that their bent arm remains supporting their head and that the extended arm is still in place.

Step 6: Adjust the Legs

Make sure the patient's bent leg remains at a right angle. You may need to adjust it slightly to ensure a stable and comfortable position.

Step 7: Open the Airway

Gently tilt their head back and lift their chin to open the airway. Check for any blockages and ensure their breathing remains steady.

Step 8: Monitor and Stay with the Patient

It is important to stay with the patient and monitor their condition until emergency services arrive. Keep an eye on their breathing and vital signs, and be prepared to respond to any changes.

It is important to note that if you suspect a spinal injury, do not attempt to move the patient until instructed to do so by emergency services personnel. Additionally, if the patient requires airway opening, use a specific technique that avoids moving their neck.

Placing a stroke patient in the recovery position is just one aspect of their care. Family members and caregivers play a crucial role in supporting the patient's recovery by assisting with daily tasks, providing emotional support, and promoting a safe and stimulating environment. Each patient's needs will vary, and it is essential to seek guidance from medical professionals to tailor the care plan accordingly.

Preventing another stroke

Medication Management

Ensure the patient takes their prescribed medications correctly and on time. Consult with their doctor before making any changes to their medication routine. This is an essential step in preventing another stroke and managing their overall health.

Healthy Diet

Adopting a healthy, balanced, and low-fat diet is crucial. Prepare meals that are nutritious and low in fat to promote cardiovascular health and reduce the risk of another stroke.

Regular Exercise

Encourage the patient to engage in regular physical activity, as recommended by their healthcare provider. Exercise can help improve their overall health and reduce the risk of a recurrent stroke.

Smoking Cessation

If the patient smokes, it is imperative to reduce or quit smoking entirely. Smoking is a significant risk factor for strokes, and discontinuing this habit can have a positive impact on their health and reduce the likelihood of another stroke.

Home Modifications

Make necessary modifications to the patient's home environment to prevent falls and ensure their safety. This may include installing grab bars, removing trip hazards like rugs, and ensuring a clutter-free space. These changes can reduce the risk of injuries and falls, which are common after a stroke.

Monitor Behavioural Changes

Be mindful of any changes in the patient's behaviour or mood. Stroke survivors may experience a range of emotions, including grief, anger, and anxiety. Offer emotional support and, if needed, consult a healthcare provider to develop an appropriate plan of action to address any concerns.

Manage Depression

Stroke survivors are at a high risk of developing post-stroke depression, which can significantly impact their recovery. Be vigilant for signs of depression and seek professional help if necessary. Treating depression effectively can enhance their overall recovery and reduce the risk of another stroke.

Regular Check-ups

Ensure the patient attends regular check-ups and medical appointments. Keeping in touch with their healthcare provider allows for the monitoring of their health, the management of risk factors, and the early detection of any potential issues.

Encourage Independence

While providing assistance, also encourage the patient to do as much as they can independently. This promotes neuroplasticity and helps them regain confidence and a sense of self-efficacy. It is a delicate balance between providing support and allowing them to push themselves within their capabilities.

Prevent Falls

Take measures to prevent falls, as they are common after a stroke and can lead to further complications. Ensure the patient's environment is safe and free of hazards. If a fall occurs, seek medical attention promptly.

Caregiver Support

Caring for a stroke patient can be challenging, so it is crucial to support the caregiver's well-being too. Encourage caregivers to take time for self-care, join support groups, and seek help from family and friends or community resources. A well-supported caregiver can provide better care for the patient, reducing the risk of another stroke.

Preparing to care for a stroke survivor at home

Caring for a stroke survivor at home can be challenging, but also rewarding. The level of care and assistance required will vary from person to person, but there are some basic steps that can be taken to prepare for the return of a loved one after a stroke.

Consult with rehabilitation professionals

It is important to understand the effects of a stroke and the potential challenges a survivor may face. Rehabilitation professionals, such as physical, occupational, and speech therapists, can provide valuable insights into the survivor's abilities and limitations. They can advise on the type of assistance and adaptive equipment that may be needed.

Meet with social workers or case managers

Social workers and case managers are a crucial part of the stroke recovery team. They can provide information on insurance coverage, setting up home health or outpatient rehabilitation, and obtaining necessary medical equipment.

Consider home modifications

Stroke survivors are often at high risk of falling due to hemiplegia (weakness on one side of the body) or balance issues. Making modifications to the home environment can improve safety and help the survivor navigate their home more easily. This may include installing grab bars and non-slip mats, removing clutter and floor mats, and ensuring cords are out of the way.

Do a "practice run"

While nothing can fully prepare you for caring for a stroke patient at home, practicing in a safe environment can be beneficial. This could involve a caregiver training session with an occupational therapist or a home visit with a therapist to ensure the home is suitably set up.

Understand preventative care

In addition to meeting the survivor's daily needs, caregivers should focus on preventative care to avoid medical complications. This includes managing medications, monitoring the survivor for any changes, taking measures to prevent falls, and promoting healthy lifestyle changes to reduce the risk of another stroke.

Caregiver self-care

Caring for a stroke survivor can be demanding, so it is important for caregivers to also prioritise their own well-being. This includes making time for self-care activities, joining support groups, and learning relaxation techniques. Additionally, when assisting with physical tasks, caregivers should use proper body mechanics to avoid injury.

Encourage daily rehabilitative exercise

Encourage the survivor to practice rehabilitative exercises that involve their affected functions. This stimulates neuroplasticity and promotes recovery. Even small accomplishments can boost the survivor's confidence and self-reliance.

Be prepared for emotional support

Stroke survivors may experience a range of emotions, including grief, anger, and anxiety, as they adjust to life after a stroke. Caregivers should provide love, patience, and support, allowing the survivor to express their feelings. It is important to be respectful and empowering, allowing the survivor to make their own decisions whenever possible.

Seek outside help

Don't be afraid to ask for help. Getting outside assistance, such as respite care or homemaker services, can give caregivers time to relax and recharge. Family, friends, and community resources can provide valuable support.

Educate yourself

Take advantage of support groups, programs, and resources offered by the hospital to learn as much as possible about stroke and your loved one's condition. The more knowledge you have, the better you can care for your loved one.

Frequently asked questions