Nursing Interventions for Cerebrovascular Attacks

How do we improve mobility and prevent joint deformities in CBV attacks?

• position

• splint

• pillow

What do we keep in mind when changing positions?

• Every 2 hours.

• Pillows between legs for side-lying.

• Avoid acute thigh flexion.

• Limit time on affected side (if sensation impaired).

• Prone positioning: Promotes hip hyperextension, prevents contractures, drains secretions.

Establishing an Exercise Program

• Prevents venous stasis.

• Forms new CNS pathways.

• Passive ROM exercises (4-5 times/day).

• Monitor for pulmonary embolus/cardiac workload.

• Short, frequent exercise sessions.

• Encourage unaffected side exercise.

• Written schedule, supervision.

Preparing for Ambulation

• Early out-of-bed activity.

• Balance training (sitting, standing).

• Short, frequent training periods.

• Assistive devices: Tilt table, wheelchair, parallel bars, cane.

Preventing Shoulder Pain

• Avoid lifting/pulling flaccid shoulder.

• Avoid overhead pulleys.

• Proper positioning/sling use.

• Finger interlacing exercises.

• Wrist/finger joint movement.

• Tactile stimulation, visual regard of affected hand.

• Elevation for edema.

• Analgesics for pain.

Enhancing Self-Care

• Encourage participation in hygiene.

• Realistic goals, daily new tasks.

• Use unaffected side.

• Functional Independence Measure (FIM).

• Adaptive clothing.

• Organized environment.

• Visual cues.

Adjusting to Physical Changes

• Visual stimuli placement.

• Head turning to compensate for visual field deficits.

• Eye contact, attention to affected side.

• Increased lighting, eyeglasses.

• Reminders of affected side, extremity placement.

Adjusting with Nutrition

• Observe for swallowing difficulties.

• Alternative swallowing techniques, small boluses, easy-to-swallow foods.

• Thick liquids/puréed diet.

• Upright position, chin tuck.

• GI feeding tube (if needed).

• Swallow assessment (within 24 hours).

Attaining Bowel and Bladder Control

• Address incontinence due to confusion/motor control.

• Intermittent catheterization, voiding schedule.

• Upright/standing position for males.

• High-fiber diet, fluids, regular toileting.

Improving Thought Processes

• Cognitive-perceptual retraining, visual imagery, reality orientation, cueing.

• Review neuropsychological testing.

• Observe performance/progress.

• Positive feedback, confidence.

• Capitalize on strengths.

Improving Communication

• Address aphasia (common with right-side paralysis).

• Face patient, eye contact.

• Usual tone, short phrases, pauses.

• Concrete topics, gestures, pictures, writing.

• Consistent words/gestures.

• Minimize distractions.

Maintaining Skin Integrity

• Assess skin frequently (bony areas).

• Specialty bed (acute phase).

• Turning schedule (every 2 hours).

• Minimize shear/friction.

• Clean, dry skin, gentle massage.

• Adequate nutrition.

Improving Family Coping

• Counseling, support systems.

• Education on stress management.

• Expected outcomes, encourage patient independence.

• Long-term rehabilitation expectations.

• Supportive, optimistic attitude.

Helping the Patient Cope with Sexual Dysfunction

• Assess sexual history.

• Interventions: Information, education, reassurance, medication adjustment, counseling, alternative positions.