Stroke - discharge

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Stroke - discharge

Alternate Names

Cerebrovascular disease - discharge; CVA - discharge; Cerebral infarction - discharge; Cerebral hemorrhage - discharge; Ischemic stroke - discharge; Stroke - ischemic - discharge; Stroke secondary to atrial fibrillation - discharge; Cardioembolic stroke - discharge; Brain bleeding - discharge; Brain hemorrhage - discharge; Stroke - hemorrhagic - discharge; Hemorrhagic cerebrovascular disease - discharge; Cerebrovascular accident - discharge

When You Were in the Hospital

You or your loved one was in the hospital after having a stroke. Stroke happens when blood flow to the brain stops. First, you or your loved one received treatment to prevent any further damage to the brain, and to help the heart, lungs, and other important parts of your body.

After you were stable, doctors did testing and treatment to help with recovery from the stroke. You may have stayed in special units that help people to recover after a stroke.

What to Expect at Home

Because of possible injury to the brain from the stroke, you may notice problems with:

  • Changes in behavior
  • Doing easy tasks
  • Memory
  • Moving one side of the body
  • Muscle spasms
  • Paying attention
  • Swallowing
  • Talking or understanding others
  • Thinking

You may need help with many daily activities you used to do alone before the stroke.

Depression after stroke is fairly common as you or your loved one learns to live with the changes. It may develop soon after stroke, but symptoms may not be present for up to 2 years after the stroke.

Moving Around

Moving around and doing normal tasks may be hard after you or your loved one have a stroke.

Make sure your home is safe. Ask your doctor or nurse about making changes in the home to make it easier to do everyday activities.

Learn to make your home safer if your loved one wanders away inside the home or away from the home.

See also:

Family and caregivers may need to help with:

  • Exercises to keep your elbows, shoulders, and other joints loose
  • Watching for joint tightening (contractures)
  • Making sure splints are used in the correct way
  • Making sure arms and legs are in a good position when sitting or lying

If your or your loved one is using a wheelchair, follow-up visits to make sure it fits well are important to prevent skin ulcers.

  • Check every day for pressure sores at the heels, ankles, knees, hips, tailbone, and elbows.
  • Change positions in the wheelchair several times per hour during the day to prevent pressure ulcers.

See also:

Thinking and Speaking

Tips for making clothing easier to put on and take off are:

  • Do not provide too many choices.
  • Velcro is much easier than buttons and zippers. All buttons and zippers should be in the front of a piece of clothing.
  • Use pullover clothes and slip-on shoes.

People who have had a stroke may have speech problems. Tips for talking with your loved one are:

  • Keep distractions and noise down. Move to a quieter room.
  • Give the person plenty of time to answer. After a stroke, it will take them longer to process what has been said.
  • Use simple words and sentences, speaking slowly. Keep your voice lower. Repeat if needed. Use familiar names and places. Tell them when you are going to change the subject. Do not yell or shout.
  • Make eye contact before touching or speaking if possible.
  • Ask questions in a manner that they can be answered with a yes or no. When possible, give clear choices. Use props or visual prompts when possible. Do not give too many options.

When giving someone instructions after a stroke:

  • Break down instructions into small and simple steps.
  • Allow time for them to be understood.

Try using other ways of communicating:

  • You may be able to use pointing or hand gestures or drawings.
  • It may help the person with aphasia and their caregivers to make a book with pictures or words about common topics or people so that they can communicate better.

See also: Communicating with someone with aphasia

Bowel Care

Nerves that help your bowels work smoothly can be damaged after a stroke. Have a routine. Once you find a bowel routine that works, stick with it. See also: Daily bowel care program

  • Pick a regular time, such as after a meal or a warm bath, to try to have a bowel movement.
  • Be patient. It may take 15 to 45 minutes to have bowel movements.
  • Try gently rubbing your stomach to help stool move through your colon.

Avoid constipation:

  • Drink more fluids.
  • Stay active or become more active.
  • Eat a diet with lots of fiber.

Ask your doctor about medicines you, or your loved one, are taking that may cause constipation (such as some medicines for depression, pain, bladder control, and muscle spasms).

Medication

Have all of your prescriptions filled before you go home. It is very important that you take your drugs the way your doctor or nurse told you to. Do not take any other drugs, supplements, vitamins, or herbs without asking your doctor about them first.

You may be given one or more of the following drugs. These drugs may help prevent another stroke:

  • Antiplatelet drugs (aspirin or Clopidogrel) help keep your blood from clotting.
  • Beta blockers or ACE inhibitor medicines may help protect your heart.
  • Diuretics (or water pills), ACE inhibitors, Beta-blockers, and other medications will help control blood pressure.
  • Statins or other drugs that lower your cholesterol.
  • If you have diabetes, control your blood sugar at the level your doctor or nurse recommends.

Do not just stop taking any of these drugs, as well as drugs for your diabetes, high blood pressure, or any other medical problems you may have.

If you are taking a blood thinner, such as warfarin (Coumadin), you may need to have extra blood tests.

Staying Healthy

If you have problems with swallowing, you must learn to follow a special diet that makes eating safer. Ask your doctor what the signs of swallowing problems are. Learn tips to make feeding and swallowing easier and safer. See also: Swallowing problems

Learn more about what you should eat to make your heart and blood vessels healthier.

  • Avoid salty and fatty foods.
  • Stay away from fast food restaurants

Try to limit how much alcohol you drink. Ask your doctor when you may start. Even if you are allowed to drink, limit yourself -- women may have one drink a day and men may have two drinks a day.

Keep up to date with your vaccinations. Get a flu shot every year. Ask your doctor if you need a pneumonia shot.

Do not smoke cigarettes. Ask your doctor for help quitting if you need to. Do not let anybody smoke in your home.

Try to stay away from stressful situations. If you feel stressed all the time or feel very sad and blue, talk with your doctor or nurse.

Many patients who have had a stroke feel sad or depressed at times. Talk to friends or family about this. Ask your doctor about seeing a professional to help you with these feelings.

When to Call the Doctor

Call your doctor if you have:

  • Problems taking drugs for muscle spasms
  • Problems moving your joints (joint contracture)
  • Problems moving around or getting out of your bed or chair
  • Skin sores or redness
  • Pain that is becoming worse
  • Recent falls
  • Choking or coughing when eating
  • Signs of a bladder infection (fever, burning when you urinate, or frequent urination)

Call 911 if the following symptoms develop suddenly or are new:

  • Numbness or weakness of the face, arm, or leg
  • Blurry or decreased vision
  • Not able to speak or understand
  • Dizziness, loss of balance, or falling
  • Severe headache

References

Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007 May 22;115(20):e478-534.

Goldstein LB. Prevention and management of stroke. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders;2007:chap 58.

Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.

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Review Date: 1/22/2009
Reviewed By: Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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