E9: Treatment (stroke)

People who have had a stroke have prompt access to an acute stroke unit and spend the majority of their time at hospital in a stroke unit with high-quality stroke specialist care. (Key: e = element | k = knowledge | s = skill)

Knowledge and understanding of…

e9k_1:
Signs and symptoms of stroke
e9k_2:
Neurological and physiological effects of stroke, monitoring, and the timeframe of changes, during and after a stroke
e9k_3:
The need for early mobilisation and positioning
e9k_4:
Assessing swallowing and managing of dysphagia
e9k_5:
Alternative methods of feeding, hydration and drug administration for patients with dysphagia
e9k_6:
The interactions between enteral feeds, fluids and drug treatment
e9k_7:
The effects of stopping ongoing drug treatment because of swallowing problems
e9k_8:
Symptoms and effects of malnourishment
e9k_9:
The importance and methods of oral hygiene
e9k_10:
The importance of avoiding catheters, as well as managing retention and promoting continence
e9k_11:
Assessing and managing problems: psychological and emotional; social and relationship; cognitive and communication; physical and functional; sensory impairment and pain; medical
e9k_12:
Cognitive effects of the stroke and their impact on the patient’s ability to consent to treatment
e9k_13:
Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations
e9k_14:
The impact of the stroke on family, friends and carers
e9k_15:
Assessment and management options for neurological, physiological, functional and psychological problems after stroke
e9k_16:
Complications after stroke and how to prevent and manage them
e9k_17:
When to refer for other specialist care (e.g. intensive care unit, hemicraniotomy, haematoma evacuation, interventional radiology, vascular surgery)
e9k_18:
Any complications of investigations, interventions and treatments for stroke and how to prevent and manage them
e9k_19:
The roles, level and number of health and social service professionals who should contribute to the care and support of individuals with stroke and those affected by stroke
e9k_20:
How to manage strokes that occur as a complication of another primary pathology

Skills and ability to...

e9s_1:
Take and interpret thorough history, record third party information where possible, and assess mental capacity
e9s_2:
Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)
e9s_3:
Perform neurological and physiological assessment and assess vital signs
e9s_4:
Perform a standardised neurological assessment using a recognised stroke scale (e.g. NIHSS, SNSS)
e9s_5:
Identify the need and level of urgency for the relevant medical, surgical and radiological investigations, interventions and treatments; obtain and interpret the results of investigations: formulate an immediate and ongoing management plan; initiate treatments within the relevant timescales
e9s_6:
Diagnose stroke using clinical information and investigations: distinguish between a stroke and a TIA; identify atypical strokes and stroke mimics; formulate and implement a management plan accordingly
e9s_7:
Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support
e9s_8:
Identify the need for more specialist or differing treatments when necessary and be able to refer to those services
e9s_9:
Monitor progress, identify neurological and non-neurological complications or deterioration and to deliver treatments
e9s_10:
Obtain and interpret the results of investigations and formulate a management plan accordingly
e9s_11:
Identify and use therapeutic methods of moving and handling the patient that are safe, depending on the individual patient or staff needs and aspirations
e9s_12:
Assess and manage: oral problems including dysphagia, nutrition and hydration; cognition; psychological and emotional problems; continence; pressure areas; mobility problems etc in collaboration with members of the multidisciplinary team
e9s_13:
Deliver relevant methods of nutrition, hydration and medication in patients with dysphagia
e9s_14:
Assess and discuss realistic goals with those affected by stroke, plan discharge and link to follow-up services for patients and carers
e9s_15:
Recognise impending death and initiate palliative care where necessary