Question

John Green, a 71-year-old patient, is being discharged from the rehabilitation unit 8 weeks after an ischemic stroke. The patient’s spouse stated that they used to enjoy going to golf outings with their friends, but the patient has not played golf since he had the stroke, and she does not want to try to golf once her husband is discharged home because he has to use a walker and can barely ambulate. She also states that her husband still has trouble speaking, and his short-term memory is not very astute so it would be embarrassing to be on a golf outing with him. The patient’s spouse has worn the same outfit to the rehabilitation unit the past 3 days, and the nurse notices the patient’s hair is unkempt and his affect is flat. The rehab nurse has made arrangements with the social worker for a physical therapist, speech therapist, and occupational therapist to provide three sessions of therapy at the patient’s home for the next 4 weeks, and then a reevaluation will follow to determine if the patient will need further therapy. The patient is able to sit independently, stand independently, and use a walker. The patient is able to ambulate 30 feet with the walker, and then he requires a short rest before he is able to ambulate another 30 feet. The patient slurs words occasionally and has hesitant speech. The patient has problems with short-term speech.

1.    What educational topics should the nurse provide the family about home care for the patient after stroke?

2.    What assessment of the spouse does the nurse need to make, and what should the nurse suggest?