Question

A 50-year-old male patient who recently had a stroke and is now staying in a rehabilitation facility. He uses a wheelchair and has a right-side weakness of his arm and leg with difficulty speaking. He meets the discharge criteria. The driver from the rehab facility is waiting to take him back. However, the surgeon has not written the discharge orders and has left the facility. What reasonable discharge plan and objectives can be made at this point?

Answer 1

Ans) Risk of falling. Make changes to your home to help you walk more easily. A therapist will decide if you need an assistive device to walk safely.

- You may need to see an occupational therapist or physical therapist to learn new ways of doing things. For example, you may need to make adjustments when bathing or dressing:

• Tips for showering or bathing:
- Test the water temperature with a hand or foot that was not affected by the stroke.
Use grab bars, a shower seat, a hand-held showerhead, and a long-handled brush.

• Tips for getting dressed:
Dress while sitting, starting with the affected side or limb.
Wear shirts that pull easily over your head. Wear pants or skirts with elastic waistbands.
Use zippers with loops attached to the pull tabs.

• Lifestyle changes:
Take your medicines exactly as directed. Don't skip doses.
Begin an exercise program. Ask your provider how to get started. Also ask how much activity you should try to get on a daily or weekly basis. You can benefit from simple activities such as walking or gardening.
Limit how much alcohol you drink. Men should have no more than 2 alcoholic drinks a day. Women should limit themselves to 1 alcoholic drink per day.
Know your cholesterol level. Follow your provider's recommendations about how to keep cholesterol under control.
If you are a smoker, quit now. Join a stop-smoking program to improve your chances of success. Ask your provider about medicines or other methods to help you quit.
Learn stress management techniques to help you deal with stress in your home and work life.

• Diet:
- Your healthcare provider will give you information on changes you may need to make to your diet, based on your situation. Your provider may recommend that you see a registered dietitian for help with diet changes. Changes may include:

Reducing the amount of fat and cholesterol you eat
Reducing the amount of salt (sodium) in your diet, especially if you have high blood pressure
Eating more fresh vegetables and fruits
Eating more lean proteins, such as fish, poultry, and beans and peas (legumes)
Eating less red meat and processed meats
Using low-fat dairy products
Limiting vegetable oils and nut oils
Limiting sweets and processed foods such as chips, cookies, and baked goods
Not eating trans fats. These are often found in processed foods. Don't eat any food that has hydrogenated listed in its ingredients.

• Follow-up care:
Keep your medical appointments. Close follow-up is important to stroke rehabilitation and recovery.
Some medicines require blood tests to check for progress or problems. Keep follow-up appointments for any blood tests ordered by your providers.
Call 911
Call 911 right away if you have any of the following symptoms of stroke:

Weakness, tingling, or loss of feeling on one side of your face or body
Sudden double vision or trouble seeing in one or both eyes
Sudden trouble talking or slurred speech
Trouble understanding others
Sudden, severe headache
Dizziness, loss of balance, or a sense of falling
Blackouts or seizures