Category: Advancing Modules

Living with dysarthria & stigma

Brenda writes an email to her friend Sharon.

Communication strategies for Deirdre

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Communication strategies for you:

  • Make sure you get the person’s full attention before you give your message. Use anything to draw their attention and wait until you have eye contact.
  • Check they are understanding you and if any doubt, stop and try again.
  • It may help to tell them about your dysarthria and your stroke.
  • Use gesture, pointing and written messages to help depending on the situation. It may help to prepare some written notes before certain meetings.
  • Slowing your rate of speech is your best strategy to compensate for imprecise articulation.
  • Take note if you are feeling tense or emotional. Try to slow down and take a deep breath.

Advice for anyone talking to you:

  • Choose a quiet place and try to cut out any background noise.
  • Show when you have understood and clarify when in doubt.
  • Speak in a normal tone and volume – remember my understanding is unaffected.
  • If I am tense or emotional, give me more time.
  • Try to achieve good eye contact and actively listen.
  • If you get stuck – suggest solutions such as writing down.
  • Ask me what to do.

 

 

 

 

 

Module test

This is the module test for ‘Thrombolysis’. It is strongly recommended that you work through the learning materials of the module prior to commencing this test. By going straight to the test you may miss out on valuable learning contained within the module. The answers to all the test questions are contained within the module. This information may have been provided in the ‘Additional Information’ boxes on some of the pages.

To gain a certificate of completion you will need to answer at least 18 of the 20 questions (90%) correctly

You should allow approximately 20 minutes to complete the test.

For testing – Correct answers:

Part 1. Q. What does ‘thrombolysis’ mean?

  1. Retrieval of blood clots
  2. Breaking up of blood clots – Correct, thrombolysis means the ‘breaking up of blood clots’.
  3. Formation of blood clots
  4. Dislodging of blood clots

Part 2. Q. Thrombolysis treatment increases the chances of a fuller recovery; however is it is not effective in every case.

  • True – Correct, this statement is true.
  • False

Part 3. Q. What type of diagnosis should thrombolysis treatment be considered for?

  1. Intracerebral haemorrhage
  2. Subdural haematoma
  3. Subarchnoid haemorrhage
  4. Ischaemic – Correct, thrombolysis treatment should be considered for ischaemic stroke.

Part 4. Q. What is the maximum time period between onset of symptoms and giving thrombolysis treatment after a stroke event?

  1. 1 hour
  2. 4.5 hours – Correct, thrombolysis treatment should be given within 4.5 hours after the stroke event.
  3. 8 hours
  4. 24 hours

Part 5. Q. What does NIHSS stand for?

  1. Neurological Institutes of Health Stroke Scale
  2. National Instrument of Health Stroke Scale
  3. National Institutes of Health Stroke Scale – Correct, NIHSS stands for National Institutes of Health Stroke Scale.
  4. Northern Ireland Health Stroke Services

Part 6. Q. What should you advise someone to do if they come upon a person having a suspected stroke?

  1. Call NHS 24
  2. Call the G.P.
  3. Call 999 – Correct, you should call 999 if you suspect someone is having a stroke.
  4. Wait and see what happens

Part 7. Q. The FAST tool can be used to help recognise someone is having a suspected stroke?

  • True – Correct, the FAST tool can be used to help recognise someone is having a suspected stroke.
  • False

Part 8. Q. Which of the following is a contraindication for thrombolysis treatment?

  1. Type 1 Diabetes Mellitus
  2. Recent severe or dangerous bleeding – Correct, recent severe or dangerous bleeding is a contraindication for thrombolysis treatment.
  3. Smoker
  4. NIHSS score of 16

Part 9. Q. A history and physical examination of the patient will distinguish an ischaemic from a haemorrhagic stroke

  • True
  • False – Correct, a history and physical examination of the patient will not distinguish an ischaemic from a haemorrhagic stroke.

Part 10. Q. What does a ROSIER score of 3 mean?

  1. Stroke is unlikely
  2. Stroke symptoms have resolved
  3. Need to consider another diagnosis
  4. Stroke is likely – Correct, a ROSIER score of 3 means that stroke is likely.

Part 11. Q. How much of the total dose of Alteplase is administered by intravenous bolus?

  1. 100%
  2. 20%
  3. 10% – Correct, 10% of the total dose of Alteplase is administered by intravenous bolus.
  4. 2%

Part 12. Q. Which of these is NOT a stroke mimic?

  1. Hypertension – Correct, hypertension is NOT a stroke mimic.
  2. Migraine
  3. Hypoglycaemia
  4. Epileptic seizure

Part 13. Q. When assessing if someone is suitable for thrombolysis treatment which of the following should NOT be done immediately?

  1. NIHSS
  2. CT Scan
  3. Bedside swallow assessment – Correct, a bedside swallow assessment should NOT be done when assessing if someone is suitable for thrombolysis treatment.
  4. Confirm time of symptom onset

Part 14. Q. An MRI scan should always be carried out before administering thrombolysis treatment?

  • True
  • False – Correct, an MRI scan should NOT always be carried out before administering thrombolysis treatment.

Part 15. Q. Which of the following is NOT assessed in the NIHSS?

  1. Visual field loss
  2. Dysphagia – Correct, dysphagia is NOT assessed in the NIHSS.
  3. Sensory loss
  4. Level of consciousness

Part 16. Q. In order to get one extra patient fully recovered, how many patients do you need to treat with thrombolysis?

  1. 1:3
  2. 1:8 – Correct, you would need to treat eight patients in order to get one extra patient fully recovered.
  3. 1:25
  4. 1:100

Part 17. Q. What does NOT require to be regularly monitored following thrombolysis treatment?

  1. Central venous pressure – Correct, central venous pressure does NOT require to be regularly monitored following thrombolysis treatment.
  2. Blood pressure
  3. Abbreviated NIHSS
  4. Modified Early Warning System

Part 18. Q. Which of the following are the most common drug reactions / side effects of thrombolysis treatment?

  1. Sweating and pyrexia
  2. Angio-oedema and bleeding – Correct, angio-oedema and bleeding are the most common drug reactions / side effects of thrombolysis treatment.
  3. Diarrhoea and vomiting
  4. Cardiac arrhythmia and chest pain

Part 19. Q. SIGN Guideline 108 Grade A evidence – Patients admitted with stroke within four and a half hours of definite onset of symptoms, who are considered suitable, should be treated with intravenous thrombolysis?

  • True – Correct, patients admitted with stroke within four and a half hours of definite onset of symptoms, who are considered suitable, should be treated with intravenous thrombolysis.
  • False

Part 20. Q. Used appropriately thrombolysis is a safe and effective treatment following ischaemic stroke.

  • True – Correct, used appropriately thrombolysis is a safe and effective treatment following ischaemic stroke.
  • False

 

 

 

 

 

 

 

Well done, you have answered all the questions correctly. Now print off a copy of your certificate which indicates that you have successfully completed this module.

[[MR:C06A1113548]] Please note: if you do not click on either of the links below there will be no permanent record of your certificate and you will be required to sit the test again.

Unfortunately you have not answered all the questions correctly. We suggest that you revise the module and undertake the test again on another occasion.

Back to: 01: Thrombolysis module home page
Back to: Advancing Modules

 

What is going on with Deirdre?

Think about the team discussion you just read and the conversation you heard earlier between Deirdre and her daughter Brenda.

Deirdre’s daughter Brenda visits the ward

Deidre’s daughter Brenda visits her that evening. Read through their conversation:

After speaking to Deirdre, Brenda is concerned about her mum’s care and also about how her mum seems. She speaks to the charge nurse who reassures her everything is being done to look after Deirdre’s toileting and other needs. The Sister tells Brenda the team will meet tomorrow to discuss her mother’s case and someone will then contact her.

Deirdre’s stroke

MDT Action Plan

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Distraction

  • try to engage her in the kinds of activities she usually enjoys
  • get her to take part in tasks in therapy

Clear rehab goals

  • focus on goals of getting home and back to doing the things she enjoys

Relaxation

  • encourage her to take part in relaxation therapy – likely to help since if she is tense and anxious that may exacerbate her headache

Education

  • ensure she understands that there is nothing sinister underlying her headache
  • reassure her that although rehab activities may increase her headache at the time this does not mean they are harmful

Involve her family in rehab

  • provide her family with information about headache after stroke
  • encourage them to work with her in rehab and in managing her pain

Key messages

  • Successful communication is everyone’s responsibility.
  • Every individual is different in terms of their communication abilities as well as their preferences. Strategies should be tailored accordingly.
  • Do not be disheartened and give up if the first strategy you try is unsuccessful- try something different.
  • Inclusive communication leads to greater autonomy, decision-making, self-esteem and better outcomes for the individual.
  • Having appropriate resources and information is essential.

Summary

  • Over the next week Steven’s functional abilities improve significantly.
  • He is more able to participate in his rehabilitation because the whole MDT know how to support his communication effectively.
  • Steven’s family are also able to support his communication and feel better equipped to interact with him and prepare for his discharge home.
  • Following a discussion between Steven, his family and the MDT, it is decided that he will be able to continue his rehabilitation with the supported discharge team and he is discharged home.