Deviation in the Standard of Rehabilitative Care When Treating a Post Cerebral Vascular Accident Patient (Stroke, CVA, TIA)

Evaluate breaches in the standard of care in a case involving the Deviation in the Standard of Rehabilitative Care When Treating a Post Cerebral Vascular Accident Patient (Stroke, CVA, TIA)

Answer the following questions to find out if the standard of care was followed for your case.

  • Was rehabilitation recommended?
    Yes
    No
    Answer unknown
    Why is this important?
    The goals of stroke rehabilitation are to maintain and optimize medical management, to maximize functional recovery, to minimize disability, and to improve quality of life and participation in society. Rehabilitation must start as part of the acute stroke inpatient stay. Rehabilitation is advised for all patients who have suffered a cerebrovascular accident, a transient ischemic attack, or a subarachnoid hemorrhage.
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  • Was the severity of the patient’s disability assessed? Why is this important?
    Answer this question
    Stroke often causes significant impairment and activity limitations. Deficits in strength, swallowing, vision, balance, muscle tone, communication, comprehension, cognition, attention, sensory perception, and bladder function are common and can cause difficulty completing activities of daily living.
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  • Was inpatient rehabilitation recommended? Why is this important?
    Answer this question
    The severity of deficits in the patient and the ability of the patient to tolerate therapy, determine the appropriate rehabilitation setting.
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  • Was the patient provided patient education with regard to stroke? Why is this important?
    Answer this question
    During the inpatient rehabilitation stage, medical management focuses on secondary stroke prevention; diet, exercise, smoking cessation, and reducing complications.
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  • Which type of stroke did the patient experience? Why is this important?
    Answer this question
    The rapid and accurate determination of the type of stroke that has occurred is vital, as treatment strategies for ischemic and hemorrhagic strokes differ significantly.
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  • Was blood pressure management initiated? Why is this important?
    Answer this question
    Optimal blood pressure management is necessary to prevent recurrence of hemorrhagic stroke.
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  • Was anti-coagulation therapy initiated to prevent ischemic stroke recurrence? Why is this important?
    Answer this question
    Anti-platelet therapy or anti-coagulation therapy is an integral component of treatment following ischemic stroke.
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  • Was patient education provided? Why is this important?
    Answer this question
    During the inpatient rehabilitation stage, much of the rehabilitation effort is directed toward educating stroke survivors about complications and the importance of adherence to medical recommendations and therapy.
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  • Were the patient's co-morbidities identified and addressed? Why is this important?
    Answer this question
    Successful rehabilitation will benefit from the early identification and treatment of any co-morbidity the patient develops or possesses. Rehabilitation of the stroke patient can be hindered by conditions such as pneumonia (usually caused by aspiration), deep venous thrombosis, urinary tract infections, shoulder pain, depression, and spasticity.
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  • Was prophylaxis initiated for deep vein thrombosis and pulmonary embolism? Why is this important?
    Answer this question
    Prophylactic anti-coagulant or anti-platelet therapy may be necessary for patients with ischemic stroke to prevent deep vein thrombosis and pulmonary embolism. Doses of heparin/low molecular weight heparin and thigh-length anti-thrombotic stockings are used taking into account the risks and benefits for patients with high risk of DVT/PE.
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  • Was hemiplegic pain treated appropriately? Why is this important?
    Answer this question
    Stroke survivors with residual hemiparesis or weakness are at risk for pain syndromes that can significantly limit rehabilitation efforts.
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  • Was the post-stroke depression managed appropriately? Why is this important?
    Answer this question
    Depression can be seen in up to one half of all stroke patients and can hamper rehabilitative efforts and progress.
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  • Was the post-stroke spasticity managed appropriately? Why is this important?
    Answer this question
    It is now known that spasticity (hyperactive stretch reflexes) is not a major determinant of activity limitations. Interventions to reduce spasticity may be considered if the level of spasticity interferes with activity or the ability to provide care to the stroke survivor.
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  • Was epilepsy managed appropriately? Why is this important?
    Answer this question
    Approximately 10% of people experience seizures 7-14 days after having a stroke.
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  • Which of the following disabilities did the patient experience? (Choose all that apply) Why is this important?
    Answer this question
    Stroke often causes significant impairment as well as activity limitations. Deficits in strength, swallowing, vision, balance, muscle tone, communication, comprehension, cognition, attention, sensory perception and bladder function are common and can be a safety issue.
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  • Was post-discharge follow-up recommended? Why is this important?
    Answer this question
    Stroke survivors and their families must be followed up by a relevant member of the rehabilitation team after their discharge from a formal rehabilitation program.
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  • Did the patient have sensorimotor impairment? Why is this important?
    Answer this question
    The sensorimotor impairments may increase the patient’s likelihood of physical injury and falling.
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  • Was the visually impaired patient referred to a neuro-ophthalmologist? Why is this important?
    Answer this question
    Patients with visual impairment need to be referred to a neuro-ophthalmologist for both treatment and follow up care.
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  • Was the patient’s visual impairment addressed and managed? Why is this important?
    Answer this question
    An ophthalmic assessment needs to be performed by the ophthalmologist and documented in the chart. Visual acuity problems often can be addressed by incorporating the use of glasses into the therapy session and by taking precautionary measures to ensure the patients safety..
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