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Stroke PatientEducation WorkbookA Guide to Understanding StrokeThis workbook is designed to help you become a well-informed participant inyour health care decisions regarding your stroke. We hope this will help you betterunderstand stroke and guide you through your recovery and rehabilitation.www.hoag.org/stroke

ForwardA Guide to UnderstandingStrokeIt is our sincere hope that this stroke patienteducation workbook will provide you and your lovedones with helpful information. This is designed tobe your personal workbook during your stages ofrecovery. Understanding what happens when astroke occurs and being a knowledgeable participantin your treatment plan are essential for your recoveryand rehabilitation.This workbook is organized to help you understandthe general and specific information regarding yourstroke. If you or a family member have questionsafter reading this material or at any time, pleasecontact the Neuroscience Stroke Nurse Navigatorat 949-764-8273.Some of the enclosed materials were selected frompublications of The National Stroke Association,The American Heart Association/American StrokeAssociation, Brain Aneurysm Foundation,The American Academy of Sleep Medicine, andThe Brain Attack Coalition.Hoag Stroke Program TeamPickup Family Neurosciences Institute949-764-6066iii

Table of Contents –A Guide to Understanding StrokeIntroductionLife After StrokeWelcome to Hoag’s Stroke Program . . . . . . . . . . . 1Meet the Team Members. . . . . . . . . . . . . . . . . . . . 1What to Expect During Your Hospital Stay. . . . . . . 3All About Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . 3Warning Signs of Stroke . . . . . . . . . . . . . . . . . . . . 5More Stroke Facts. . . . . . . . . . . . . . . . . . . . . . . . . 6Frequently Asked Questions . . . . . . . . . . . . . . . . . 6Take These Step to Prevent a Second Stroke. . . . . 7Job Retraining/Volunteering. . . . . . . . . . . . . . . . . 46Driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Sexuality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Risk Factors and PreventionFamily InvolvementRisk Factors and Prevention . . . . . . . . . . . . . . . . . 8Uncontrollable Stroke Risk Factors . . . . . . . . . . . . 9Controllable Stroke Risk Factors . . . . . . . . . . . . . . 9The Caregiver’s Role. . . . . . . . . . . . . . . . . . . . . . 51Taking Care of Yourself . . . . . . . . . . . . . . . . . . . . 52Working Together . . . . . . . . . . . . . . . . . . . . . . . . 54Effects of StrokeCommunity ResourcesYour Brain and You. . . . . . . . . . . . . . . . . . . . . . . 11Right-Brain vs. Left-Brain Stroke. . . . . . . . . . . . . 13Characteristics Based on Location of Stroke . . . . 14Physical Effects. . . . . . . . . . . . . . . . . . . . . . . . . . 14Caregiver’s Bill of Rights . . . . . . . . . . . . . . . . . . . 55A Caregiver’s Resource Guide. . . . . . . . . . . . . . . 55Where To Turn For Help. . . . . . . . . . . . . . . . . . . . 56Palliative Care Medicine Consult Serviceat Hoag Hospital. . . . . . . . . . . . . . . . . . . . . . . . . 58MedicationsMedications To Help Manage and Prevent Stroke. 17RehabilitationYour Rehabilitation Program. . . . . . . . . . . . . . . . . 21Personal Care. . . . . . . . . . . . . . . . . . . . . . . . . . . 23Mobility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Home Safety Tips. . . . . . . . . . . . . . . . . . . . . . . . 28No Such Word As “Can’t” . . . . . . . . . . . . . . . . . . 29NutritionIntroduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Healthy Eating After A Stroke. . . . . . . . . . . . . . . . 30Dysphagia Diet Summary. . . . . . . . . . . . . . . . . . . 32Fat Facts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Healthy Substitutions to Reduce Fat . . . . . . . . . . 35Sodium-Controlled Diet. . . . . . . . . . . . . . . . . . . . 38Understanding Food Labels. . . . . . . . . . . . . . . . . 41Eating Out. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Recommended Books/Cookbooks . . . . . . . . . . . 45ivLifestyle ModificationSmoking Cessation. . . . . . . . . . . . . . . . . . . . . . . 49Stop Smoking Directory. . . . . . . . . . . . . . . . . . . . 49Stress Management . . . . . . . . . . . . . . . . . . . . . . 50AppendixGlossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Meet the TeamMembersHoag Stroke ProgramMission StatementHelping you to maximize your recovery is a multidisciplinary team effort. The stroke team includesdoctors, nurses, nursing aides, respiratory therapists,physical therapists, occupational therapists, speech/language pathologists, care managers, socialworkers, dietitians, your family, friends, and YOU.Stroke patients at Hoag receive the highest levelof care through a patient-centered, integrated,multidisciplinary team approach, using the best inevidence-based practice, state-of-the-art technologyand advanced research.Pickup Family Neurosciences Institute’s StrokeProgram is DNVGL certified as a ComprehensiveStroke Center at its Newport Beach campus, anda Primary Stroke Center at its Irvine campus. HoagStroke Program has received the American StrokeAssociation’s “Get With the Guidelines” – StrokeGold Plus Performance Achievement Award and theTarget Stroke Honor Roll Elite Award.Our Stroke Program is patient-centered with anadvanced approach to caring for our patients. TheStroke Team is multidisciplinary involving nurses,therapists, care managers, social workers as well asphysicians from other specialties to assure optimalmedical management and therapies are provided toeach of our stroke patients.Hoag Newport Beach is designated a StrokeNeurology Receiving Center with Orange County EMS.IntroductionWelcome to Hoag’sStroke ProgramYour physician will determine which members ofthe multi-disciplinary team will assist you in yourrecovery. Although these professionals have differentspecialties, they share a common goal of helping youto recover.Primary Care PhysicianYour primary care physician or hospitalist directs andplans your medical care in cooperation with yourneurologist and neurosurgeon.NeurohospitalistYour neurohospitalist is a hospital-basedneurologist who diagnoses and treats diseasesof the nervous system.Stroke Program Medical DirectorThe Stroke Program Medical Director is aNeurohospitalist who is fellowship trained in strokeand cerebrovascular disease. He oversees anddirects the care of the stroke patient in conjunctionwith the other physicians, nurses and staff thatmake up the stroke team. He also ensures thatpatients receive consistent, state-of-the-art care inaccordance with the latest scientific research.Registered NurseYour registered nurse (RN) will assist your progress,monitor your recovery and administer yourmedications. Throughout your hospitalization, yourRN will assess your neurological function, level ofpain, signs and symptoms of any complications.Your RN will educate you regarding prevention ofcomplications and help communicate any concernsthat you and your family may have to your physiciansand other healthcare members.Patient Care AssistantYour patient care assistant will help you withpersonalized care and daily needs. He or she mayalso perform procedures such as blood pressure,temperature and drawing of blood.1

IntroductionStroke Program Nurse NavigatorYour stroke program nurse navigator workscollaboratively with the physicians, nurses andmultidisciplinary team to oversee your care andmanage quality improvement. Your navigator willalso assist with your education regarding strokesigns and symptoms, treatment and preventionof complications, and will meet with you and yourfamily to assess your individual needs. At 30 daysand 90 days after discharge, you will receive a phonecall from your navigator to assess your progress andreinforce any education. Hoag’s nurse navigator alsocoordinates the monthly support group meetingsand educational flyers mailed to your home.Respiratory TherapistYour respiratory therapist (RT) works with thehealthcare team to help maintain and/or improvethe health of your lungs. He or she will assist youwith breathing exercises, breathing medications,ventilator care and coughing techniques.Speech/Language Pathologiststrength, and function of the arms, and may utilizemodified techniques and/or adaptive equipment.OTs will also address problems related to vision,perception, problem-solving, safety, reasoning,decreased sensory awareness, sitting balance/endurance and positioning. One of the importantaspects of therapy is the education and training forthe patient and caregiver.Physical TherapistPhysical therapists (PT) will help you regain the abilityto be mobile again. They focus on deficits in yourstrength, balance, stamina, coordination and safetyto help you regain bed mobility along with the abilityto stand up, balance, walk, and navigate stairs.Your PT will also assess the need for any equipmentsuch as a cane or walker, address any safety issuesfor returning home, and provide training for youand your family that will assist you through a safetransition back to self sufficiency.Care ManagerYour speech/language pathologist (SLP) will workwith you and your family to evaluate and treatany problems you may have in your ability to uselanguage. If needed, the SLP will assess your abilityto swallow. Following this assessment, he or shemay make recommendations to your physician toensure safety in swallowing, adequate nutritionalintake and prevention of aspiration.Your care manager is an RN or social worker whoassesses your status and evaluates your treatmentplans throughout your hospital stay. He or she worksclosely with your primary physician, healthcareprofessionals and family to develop a qualitydischarge plan and coordinate all options for posthospital continued care, including transitionto a lower level of care, alternative medical services,durable medical equipment and supplies.Dysphagia/Dietary TeamSocial WorkerYour physician may initially order no liquids or foodby mouth (NPO) until your swallowing ability hasbeen evaluated. The dysphagia team will evaluate ifyou have difficulty swallowing (dysphagia). After theevaluation, the dysphagia team will recommend anappropriate diet.The primary goals of the dysphagia evaluation areto ensure that swallowing is safe (no food or liquidgoing down the airway), and that intake of food/liquidis efficient and sufficient.Occupational TherapistOccupational therapists (OT) will assist you inmanaging activities of daily living (ADL) such asself-feeding, bathing, dressing, home managementskills and community re-entry. These tasks areaccomplished by working to improve coordination,2The clinical social worker is a licensed professional(LCSW) who will help provide you and your familywith emotional counseling, crisis intervention,support groups and community resourceinformation.DietitianThe dietitian works with your doctor to meet yournutritional needs. He or she may check your eatinghabits and teach you about your diet. He or she willmake sure that meals are healthy and tasty.ChaplainThe hospital chaplain is available to providespiritual guidance and emotional support foryou and your family.