Merck Manual

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Preventing and Treating Problems After a Stroke

Preventing and Treating Problems After a Stroke

Problem

Measures

To prevent blood clots, doctors may give anticoagulants, such as heparin or low molecular weight heparin, put elastic or air-filled support stockings on the person’s legs to improve blood circulation, or both.

Moving the legs, which improves blood flow, can also help. People, if able, are encouraged to walk or simply move their legs (for example, extending and flexing their ankles). If people cannot move their legs, a therapist or other staff member moves their legs for them (called passive exercise).

Nurses, other staff members, or caregivers should frequently turn or reposition people who are confined to a bed or wheelchair. Areas likely to develop pressure sores should be inspected every day.

Permanent shortening of muscles that limits movement (contractures)

Moving the limbs can prevent contractures. People, if able, are encouraged to move and change positions regularly. Or a therapist or other staff member moves their limbs for them and makes sure the limbs are placed in appropriate resting positions. Sometimes splints are used to prevent the limbs' muscles from shortening.

People are evaluated for difficulty swallowing. If they have difficulty, care is taken to provide them with enough fluids and nourishment. Sometimes learning simple techniques (for example, how to position the head or how to breathe when swallowing) can help the person swallow safely. Tube feeding may be necessary until the ability to swallow returns. The feeding tube may be inserted directly into the stomach through a small incision in the abdomen.

If people smoke, they are encouraged to stop.

Therapists also teach them to do deep breathing exercises and to cough to clear the airways. Therapists may provide a handheld breathing device.

If needed, oxygen is provided through a face mask or a tube inserted in the nose or in the mouth.

Health care practitioners regularly check for signs of urinary problems.

If possible, a urinary catheter, which can cause urinary infections, is not used. If a catheter is needed, it is removed as soon as possible.

Discouragement and depression

Doctors discuss the effects of the stroke with affected people and their family members or other caregivers. The discussion includes the type of recovery that can be expected and ways to cope with limitations of function. People and their caregivers are put in contact with stroke support groups. Formal counseling or drugs may be necessary to treat depression.