Welcome to the Acute Stroke, Rehabilitation &
Haematology Unit
The
information within this package is designed to provide a useful introduction to
rehabilitation and medical nursing. Please set some time aside to read the provided
information and ask if you have any queries about the contents.
General Ward Information
The Unit is a 22 bedded (16 Stroke / Rehab. & 6 Haematology) mixed sex adult medical ward
specialising in Acute Stroke, Rehabilitation and Haematology. There is a strong emphasis on
neurological conditions i.e. Strokes, Parkinson's disease and Multiple Sclerosis.
During your time on the ward you will have the opportunity to nurse individuals with a wide
variety of needs and medical problems. We admit patients from the Emergency Assessment
Unit, Accident and Emergency, Intensive Care, other wards and hospitals. Patients
transferred within the hospital can often be assessed prior to coming to the ward by an MDT
member; this is to ensure they are suitable / appropriate for the unit.
On the unit all staff pride ourselves on maintaining high quality fundamental nursing care,
which is current and evidence based, this will become evident during your placement with us...
As a team, all staff are very proud to be part of an ever improving unit, seeing our Ward
Manager, Sister Julie Brown receive an MBE in the ‘2014’ New Years Honours list for
services to Stroke and General Nursing.
Mission Statement
‘To provide the individual with a high quality service which is flexible and responsive to the
clients’ needs as well as being cost effective’?
Ward Philosophy
‘We believe rehabilitation and acute care should be planned according to the individual
patient's needs, with an ultimate goal of achieving the highest level of personal independence,
maximum integration into the community and the most satisfying quality of life compatible
with their disability.’
Student Philosophy
‘During your placement you will have a variety of opportunities to enhance your skills and make
your stay with us beneficial to your educational needs. We often invite a speaker to give
updates / provide information etc. which is appropriate to the ward needs. We have ward
based Clinical Nurse Specialists who will be very happy for you to spend some time with them.
The ward also has an excellent multidisciplinary team who are always very willing for you to
spend some time with them. We very much want you to enjoy your time with us, learn as much
as possible and meet all your outcomes. Please do see your mentor or a member of staff if you
have any concerns or queries no matter how small they are.’
History of the unit / Charter Mark
The development of an Acute Stroke and TIA Service with minimal resources.
Aim
Nevill Hall Hospital is a district general hospital in the heart of Abergavenny, a Welsh market
town. It is one of three District General Hospitals in Gwent Healthcare NHS Trust serving a
largely rural population of 300,000 people. On average 350 - 400 new strokes and 200 TIAs
are referred to Nevill Hall for assessment, investigations and treatment each year. The
'Acute Stroke Service' is provided by all members of a multidisciplinary team based on an
acute stroke ward. In addition the service is complimented by full co-operation from
radiology, pharmacology, vascular technology and pathology departments.
Up until 10 years ago the care offered to these patients was disorganised and random. It
lacked leadership and co-ordination, but most importantly the service did not have an acute
stroke unit.
Stroke patients were scattered amongst general medical or care of the elderly wards and did
not receive therapy or care from any personnel with a special knowledge or interest in stroke.
The service needed a leader and a geographically identified area that could form a stroke
unit.
The results of the 1998 RCP Sentinel Stroke Audit demonstrated that overall Nevill Hall was
performing well below the national average in caring for stroke patients. In particular;
i. Only 44% of patients received CT <24 hours
ii. Only 34% of patients weighed during admission
iii. Only 55% of patients had their swallowing assessed within 72 hours of admission
iv. Only 14% had risk factors discussed with them
v. Only 25% had diagnosis and prognosis discussed with them
vi. No evidence that carers' needs were assessed
Complaints were high and staff morale was low. Staff on the care of the
elderly/rehabilitation unit lacked a speciality that they could excel in and battled to prevent
inappropriate patients being admitted to their ward.
Methodology
In 2000 a care of the elderly consultant was nominated as the stroke lead and the only
funding that was made available, was to appoint a Clinical Nurse Specialist for acute stroke
care.
With vision and enthusiasm, a sign declaring 'An Acute Stroke Unit' was placed above the
door of the existing rehabilitation ward signalling the birth of the Acute Stroke Service. It
was agreed that all stroke patients, whatever their age of disability, could and should be
admitted to the Acute Stroke Unit.
The following developments took place without resource enhancement;
• Lead Consultant for Stroke identified
• Appointed Clinical Nurse Specialist for Stroke
• Dysphagia screen training - Qualified nurses
• Direct admissions to Stroke Unit
• Integrated Stroke Pathway introduced
• Weekly Carers' Clinic on the Stroke Unit
• Fast-Track system all strokes to Stroke Consultant
• Weekly TIA Clinics
• Protected mealtimes
• Vascular examinations on site
• CT slots allocated for stroke patients
• Charter Mark Award for Acute Stroke Service
• 7 day CT scanning piloted successfully
• 1000 Lives Campaign highlighted absence of Complaints
Results
Regular auditing of the service provided Sentinel Audits 2002/2004/2006/2008 (above median average)
2004 Sentinel Audit;
• 50% patients received CT < 24 hours
• 92% patients weighed during admission
• 98% patients treated in the stroke unit
• 92% scored with communication with patients and carers
• Overall top in Wales
TIA audit
Dysphasia audit
7 day CT scan audit
Awarded the governments Charter Mark Award 2006
(Recognition of a public service from clients and users perspective)
Evaluation
The Stroke Service has successfully evolved without additional monies over a period of 10
years:
1. Stroke patients are now admitted directly to a stroke unit under the care of the lead
consultant for stroke.
2. They are able to receive their CT head scan within 24 hours, 7 days a week.
3. All qualified nurses are trained to perform dysphagia screening as soon as patients are
able.
4. The ward sister carries out a carers' clinic every week, listening to both patients and their
carers' concerns.
5. Protected mealtimes have been introduced so that patients are offered peace and privacy
to maximise their nutritional intake.
6. TIA clinics are held most week days, in order to reduce the length people have to wait.
7. Carotid Doppler scanning is now performed on site and at the same time as TIA clinic.
Reflection
Networking with other areas of excellence helps to visualise your goals. We have listened to
the patients and their carers, regularly reviewing their needs and expectations and acting
upon them. We worked with other disciplines and departments within the hospital to
reconfigure the service including radiology and vascular departments. We worked closely with
our partners in the community; Primary Care, Social Services and the Voluntary Sector.
Further action
Keep trying - never give up. Do not let the lack of resources get you down. Energy, clear
multidisciplinary objectives, enthusiasm and a motivated workforce is worth far more than
money. A lot can be achieved within the available resources.
Haematology
Haematology is quite a new speciality to the unit, we inherited 6 haematology beds on the unit
approximately three years ago, and we liaise with Windsor Suite (Haematology Day unit,
NHH). Holding these beds has provided excellent learning opportunities for all staff,
increasing our knowledge and competence within nursing. Haematology patients can become
acutely ill very quickly; therefore we have a system on the unit whereby we can instigate
direct admission to the unit from home for these patients, if deemed necessary. The types of
patients we see are those with Lymphoma or Myeloma. Often these patients are post
chemotherapy and therefore can be neutropenic. When admitted they often require reverse
barrier nursing, and commencement on the neutropenic sepsis pathway. Many of these
patients have Hickman / Pic Lines.
The Nursing Staff
Sister Julie Brown MBE, is the Ward Manager, running the ward with assistance from the
rest of the team. We use a team nursing approach in order to provide continuity of care for
the patients. We aim to provide high quality; evidence based nursing care, always following
national guidelines and trust policies. We believe it important to include family and friends
where possible.
The staff will vary in experience and time qualified, you will have the opportunity to work
with a variety of them during your placement , this includes Staff and Auxiliary Nurses,
Physiotherapists, Occupational Therapists, Rehab Assistants and other MDT members. The
staff aims to provide a supportive learning environment for students, but if you have any
difficulties or queries please speak to someone as soon as possible about it so we can help you.
Nursing Skills
The skills required by rehabilitation nurses are vast. There is presently no definition of the
overall role of a rehabilitation nurse but many suggestions have been put forward by various
authors. The kinds of activities in which a nurse may engage in during the early stages of
rehabilitation are:
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protecting skin against tissue breakdown (inc. assessing and dressing wounds)
positioning to prevent nerve damage, pain and abnormal limb function
maintenance of fluid and nutritional intake (inc. NG and PEG feeding)
helping with elimination
maintaining personal hygiene
administering medication (promoting self medication)
communicating with significant others
promoting patient advocacy within the MDT
As the patient becomes more independent they will begin to take on more responsibility of
these activities and the nurse must learn to take a more 'hands off' approach to patient care.
It is hoped that the patient will become totally independent in some areas, but if this is not
possible the patient should be encouraged to make decisions regarding their care. For
example, they may not be physically able to get their clothes out of the wardrobe but they
are capable of choosing what they want to wear. There are Nurses on the ward who have a
special interest in specific areas i.e. continence, wound care, diabetes, and health and safety
etc. They will be happy to help you.
Learning Opportunities available depending on your individual needs
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Managing Nutrition
PEG feeding (becoming confident in setting up a PEG feed)
Naso-Gastric (NG) feeding
Fundamental Patient Care
Working with the Multidisciplinary Team (MDT)
Attend MDT meetings and ward rounds
Observing speech and swallow assessments
Learning to communicate with patients who have problems with communication
(i.e. speech/hearing/visual problems)
Continence Care – The Continence Nurse Specialist liaises with the ward frequently to offer
support and advice
Monitoring of essential observations - blood pressure, pulse, respirations, oxygen saturation
and temperature
Sending specimens to pathology
To be aware of policies and procedures at ward level which are also available on the Intranet
Be involved in administration of medications - Intravenous, Subcutaneous, oral and via PEG or
NG
Become familiar with ward documentation
To be familiar with all the manual handling equipment available on the ward
Windsor Suite
Thrombolytic therapy
Care of Hickman / Pic lines
Rehabilitation
The ward is a designated area for rehabilitation. Patient rehabilitation incorporates many
aspects such as protected meal times, visiting and rest. There is no set time that a patient
may stay on the ward, some patients may stay for a few days and others a few weeks, it
depends on their rehabilitation needs and social requirements before discharge. A patient's
discharge often requires involvement from many of the members of the MDT.
Rehabilitation is designed to enable the patient to achieve an optimum level of functioning. Its
aim is to minimise handicap resulting from impairment and provide them with an acceptable
standard of living. The nurse has many roles in the co-ordination of rehabilitation, many of
which you will become responsible and accountable for. For example:
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liaise with patients and carers
initiate contact with other team members
give and receive information from and to all involved in rehabilitation
administer prescribed therapy
take part in assessing, planning, implementing and evaluating of goals
encourage and support the patients and carers
Rehabilitation requires certain skills if it is going to be successful for the patient, carers and
nurses. These are motivation, knowledge, skill and perseverance.
Common Investigations
There are hundreds of tests and investigations to diagnose illness / disability. During your
placement you will have the opportunity to prepare patients, observe investigations and care
for them afterwards. The following are the most common investigations in which you are likely
to be involved whilst on the ward. Make notes about any specific preparation, aftercare and
what the test involves if you are able to go with the patient. Please ask to observe as many
investigations as possible during your stay with us.
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Insertion of PEG
MRI scan
Abdominal Ultrasound
Doppler
Gastroscopy
X-ray procedures
CT scan
Videofluroscopy
Cardiac Echo
TOE
ECG
Lumber puncture
Ultrasound Scan
Telemetry
APL Sreen
Medical Conditions and Rehabilitation Problems
Throughout your placement you will be involved in caring for patients with a wide variety of
medical and rehabilitation needs. Those listed below would be common on any
medical/rehabilitation ward. Make notes about the nursing care including drug therapy if
relevant.
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Stroke (CVA)/TIA (Stroke Clinical Nurse Specialist based on the ward)
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Ischaemic Heart Disease (IHD)
Multiple Sclerosis
Rheumatoid/Osteo Arthritis
Chronic Obstructive Pulmonary Disease (COPD)
Parkinson's disease
MRSA/infectious diseases
Dementia/Alzheimer's disease
Chest infection/pneumonia
If you are unsure about any of the above and their treatment, please ask someone for
further information.
Handover / Safety Briefing / PSAG
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Prior to commencement of the shift a Safety Briefing takes place at the nurses’ station,
outlining a brief rundown of any identified or potential problems encountered by the previous
shift. This briefing is given by the nurse in charge. This is for all staff members to listen to,
prior to receiving the patient handover. We then split into two teams where a verbal
handover is given to the nurse in charge of each of the teams, this is then relayed to other
team members within the hour.
Patient Safety At a Glance (PSAG), this is a board on the ward used by all MDT members and
updated at least twice daily, by nursing staff or therapists.
‘ The use of visual management to show important patient information so that it can be
updated regularly, seen at a glance and used effectively. The aim is to make patient
information clear and easily understandable for all relevant disciplines.’ Things considered
are;
Patient status
Expected date of discharge
Next Actions…referrals
Patient location on ward
Waiting for…
Ready for discharge
Dietary status
Risk assessments
Responsible nurse/consultant
Admissions to ward
Transforming Care
Our ,Ward Vision, within Transforming Care is;
‘To provide the individual with a high quality of care in a safe, clean environment where
patients feel happy and well cared for – staff are happy to come to work,
Pre and post aims for Transforming Care within the ward, can be seen on the story board on
the unit.
The Medical Staff
With having two main specialities (Stroke & Haematology), we have specific consultants within
these fields;
Dr Bella Richards – Stroke
Dr Chillcott – Haematology
Dr Parry-Jones - Haematology
Dr Lewis - Haematology
Each consultant has a senior house officer working for them, along with staff grade doctors
who are available for a more senior opinion. Weekly multidisciplinary meetings (MDM) are held
in order to provide a holistic approach to the patient's care and future plans. In addition to
the doctors, a nurse, physiotherapist, occupational therapist, social worker, dietician, speech
and language therapist and occasionally a clinical psychologist are present at the meeting.
If you want to bleep a doctor or anyone else, the bleep system is as follows:
Dial 765 followed by the bleep number
Then enter the ward extension number
Wait for the recorded message to say that your paging request has been accepted and
replace the handset
The Ward Clerk
Sue Evans is our ward clerk covering 4 days a week.
The main role is to off load some of the administrative work from the nursing staff to enable
us to spend more time with patients and relatives. Some examples of what is done:
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answering the telephone and making referrals
booking ambulances
admitting and discharging patients
making out-patient appointments
requesting and maintaining medical notes
ordering supplies and equipment
liaising with consultants' secretaries
filing results in appropriate places
Sue is a valuable resource and you may find it useful to spend some time with her during your
placement to learn about administrative work that is required to ensure the ward runs
smoothly. Sue has an excellent knowledge of the hospital and its various departments if you
want to know where anything is.
The Multidisciplinary Team (MDT)
On the unit we work closely with other professionals in order to provide the optimum
standard of patient care. We make referrals on a daily basis or when the relevant person is
visiting the ward. You may wish to spend some time with one or more of the different
disciplines in order to gain a holistic insight into rehabilitation / nursing care.
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Physiotherapists - present on the ward daily, they also hand over from the nursing staff
every Monday morning to pick up any new referrals or problems. Physiotherapists rotate
frequently so the best time to meet with them is when they are on the ward.
Occupational Therapists - present on the ward daily. Occupational Therapists rotate
frequently so the best time to meet with them is when they are on the ward.
Speech and Language Therapists - visit the ward regularly and can be contacted in the SALT
department.
Dieticians - visit the ward regularly and can be contacted in the dietetics department.
Social Workers - can be contacted in the social work department. There is a list of social
workers that work outside the area i.e. Powys, Torfaen, and Blaenau Gwent etc.
Pharmacists - visit the ward on a daily basis and can be contacted in the pharmacy.
Stroke Specialist Nurse (CNS) – Based on the ward Monday – Friday, and also rotate to Tia
clinic, in NHH
Windsor Suite – Haematology Day unit, in NHH
Rehab Assistants- Assists physio and occupational therapists
Shift Times / Off Duty
Nursing staff on the unit generally follow a 12 hour shift pattern, occasionally 6 hour shifts
can also be worked.
Day shift
0700hrs - 1930hrs
Night shift 1900hrs - 0730hrs
The E-Rostering system is used within the hospital, whereby requests for Off Duty can be
made on the intranet by each staff member. (Not Students)
Due to the fast pace and high intensity on the unit, students are not encouraged to work more
than two consecutive 12 hour shifts. Often it is more conducive towards learning if students
follow a 5 day week shift pattern.
All students will be allocated a Main & Co. Mentor, and should aim to work at least 40% of
shifts with the Main Mentor. If you have any queries or special requests, please liaise with
either of your mentors or a senior member of the ward staff.
Ward Layout
During your first day you will be orientated to the ward layout, and all emergency systems. If
you have any problems finding any equipment etc, please speak to any member of staff.
Sickness
If you are ill and unable to attend work it is essential that you contact the ward as soon as
possible. You should also make yourself aware of the sickness policy for the trust. When you
ring please ask to speak to the nurse in charge and tell them what the problem is and how long
you anticipate being off work. You must contact the ward on a daily basis if you are unsure
how long you will be sick.
Uniform
Whilst on duty on the ward it is important to remain professional at all times. The correct
uniform must be worn with your name badge displayed, long hair should be tied back and
jewellery kept to a minimum. Mobile phones are not permitted in the clinical area. Uniforms
are not to worn into work, changing facilities and locker is provided on the unit.
Manual Handling
Your manual handling specialists on the ward are SN.Sian Langdon and AN Eva Kozik. There
are a number of manual handing aids on the ward to assist with the transferring and moving of
patients such as slide sheets and hoists, therefore uncluttered wards are essential. All
nursing staff are trained in the correct manual handling techniques and it is important that
you adopt the same methods and precautions to avoid injuring yourself or others. If you have
any questions or concerns regarding manual handling please ask.
Cardiac Arrest
In the event of a cardiac arrest you may be asked to call the crash team. This is done by
dialling 2222. Switchboard will answer the phone immediately. You will need to tell them
clearly where the cardiac arrest is. Do not replace the receiver until the switchboard has
repeated the ward back to you. The emergency trolley, defibrillator and suction equipment
are checked every night, and are located in the treatment room; these will be shown to you on
your ward orientation. You should make yourself familiar with this equipment. You are
responsible to attend an annual CPR/ BLS training session.
Fire Safety
In the event of finding a fire, you should raise the alarm by shouting and breaking the 'break
glass' points. You should familiarise yourself with the Health Board policy on Fire Safety and
attend an annual lecture.
Abbreviations
During your placement and training you will come across numerous abbreviations in handover,
written work and everyday use. Here are some of the most common used:
AF
Arterial Fibrillation (cardiac Arrhythmia)
BD
Twice daily (frequency of tablets, observations or BMs)
BM
Blood sugar monitoring
BNF
British National Formulary (drug Bible)
CBD
Closed bag drainage (used in catheterisation)
CCF
Congestive cardiac failure (right sided heart failure)
CD
Clostridium Difficile (infected stools)
COPD
Chronic Obstructive Pulmonary Disease
CPR
Cardio-pulmonary resuscitation
CSU
Catheter specimen of urine
CT
Computerised tomography
CVA
Cerebro-vascular accident
CVP
Central venous pressure (pressure in right atrium)
DVT
Deep vein thrombosis (blood clot in the leg)
ECG
Electro-cardiogram (tracing of heart rhythm)
ERCP
Endoscopic retrograde cholangio-pancreatography
FOB
Faecal occult blood (stool sample to detect bleeding on the bowel)
IHD
Ischaemic heart disease
IM
INR
IV
IDDM
LFT
Intra-muscular (injecting into the muscle)
International normalised ratio (blood test for patients on warfarin)
Intra-venous (injecting into the vein)
Insulin dependant diabetic
Liver function tests (blood tests)
LP
LVF
MI
MRI
MRSA
MSU
NAD
NG
NIDDM
OD
OT
PE
PEG
PRN
PT
QDS
SAH
SALT
SDH
SVT
SW
TDS
TIA
TTO
USS
VF
Lumbar puncture
Left ventricular failure (left sided heart failure)
Myocardial infarction (heart attack)
Magnetic resonance imaging (scan)
Multi resistant staphylococcus
Mid stream urine (specimen)
No abnormalities detected
Naso-gastric (feeding tube)
Non insulin dependant diabetic (controlled on tablets or diet)
Once daily (frequency of tablets, observations etc)
Occupational Therapist
Pulmonary embolus (clot on lung)
Percutaneous endoscopic gastrostomy
'pro re nata' (Latin for 'as required')
Physiotherapist
Four times a day
Sub-arachnoid haemorrhage (bleed in the brain)
Speech and Language Therapist
Sub-dural haemorrhage (bleed in the brain)
Supra-ventricular tachycardia (fatal heart rhythm)
Social worker
Three times a day
Transient ischaemic attack (a small stroke)
Tablets to take out (patient's discharge medication)
Ultrasound scan
Ventricular fibrillation (cardiac arrthymia)
GLOSSARY
AMAUROSIS FUGAX (TRANSIENT MONOCULAR BLINDNESS): a sudden blindness, often
like a black shutter coming down affecting one eye. This is usually the result of problems with
the circulation to the brain and eye and is a sort of mini-stroke affecting the eye. Needs to
be assessed by a doctor.
ANEURYSM: an abnormal weak area of blood vessel wall prone to bursting (a common cause of
a subarachnoid haemorrhage).
APOPLEXY: a very old term for stroke.
ARTERY: a blood vessel usually carrying blood pumped from the heart to parts of the body.
This is the higher pressure part of the blood supply system.
ASPIRIN: a well known drug that thins the blood and prevents clotting. Used to treat
patients with stroke.
ATHEROSCLEROSIS: the medical condition that leads to the furring up and blockage of
blood vessels. This damage to the blood vessels is often a source of blood clots, leading to
strokes and heart attacks.
ATHEROTHROMBOSIS: the condition of abnormal blood clots forming on damaged blood
vessels (atherosclerosis).
ATRIAL FIBRILLATION (AF): an abnormal heart condition where the heart beats
irregularly, often causing palpitations; it can lead to strokes caused by abnormal blood clots
formed in the heart.
CAROTID ARTERIES: the two main blood vessels in the front of the neck which make up two
of the four main blood vessels supplying the brain.
CEREBROVASCULAR ACCIDENT (CVA): an old term for stroke.
CEREBRAL HEMISPHERE: the main right and left parts of the brain are called the cerebral
hemispheres. The left hemisphere usually controls the right side of the body. The right
hemisphere usually controls the left side of the body. Language is controlled by the left
hemisphere in right-handed people and also in about 50 per cent of left-handed people.
CLOPIDOGREL: a blood-thinning agent that can help prevent stroke.
CT (COMPUTED TOMOGRAPHY) SCANNER: the x-ray machine that can produce detailed
pictures of the body. A brain CT scan can show the cause of stroke and exclude abnormal
bleeding in the brain.
DIABETES: a common condition that causes abnormally high levels of sugar in the body.
Often need treatment by diet, special pills or insulin.
DIPYRIDAMOLE: a blood-thinning agent that can help prevent stroke.
DISSECTION: an abnormal tear in the blood vessel wall that can cause strokes, especially if
the blood vessel has been damaged by a sudden bang or pressure over the blood vessel. This
can be a cause of a stroke after attempting strangulation or a sports injury.
DYSARTHRIA: a problem of producing the sounds of speech. This may merely be a slurring of
speech but in severe cases can mean a total loss of speech (anarthria).
DYSPHASIA: a problem of language production. Mild forms can cause word-finding
difficulties, moderate dysphasia causes muddled words and phrases, and severe cases result
in no language at all (aphasia). The term is also used for difficulty in understanding speech.
ECHOCARDIOGRAPHY: a detailed scan of the heart using ultrasound. A special probe is
placed on the chest wall and the sound waves can be analysed to form pictures of the heart
beating.
ELECTROCARDIOGRAM (ECG): a recording of the electrical activity of the heart by
attaching wires on the arms, chest wall and legs. A very common test after a stroke as heart
disease is common in people with stroke.
HAEMORRHAGE: an escape of blood (abnormal bleed).
HEMIANOPIA: a loss of vision in part of the visual field. For example, some people with large
strokes affecting the left side of the brain lose the ability to see to the right.
HEMI PARESIS: a weakness affecting the arm and leg on the same side of the body as a
result of problems with the brain or spinal cord (often abbreviated to ‘hemi’ by patients and
medical staff).
INDAPAMIDE: a mild diuretic (water tablet) to lower blood pressure.
INFARCT: permanent damage to body tissue (tissue death). A cerebral infarct is when part
of the brain is irreversibly damaged by a blocked blood vessel
INTRAVENOUS: the method of giving fluids straight into the blood supply system of the
body. The veins are the low-pressure blood vessels and are relatively easy to use.
ISCHAEMIC: tissue starved of a normal blood supply as a result of a blocked or narrowed
blood vessel. Often leads to permanent damage, for example, a stroke in the brain.
MAGNETIC RESONANCE IMAGING (MRI): a sophisticated scanning technique that uses a
powerful magnet (rather than x-rays) and computer to produce detailed pictures of the body.
People with metal implants (for example, an intracranial aneurysm clip or a pacemaker) cannot
be scanned because the magnetic field is so powerful that it can dislodge the metal.
MIGRAINE: a common medical condition characterised by flashing lights, feeling sick, a
throbbing one-sided headache and an overwhelming need to lie down in a darkened room. Can
be very mild or very severe. Very occasionally a severe attack can cause a stroke.
OCCUPATIONAL THERAPIST: a therapist who helps people do everyday activities such as
wash, dress, eat, make meals and use the toilet.
OESTROGEN: a female hormone, used in the oral contraceptive pill.
PERINDOPRIL: a commonly used blood pressure-lowering tablet, which is also used to treat
heart failure.
PHYSIOTHERAPIST: a therapist who uses movement and exercises to help people recover
from stroke and other disabling conditions.
PRIMARY INTRACEREBRAL HAEMORRHAGE: an abnormal collection of blood in the brain
resulting from a burst blood vessel (artery). The second most common cause of stroke.
PULMONARY EMBOLISM: a blood clot which travels to the lung and damages part of it. This
can be a complication of stroke, especially if there has been a leg thrombosis. Potentially very
serious and can result in death.
RANDOMISED: the method of allocating clinical trial treatment in medical research. This
makes sure that the doctor and patient do not cheat and choose the treatment themselves.
SEIZURES: an electrical storm in the brain often causing loss of consciousness, abnormal
muscle twitching, abnormal behaviour and a short period of excessive sleepiness (or varying
combinations of the above). Epilepsy is the term given to a condition with frequent attacks. A
single attack can occur with the onset of stroke and stroke is the most common cause of
epilepsy in older people.
SIMVASTATIN: a tablet form of the ‘statin’ group of cholesterol-lowering pills used to treat
patients with heart attacks and strokes.
SOCIAL WORKER: a member of the stroke team with expertise in financial matters (for
example, benefits), local services to care for patients after hospital discharge (for example,
home care and meals on wheels), and assessing whether people need continuing care in
residential or nursing homes. In the UK, social workers are usually employed by the local
council, although they are often based within the NHS hospital.
SPEECH AND LANGUAGE THERAPIST: a member of the stroke team with special expertise
in assessing communication and language. They have also developed a very important role in
assessing the safety of the swallow mechanism and help to advise the nursing team on the
best feeding methods for patients with stroke.
STATINS: a class of cholesterol-lowering pills, which will be increasingly used to treat
patients with stroke.
STROKE: a sudden onset of loss of neurological function (for example, weakness affecting
arm and leg, speech problem), with symptoms that last more than 24 hours, resulting from a
problem with the blood supply to the brain.
SUBCUTANEOUS: the method of giving fluids into the body by allowing the body to absorb
the fluid from under the skin. A really useful way of giving people extra fluids with few side
effects.
THROMBOLYTIC THERAPY: powerful blood clot-dissolving treatment. The main treatment
for heart attacks and a promising treatment for some strokes. Unfortunately, it can cause
severe bleeding in some people and more research will be needed to check that this type of
treatment should be used. Recombinant tissue plasminogen activator (rtPA) and streptokinase
are the most commonly used thrombolytic agents in the UK.
TICLOPIDINE: a blood-thinning agent which can prevent stroke. It is only rarely used in the
UK because of important side effects on the blood. Needs to be carefully monitored with
frequent blood tests.
TRANSIENT ISCHAEMIC ATTACK (TIA): a mini-stroke with symptoms that fully recover
in less than 24 hours (often recover within seconds or minutes). Can be a warning that a more
severe stroke is about to happen. Should be assessed by a doctor.
TRANSIENT MONOCULAR BLINDNESS: see Amaurosis fugax.
TRANSOESOPHAGEAL ECHOCARDIOGRAPHY (TOE): a special heart scan by using sound
waves from a tube placed in the oesophagus (gullet). Needs a skilled person to place the tube
in the correct place and the patient usually requires a mild sedative or throat spray.
WARFARIN: a commonly used tablet to thin the blood. Very useful for preventing strokes
but can cause abnormal bleeding.