national-clinical-guidelines-for-stroke-fourth-edition

Nursing concise guide for stroke 2012
National clinical guideline for stroke
programmes which may include
pharmacological agents and/or psychological
support.
B All patients should be advised to take regular
exercise as far as they are able:
● Exercise programmes should be tailored to
the individual following appropriate
assessment, starting with low-intensity
physical activity and gradually increasing to
moderate levels.
● All adults should aim to be active daily and
minimise the amount of time spent being
sedentary (sitting) for extended periods.
● For adults over the age of 19 years, this
activity should add up to at least 150
minutes of moderate intensity, over a week,
in bouts of 10 minutes or more (eg 30
minutes on at least 5 days per week). They
should also engage in muscle strengthening
activities at least twice per week.
● For older people at risk of falls, additional
physical activity which incorporates balance
and coordination, at least twice per week, is
also recommended.
C All patients should be advised to eat the
optimum diet:
● eating five or more portions of fruit and
vegetables per day from a variety of sources
● eating two portions of oily fish per week
(salmon, trout, herring, pilchards, sardines,
fresh tuna).
D All patients should be advised to reduce and
replace saturated fats in their diet with
polyunsaturated or monounsaturated fats by:
● using low-fat dairy products
● replacing butter, ghee and lard with
products based on vegetable and plant oils
● limiting red meat intake especially fatty cuts
and processed forms.
E Patients who are overweight or obese should be
offered advice and support to aid weight loss,
which may include diet, behavioural therapy
and physical activity.
F All patients, but especially people with
hypertension, should be advised to reduce their
salt intake by:
● not adding salt to food at the table
● using as little salt as possible in cooking
● avoiding high-salt foods, eg processed meat
products, such as ham and salami, cheese,
stock cubes, pre-prepared soups and savoury
snacks such as crisps and salted nuts.
G Patients who drink alcohol should be advised
to keep within recognised safe drinking limits
of no more than three units per day for men
and two units per day for women.
Blood pressure (5.4.1)
A All patients with stroke or TIA should have
their blood pressure checked. Treatment should
be initiated and/or increased as is necessary or
tolerated to consistently achieve a clinic blood
pressure below 130/80, except for patients with
severe bilateral carotid stenosis, for whom a
systolic blood pressure target of 130–150 is
appropriate.
Pain management (6.19.1.1)
A Every patient with stroke should be asked
whether they have any pain, and severity
assessed using a validated score at onset and
regular intervals thereafter. Each review should
include assessment of:
● pain reduction
● adverse effects
● daily activities and participation (such as
ability to work and drive)
● mood (in particular, whether the person
may have depression and/or anxiety)
● quality of sleep
● overall improvement as reported by the
person.
Shoulder pain and subluxation (6.19.2.1)
A Every patient with functional loss in their arm
should have the risk of developing shoulder
pain reduced by:
● ensuring that everybody handles the weak
arm correctly, avoiding mechanical stress
and excessive range of movement
136 © Royal College of Physicians 2012