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

● avoiding the use of overhead arm slings
● careful positioning of the arm.
B Every patient with arm weakness should be
regularly asked about shoulder pain.
C Every patient who develops shoulder pain
should:
● have its severity assessed, recorded and
monitored regularly
● have preventative measures put in place
● be offered regular simple analgesia.
Musculoskeletal pain (6.19.4.1)
A Any patient with musculoskeletal pain should
be carefully assessed to ensure that movement,
posture and moving and handling techniques
are optimised to reduce the pain.
B Any patient continuing to experience pain
should be offered pharmacological treatment
with simple analgesic drugs taken regularly.
Oral health (6.22.1)
A All stroke patients especially those who have
difficulty swallowing, and are tube fed, should
have oral and dental hygiene maintained
(involving the patient or carers) through
regular (at least 3 times a day):
● brushing of teeth with a toothbrush, and
dentures and gums with a suitable cleaning
agent (toothpaste or chlorhexidene
gluconate dental gel)
● removal of excess secretions.
B All patients with dentures should have their
dentures:
● put in appropriately during the day
● cleaned regularly
● checked and replaced if ill-fitting, damaged
or lost.
C Those responsible for the care of patients
disabled by stroke (in hospital, in residential
and in home care settings) should be trained
in:
● assessment of oral hygiene
● selection and use of appropriate oral
hygiene equipment and cleaning agents
Nursing concise guide for stroke 2012
● provision of oral care routines
● recognition and management of swallowing
difficulties.
Nutrition: assessment and management
(6.23.1)
B Screening for malnutrition in stroke patients
should be repeated:
● weekly for hospital inpatients
● at first appointment in outpatients
● on admission and where there is clinical
concern in care homes or rehabilitation
units.
C Nutritional support should be initiated for all
stroke patients identified as malnourished or at
risk of malnutrition. This may include
specialist dietary advice, oral nutrition
supplements, and/or tube feeding.
Bowel and bladder impairment (6.24.1)
A All wards and stroke units should have
established assessment and management
protocols for both urinary and faecal
incontinence, and for constipation in stroke
patients.
B Patients with stroke who have continued loss of
bladder control 2 weeks after diagnosis should
be reassessed to identify the cause of
incontinence, and have an ongoing treatment
plan involving both patients and carers. The
patient should:
● have any identified causes of incontinence
treated
● have an active plan of management
documented
● be offered simple treatments such as
bladder retraining, pelvic floor exercises
and external equipment first
● only be discharged with continuing
incontinence after the carer (family
member) or patient has been fully trained
in its management and adequate
arrangements for a continuing supply of
continence aids and services are confirmed
and in place.
© Royal College of Physicians 2012 137
Nursing concise guide for stroke 2012