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

Nursing concise guide for stroke 2012
National clinical guideline for stroke
C All stroke patients with a persistent loss of
control over their bowels should:
● be assessed for other causes of
incontinence, which should be treated if
identified
● have a documented, active plan of
management
● be referred for specialist treatments if the
patient is able to participate in treatments
● 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.
D Stroke patients with troublesome constipation
should:
● have a prescribed drug review to minimise
use of constipating drugs
● be given advice on diet, fluid intake and
exercise
● be offered oral laxatives
● be offered rectal laxatives only if severe
problems remain.
Driving (6.27.1)
A Before they leave hospital (or the specialist
outpatient clinic if not admitted), every person
who has had a stroke or transient ischaemic
attack should be asked whether they drive or
wish to drive.
Work and leisure (6.29.1)
A Every person should be asked about the work
and/or leisure activities they undertook before
their stroke.
C Patients who wish to return to or take up a
leisure activity should have their cognitive and
practical skills assessed, and should be given
advice and help in pursuing their activity if
appropriate.
Sexual dysfunction (6.31.1)
A Every patient should be asked, soon after
discharge and at their 6-month and annual
reviews, whether they have any concerns about
their sexual functioning. Partners should
additionally be given an opportunity to raise
any problems they may have.
B Any patient who has a limitation on sexual
functioning and who wants further help
should:
● be assessed for treatable causes
● be reassured that sexual activity is not
contraindicated after stroke and is
extremely unlikely to precipitate a further
stroke
● if suffering from erectile dysfunction, be
assessed for the use of sildenafil or an
equivalent drug
● avoid the use of sildenafil or equivalent
drug for 3 months after stroke and until
blood pressure is controlled
● be referred to a person with expertise in
psychosexual problems if the problems
remain unresolved.
Further rehabilitation (7.1.1)
A Any patient whose situation changes (eg new
problems or changed environment) should be
offered further assessment by the specialist
stroke rehabilitation service.
People with stroke in care homes (7.5.1)
A All people with stroke in care homes should
receive assessment and treatment from stroke
rehabilitation services in the same way as
patients living in their own homes.
B All staff in care homes should have training
on the physical, psychological and social
effects of stroke and the optimal management
of common impairments and activity
limitations.
138 © Royal College of Physicians 2012