Once a patient's stroke has been evaluated and his condition has been stabilized, he'll be transferred out of the ER and into a hospital bed. How long he spends in the hospital depends on a number of factors, including the type and severity of his stroke, what medical complications arise, and the extent of his disability. But it's unlikely that he'll be in the hospital for long. According to the National Center for Health Statistics, the average length of hospitalization for stroke in 2005 was 5.2 days.
Even though the person you're caring for is out of the ER, serious complications may still arise. An estimated one out of five stroke patients dies during his hospital stay.
The patient's treatment team has two main goals: To prevent another stroke from occurring and to minimize and respond to any complications.
To this end, the person you're caring for will undergo more testing to determine the cause of this stroke. Although the doctors should know what type of stroke he had, they'll still need to pinpoint the exact cause. They may perform one or more of the following tests:
Carotid ultrasound to determine if either carotid artery is narrowed or blocked. This test is noninvasive and painless: A technician applies jelly to the patient's neck, then slides an ultrasound wand over the skin covering his carotid artery.
Transcranial Doppler test for blockages in the large brain arteries. This test is similar to the carotid ultrasound, although the sound waves go through the patient's skull instead of his neck.
Cerebral angiogram to look for atherosclerosis or a brain aneurysm. The patient will be sedated to minimize his anxiety and discomfort during this procedure. A long, thin catheter, or tube, is inserted into a large artery in his groin, then maneuvered all the way through blood vessels into his chest. Once the tube reaches his carotid artery, dye is injected, which travels through the artery into the brain. Then a series of X-rays is taken to spot any abnormalities in the blood vessels of the brain. Because this procedure carries a slight risk of causing another stroke, it will be performed only if other tests are inconclusive.
Depending on the patient's test results, his doctors will treat him to reduce his risk of having another stroke:
For an ischemic stroke, he may be given anticlotting drugs, have a procedure known as a carotid endarectomy, or both.
For a hemorrhagic stroke, he may need to have a torn brain artery or aneurysm repaired, both of which require major surgery.
No matter what type of stroke he had, risk factors such as high blood pressure, high cholesterol, and diabetes will be evaluated and treated.
Complications could include brain swelling, seizures, clots in his legs, aspiration due to difficulty swallowing, arrhythmias, bleeding stomach ulcers, and pressure sores. The patient's doctors will be on the lookout for these serious and potentially fatal complications.
The patient's hospital stay may be even more stressful for you than his stroke and time in the ER. Now that you're no longer in crisis mode, you have more time to think -- and worry -- about the future. But try to use that time to prepare for life after his discharge instead:
Figure out how much care he will need. The extent of his stroke-related disability may not be immediately obvious, but it will become clearer as his recovery progresses. Talk to his rehabilitation team about how much care he'll need immediately after discharge, then discuss options for his care with his family or friends. Will he be able to return to his own home or to a family member's home? Or will he need more short-term or long-term a
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