Stroke after care, which includes simple
protocols to prevent fever, hyperglycemia, and aspiration pneumonia, can lead
to profound differences
in patients who survive stroke
. Patients who receive
after care are less likely to die or be
dependent and have improved physical function at 90 days compared to patients
given standard care. The study making these conclusions was published Online
First by The Lancet
, and was
carried out by Professor Sandy Middleton, and his team.
It is true that organised stroke unit care has significantly
reduced deaths and disability from stroke. Attention continues to be limited to
the management of the patient in the first 72 hours flowing stroke. In spite of
the attached importance of hyperglycaemia,
swallowing management and fever to
long-term patient recovery,
these entities are not managed well.
recent study was performed at 19 acute stroke units (ASUs) in New South Wales,
Australia. The fever, hyperglycaemia, and swallowing nursing care protocol was
weighed against the current stroke management guidelines. Fever was managed by monitoring the patients' temperature every
4 hours and where required, paracetamol was used to lower temperature. Blood
sugar shoot-ups (termed hyperglycemia) were kept in check by frequent blood
glucose monitoring and
timely infusions of insulin or saline
depending on blood sugar levels and whether diabetes was present or absent. Swallowing difficulties were also
taken care of so as to prevent a condition called aspiration pneumonia
(a major cause of death in stroke patients). Aspiration
pneumonia is a fatal inflammation of the lungs and airways following inhalation
of foreign material.
Patients who received the fever, hyperglycaemia, and swallowing nursing care protocol were found to be 16 per
cent more likely to be alive and independent after three months compared to
those who received the 'standard care'. It is thus clear that nursing care
makes a significant difference for stroke patients after discharge.
"Implementation of evidence-based treatment
protocols to manage fever, hyperglycemia, and swallowing dysfunction in acute
stroke (QASC): a cluster randomised controlled trial." The Lancet, Early Online Publication, 12 October 2011.