Ask the Doc 1: How to manage and regulate blood pressure of a recovering stroke patient.

I would like to ask how can one manage and regulate blood pressure for a recovering stroke patient.

To answer this question, one must ask oneself, What is a stroke?

A stroke tends to occur when a vessel in the brain ruptures or is blocked by a blood clot or air embolus. Stroke medical treatments work to either open the blockage or treat the burst vessel.

80% of all strokes are preventable. It starts with managing key risk factors, including high blood pressure, cigarette smoking, atrial fibrillation and physical inactivity. More than halfof all strokes are caused by uncontrolled hypertension or high blood pressure, making it the most important risk factor to control.

There are two types of strokes:
1. Ischaemic. An ischaemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87% of all stroke cases.

2. Haemorrhagic- A hemorrhagic stroke occurs when a blood vessel ruptures and spills blood into brain tissue either as a result of high pressure or a weakened vessel wall. Themost common cause for this kind of rupture is uncontrolled / poorly controlled hypertension (high blood pressure).

If you’re having a stroke, it’s critical that you get medical attention right away. Immediate treatment may minimize the long-term effects of a stroke and prevent death.

First and foremost, it is best to prevent a stroke at all costs, but if that has already occurred, then one is left with the long term goal of rehabilitating the stroke victim back to
normal health.

More than 50% of strokes are caused by high blood pressure, but once a stroke occurs, usually what ensues is a drop in the stroke victims blood pressure so one has to be cautious in managing the person’s blood pressure as an over zealousness in crashing the stroke victims blood pressure could result in another stroke.

Unfortunately, once the stroke has happened, the damage has already been done.  The mainstay of management would be to rehabilitate the patient as well as regular monitoring of the patients blood pressure and pulse rate.

Management and effective regulation of a stroke victim’s blood pressure would require the following:-

1.An accurate blood pressure measuring device as a lot of the automatic ones give varying results.  It would be wise to take your automatic blood pressure device to your Doctor to compare it with manual readings to ensure the device is an accurate one.  Once this has been established, the patient’s blood pressure is taken 3 times a day, 1st thing in themorning, afternoon and in the evening.  The pulse rate and blood pressure readings should be charted in a notebook and showed to the managing Physician during medical checkup.

This step alone is probably the most single factor in ensuring the stroke patient’s blood pressure is effectively monitored/managed.  Ideally, there are ambulatory blood pressure devices that can be connected to the patient and these will automatically take the blood pressure readings at intervals throughout the day usually over a period of one week and charted for later review by the managing Physician but these devices are not cheap and are not readily available in this environment.

2.If the stroke was identified as being ischaemic in nature, then the patient’s doctor will place him/her on a drug called Clopidogrel.

3.If the patient has high cholesterol, routine lipid profile tests every 3-6 months will have to be done and the patient’s diet will have to be modified by a Dietician.  The patient mayalso be placed on anti-cholesterol medication as cholesterol worsens heart disease / hypertension.

4.In most cases, stroke victims tend to lose some functioning of their limbs usually one side of their body is affected depending on which side of the brain the stroke occurred.So, most stroke patients will benefit from some form of physical rehabilitation or Physiotherapy.

5.Sometimes the speech patterns of the stroke victim may also be affected.  In an ideal setting, a Speech therapist would be highly recommended but where there is none, frequent conversations and encouragement by loved ones will go along way in rehabilitation.

6.Most stroke victims are depressed.  They should be visited often by their loved ones and encouraged.

7.They will also need a caretaker as most stroke victims are very reluctant in moving around and should be encouraged to do so as lying all day in one position will only predispose the patient to the development of pressure/bed sores which is a rather difficult thing to treat.  They should be turned from one position to another every 2 hours to ensure bed

sores don’t develop.

8.All in all, how fast a stroke victim recovers is multifactoral.  A stroke victim surrounded and encouraged with the aid of his family will usually recover faster than a stroke victim that is neglected and locked away in a dark room.

Dr Akindele Goodluck is  a Medical Doctor and General Surgeon. He is the Medical Director of Goodluck Specialist Hospital based in Lagos. He offers special Mobile services to his patients. He Can be reached on goodluck_specialist_clinic@yahoo.com

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