Discharge Planning Instructions

A.
DISCHARGE PLANNING INSTRUCTIONS
MEDICATION
 Continue medication as prescribed by the doctor.
EXERCISE
 "Passive Range of Motion Exercises"
If the stroke victim has suffered paralysis of one side of the body, passive
range of motion exercises are done for the shoulder, elbow, wrist, fingers,
hip, knee, ankle, foot, and toes by the physical therapist at bedside. Passive
range of motion means that the therapist supports and moves the body part
through the full range of motion. These exercises maintain good blood flow
and keep the muscles and tendons flexible, preventing the joints from
tightening. For example, if the shoulder joint is not stretched, the patient can
develop a "frozen shoulder syndrome" which can be very painful. It is
important to prevent range of motion limitations because this impairs
function and tends to cause pain. After the patient is discharged, a Home
Health Physical Therapist will provide a Home Exercise Program with clear
written instructions and illustrations and will train a family member how to
carry out these exercises.
 "Active Range of Motion Exercises"

If the stroke victim starts to recover and begins to have voluntary muscle
strength on the involved side then the physical therapist may instruct the
individual in active exercises. "Active exercise" means the patient will lift or
move the body part through the range of motion against gravity without help.
These exercises help to strengthen the muscles on the weak side, but also
should be done on the good side.
 "Constraint-Induced Movement Therapy (CIMT)"

CIMT is being used in some stroke rehabilitation centers. It involves
constraining the unaffected limb in order to force the patient to use the
affected limb.
 "Balance and Transfer Exercises"

With the assistance of a physical therapist, the patient will practice moving
from lying to sitting position and then practice sitting balance. Next they will
learn to transfer from bed to wheelchair and back to bed sometimes using a
sliding board if necessary.
 "Gait (Walking) Training Exercises"

The patient generally starts practicing standing up in the parallel bars with
the assistance of a physical therapist. Next the patient learns to shift weight
from one leg to the other, shifting both from side to side and from front to
back. After this the patient walks a short distance between the parallel bars
using the bars for support. Next, with the assistance of a physical therapist,
the patient will walk outside the bars using a quad cane or walker if needed.
The therapist places a wide canvas belt, called a "gait belt", around the
patient's waist to provide a way of holding on to him or her and a way to
adjust balance and prevent falls.
 "Home Assistive Devices"

Once the patient is at home, a Home Health Physical Therapist will visit and
make recommendations for creating a safe and supportive environment.
Items of concern might be the need for hand-hold bars and/or seats in
showers and tubs, toilet adapters to raise the seat level, clear areas around
beds and through the house so that the patient does not fall, etc.
TREATMENT
 The most effective cerebrovascular accident treatment plan uses a
multifaceted approach. This includes preventive care aimed at minimizing the
risk factors for having a cerebrovascular accident or a recurrent
cerebrovascular accident. Preventive measures include regular medical care
to monitor and address such risk factors as high cholesterol, obesity,
smoking, diabetes, hypertension and excessive alcohol consumption.
 Physiotherapy: Physical therapy to rehabilitate muscles, joints, or other

structures.
 Symptomatic support
 Speech therapy
 Treatment of underlying medical conditions
 Positioning the person on the ground, with legs slightly elevated or leaning
forward and the head between the knees
 Thrombolysis treatment
 Adequate sleep
HEALTH TEACHING
GROOMING
 Place the patient in wheelchair or stationary chair. This assists with support
when dressing. Dressing can be fatiguing.
 Encourage use of clothing one size larger. This ensures easier dressing
comfort.
 Suggest elastic shoelaces or loop and pile closures on shoes. These eliminate
tying.
HYGIENE
 Instruct patient to select bath time when he or she is rested and unhurried.
Hurrying may result in accidents and the energy required for these activities
may be substantial.
 Provide patient with appropriate devices (e.g., long-handled bath sponge;
shower chair; safety mats for floor; grab bars for bath or shower). These aids
in bed bathing.
 Encourage patient to comb own hair (a one-handed task). Suggest hairstyles
that are low-maintenance. This enables the patient to maintain autonomy.
 Encourage patient to perform minimal oral-facial hygiene as soon after rising
as possible. Assist with brushing teeth and shaving, as needed.
 Assist patient with care of fingernails and toenails as required. These reduce
injury.
BOWEL MOVEMENT
Offer bedpan or place patient on toilet every 1 to 1½ hours during day and three
times during night. This eliminates incontinence. Time intervals can be lengthened as
the patient begins to express the need to toilet on demand.
OUT PATIENT DEPARTMENT
Follow up check -up as advised by the doctor.
DIET
 Encourage patient to eat soft foods to chew and swallow it easily.

 Instruct to eat on the unaffected side of the mouth and hand.
 Ensure patient to wear dentures and eyeglasses if needed.
 Provide patient appropriate utensils such as drinking straw, food guard,
rocking knife, non-skid place mat to aid in self-feeding.
 Place patient in optimal position for feeding, preferably sitting up in a chair;
support arms, elbows, and wrists as needed.
 If patient has visual problems, instruct the patient about the placement of the
food in the plate.

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A.

DISCHARGE PLANNING INSTRUCTIONS

 "Active Range of Motion Exercises"

 "Constraint-Induced Movement Therapy (CIMT)"

 "Balance and Transfer Exercises"

 "Gait (Walking) Training Exercises"

 "Home Assistive Devices"

 Physiotherapy: Physical therapy to rehabilitate muscles, joints, or other

OUT PATIENT DEPARTMENT

Follow up check -up as advised by the doctor.

 Encourage patient to eat soft foods to chew and swallow it easily.

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