Physiological observations (or “obs” ) are recorded from patients in acute settings at various intervals, depending on how closely they need to be monitored for any potential changes. During and for 24hrs after thrombolysis, a patient’s obs are recorded every 15 minutes. Usually obs are taken every 4 hours although if one physiological aspect is fluctuating this is increased to hourly to keep a closer check on indications of any conditions which may adversely affect the patients health eg infection, dehydration, haemorrhage etc.
Usual obs taken for acute patients are:
Heart Rate– usually 50-80 bpm, recorded by pulse or heart monitor
Respiratory Rate (RR)– usually 14-20 breaths/minute, recorded by counting chest movements
Temperature – usually 36-37’C
O2 saturation– usually 95- 98% although smokers/COPD may have a lower target saturation set by doctor eg 85%
AVPU– Alert/responds to Verbal/ responds to Pain/Unresponsive; measuring drowsiness with a shortened version of the Glasgow Coma Scale
Glasgow Coma Scale (GCS)– patient’s level of consciousness cored out of 15. Note that a coma patient or toaster will have a minimum score of 3. Aphasic patients are scored out of 10, and you should test a stroke patient’s unaffected side since a side with hemiparesis does not truly reflect their level of consciousness.
Blood Pressure (BP)- usually 120/80 (systolic over diastolic) although expected to be higher in stroke patients. BP is often higher in stroke patients, up to 220/110. A sudden drop in BP can cause patient to faint/collapse, known as syncope. A fluctuation in BP during sit to stand can also cause patient nausea and dizziness, and lying down can reduce these symptoms in this circumstance. According to NICE guidelines, BP should be ideally be 185/100 or lower for patients who are potentially suitable for thrombolysis.
Blood Glucose– 5-7 mmol/litre is normal, 7-11 mmol/l indicates impaired glucose tolerance. Above 11 mmol/l indicates diabetes. Medication such as steroids can increase the blood glucose level in a patient. Higher blood glucose leads to reduced immunity and increased risk of seizures in stroke patients. According to NICE guidelines, patients with acute stroke should be treated to maintain a blood glucose concentration between 4 and 11 mmol/l.
There are a lot of medical latin-sounding words used to describe the different stroke symptoms. Below is a list together with the way that I remember them.
In brackets is (Ph) or (M) to indicate whether the symptom is physical or mental. Physical could be movement or sensation; and Mental means cognitive processes such as perception or attention.
Around 40% of the brain is actually involved with vision, since it includes ocular motor movement, planning of these movements, receipt of the visual information, processing of it and then decisions made on the visual information – these decisions could be visuospatial, emotional etc.
Hemianopia (Ph) (hemi=half; plegia=paralysis)
Loss of vision in either L or R half of both eyes. So not loss of vision in left eye, but loss of left visual field in both eyes. The information from one side is not transmitted to the brain.
The information from eyes is being transmitted to the brain, but information for one side is ‘ignored’ or not processed by the brain.
Diplopia (Ph) (diplo=double; op=eye)
Continuous uncontrolled eye movements, seen with involuntary flickering movements of the eyes either L-R or up-down.
A stroke is similar to how a heart attack stops the blood going to the heart -but for the brain. So like a ‘brain attack’ or a sudden ‘strike’ to the brain. Depending where the blood is stopped from getting to in the brain, depends on what effect it’ll have on the person. Once deprived of blood and therefore oxygen, parts of the brain begin to die after only a few minutes and so a stroke is classed as a medical emergency.
Causes of stroke
Ischaemic– blood vessel blocked by clot, stopping flow. Most common 85% cases. Clot could be due to narrow arteries, clot in artery, or clot travelling from somewhere else to the brain. Brain area that dies is called aninfarct… ‘the naughty clot “schemes” to injure the brain’
Haemorrhagic-blood vessel ruptures and blood leaks out. 15% cases. The leaking blood building up also causes extra pressure inside the skull. Leak could be due to high blood pressure or a weakened/bulging blood vessel wall (‘aneurysm’)…‘haemorrhage of blood’
Where the brain dies dictates which abilities will be lost. The right side of the brain controls the left side of the body, and vice versa.This means an injury to the left side will affect movement in the right side of the body.
The different areas of the brain control different tasks:
Frontal lobe (front)
initiation and motivation
appropriate socialising & interactions with others
Broca’s area -produce spoken language
Parietal lobe (top middlestrip: like saddle on a horse on the prairies, you experience a lot of unusual sensations as you ride through the desert like heat, smells, sore bum etc!)
perception: processing sensation from touch/pressure/temp/pain
Wernicke’s area-understand received language: spoken & written
Occipital lobe (back: why a blow to back of the head often affects vision)
processing visual input from eyes
Temporal lobes (front either side:where your temples are located, a lot of old artefacts are stored (memory) and labelled (different things identified) in an old temple)
distinguishing different smells & sounds apart
visual & verbal memory (for words & names)
Cerebellum (bottom underneath, Latin for ‘little brain’)
controls smooth (involuntary) muscles like gut or maintaining balance
Brain stem (stick at bottom, joining onto spinal cord)