What Are the Key Considerations for Nursing Care of Cerebral Infarction?

There are many details to pay attention to in the nursing of cerebral infarction. Some physical exercises can be done during the recovery period, but do not over-exercise to avoid high-intensity exercise. In addition, the daily diet should be low in cholesterol and high in protein, and avoid excessive intake of meat to facilitate digestion. It is also important to keep warm, maintain a relaxed mood, and avoid excessive emotional excitement, which may lead to recurrence of the disease.

Comprehensive treatment includes:

(1) Positioning and exercise: Most patients need to rest in bed after onset, and should start activities as soon as possible after the condition stabilizes.

(2) Nutrition and rehydration: All patients need to undergo a swallowing test to assess swallowing function. Most patients initially require intravenous fluid treatment, and if necessary, a nasogastric tube or nasoduodenal tube should be inserted to provide nutrition and medication. Percutaneous endoscopic gastrostomy (PEG) catheterization is commonly used for patients who need long-term feeding through a tube.

(3) Infection control and prevention: Pneumonia and urinary tract inflammation are common complications, and severe stroke patients may require prophylactic antibiotics.

(4) Deep vein thrombosis and pulmonary embolism: Approximately 10% of patients die from pulmonary embolism after stroke. The emboli of pulmonary embolism usually originate from venous thrombosis of the lower extremities. Patients who cannot move and elderly patients with severe stroke have the highest risk of developing deep venous thrombosis. Preventive measures include early mobilization, use of antithrombotic drugs, and the use of external compression devices. Low molecular weight heparin is the preferred subcutaneous injection, twice a day. Long-term treatment usually requires oral anticoagulants such as warfarin. Low-intensity anticoagulation can play a preventive role, but the specific anticoagulation level has not been determined.

Blood pressure management:

1) Principle: Elevated blood pressure is common in stroke patients. Most patients' blood pressure will decrease automatically within 4 to 10 days after onset. The management of blood pressure should be selected based on different stroke subtypes.

2) Management of hypertensive emergencies: Antihypertensive treatment should be used and blood pressure changes should be closely monitored in the following situations: hypertensive encephalopathy, hypertensive nephropathy, hypertensive heart failure/myocardial infarction, aortic dissection, preeclampsia, and cerebral hemorrhage with systolic blood pressure >180mmHg.

3) Blood pressure management for thrombolysis patients: Before thrombolysis, the patient's blood pressure should be ≤185/110mmHg. If this criterion cannot be achieved, thrombolysis cannot be performed. Within 24 hours after thrombolysis, the blood pressure should be maintained below 180/105mmHg.

4) Blood pressure management for general patients: Antihypertensive treatment should be given when the patient's blood pressure is >220/120mmHg, and the blood pressure should be reduced by 15% to 25% within the first 24 hours after onset. However, for patients suspected of hemodynamic stroke or bilateral carotid stenosis, the blood pressure should not be excessively reduced. If the stenosis of the large arteries has been resolved, it may be considered to gradually control the blood pressure to below the target value.