Stroke - discharge
Cerebrovascular disease - discharge; CVA - discharge; Cerebral infarction - discharge; Cerebral hemorrhage - discharge; Ischemic stroke - discharge; Stroke - ischemic - discharge; Stroke secondary to atrial fibrillation - discharge; Cardioembolic stroke - discharge; Brain bleeding - discharge; Brain hemorrhage - discharge; Stroke - hemorrhagic - discharge; Hemorrhagic cerebrovascular disease - discharge; Cerebrovascular accident - discharge
You were in the hospital after having a stroke. Stroke happens when blood flow to part of the brain stops.
At home follow your health care provider's instructions on self-care. Use the information below as a reminder.
When blood flow to an area of your brain stops, it's serious. It's called a stroke, and will often cause permanent, debilitating damage to your brain and change your life. Let's talk about strokes. If blood flow to your brain is stopped for longer than a few seconds, your brain can't get blood and oxygen. Brain cells die, causing permanent damage. There are two types, ischemic stroke and hemorrhagic stroke. Ischemic stroke happens when a blood clot forms in a very small artery, or when a blood clot breaks off from another artery and lodges in your brain. Hemorrhagic strokes can happen when a blood vessel in your brain becomes weak and bursts open. High blood pressure is the number one risk factor for strokes. People with atrial fibrillation, when your heart rhythm is fast and irregular, diabetes, a family history of stroke, and high cholesterol are most at risk. You are also at risk for stroke if you are older than age 55. Other risk factors include being overweight, drinking too much alcohol, eating too much salt, and smoking. Symptoms of a stroke usually develop suddenly, without warning. You may have a severe headache that starts suddenly, especially when you are lying flat, often when you awake from sleep. Your alertness may suddenly change. You may notice changes in your hearing, your sense of taste, and your sense of touch. You may feel clumsy or confused or have trouble swallowing or writing. So, how are strokes treated? A stroke is a medical emergency. Immediate treatment might save your life and reduce disability. Call your local emergency number -- or have someone call for you -- at the first sign of a stroke. Most of the time, someone having a stroke should be in the hospital within three hours after symptoms first begin. If a doctor suspects you've had a stroke, the doctor will check for problems with your vision, movement, feeling, reflexes, and your ability to understand and speak. You may have several tests to check for blocked or narrowed arteries. If the stroke is caused by a blood clot, you'll be given a clot-busting drug to dissolve the clot. Treatment depends on how bad your stroke is and what caused it. But you will probably need to stay in the hospital for a few days. Besides clot-busting drugs, called thrombolytics, you may need blood thinners, medicine to control high blood pressure, and surgery to unclog one of your carotid arteries-which carry blood to the brain. After your stroke, treatment will focus on helping you recover as much function as possible, and preventing future strokes. Most people need stroke rehabilitation therapy. If you can return home, you may need help making safety changes in your home and to help you with using the bathroom, cooking, dressing, and moving around your home. After a stroke, some people have trouble speaking or communicating with others, and a speech therapist might help. Depending on the severity of the stroke, you may have trouble with thinking and memory, problems with your muscles, joints, and nerves, trouble going to the bathroom, and difficulty swallowing and eating. Therapies and support for you and your family are available to help with each of these problems. Your treatment will also focus on preventing another stroke. You may need to be on several medications to help prevent this. And, eating healthy and controlling problems like diabetes and high blood pressure can be very important.
When You're in the Hospital
First, you received treatment to prevent further damage to the brain, and to help the heart, lungs, and other important organs heal.
After you were stable, doctors did testing and started treatment to help you recover from the stroke and prevent a future stroke. You may have stayed in a special unit that helps people recover after a stroke.
What to Expect at Home
Because of possible injury to the brain from the stroke, you may notice problems with:
- Changes in behavior
- Doing easy tasks
- Moving one side of the body
- Muscle spasms
- Paying attention
- Sensation or awareness of one part of the body
- Talking or understanding others
- Seeing to one side (hemianopia)
You may need help with daily activities you used to do alone before the stroke.
Depression after a stroke is fairly common as you learn to live with the changes. It may develop soon after the stroke or up to 2 years after the stroke.
DO NOT drive your car without your doctor's permission.
Moving around and doing normal tasks may be hard after a stroke.
Make sure your home is safe. Ask your doctor, therapist, or nurse about making changes in your home to make it easier to do everyday activities.
Family and caregivers may need to help with:
- Exercises to keep your elbows, shoulders, and other joints loose
- Watching for joint tightening (contractures)
- Making sure splints are used in the correct way
- Making sure arms and legs are in a good position when sitting or lying
If you or your loved one is using a wheelchair, follow-up visits to make sure it fits well are important to prevent skin ulcers.
- Check every day for pressure sores at the heels, ankles, knees, hips, tailbone, and elbows.
- Change positions in the wheelchair several times per hour during the day to prevent pressure ulcers.
- If you have problems with spasticity, learn what makes it worse. You or your caregiver can learn exercises to keep your muscles lose.
- Learn how to prevent pressure ulcers.
Thinking and Speaking
Tips for making clothing easier to put on and take off are:
- Velcro is much easier than buttons and zippers. All buttons and zippers should be on the front of a piece of the clothing.
- Use pullover clothes and slip-on shoes.
People who have had a stroke may have speech or language problems. Tips for family and caregivers to improve communication include:
- Keep distractions and noise down. Keep your voice lower. Move to a quieter room. DO NOT shout.
- Allow plenty of time for the person to answer questions and understand instructions. After a stroke, it takes longer to process what has been said.
- Use simple words and sentences, speak slowly. Ask questions in a way that can be answered with a yes or no. When possible, give clear choices. DO NOT give too many options.
- Break down instructions into small and simple steps.
- Repeat if needed. Use familiar names and places. Announce when you are going to change the subject.
- Make eye contact before touching or speaking if possible.
- Use props or visual prompts when possible. DO NOT give too many options. You may be able to use pointing or hand gestures or drawings. Use an electronic device, such as a tablet computer or cell phone, to show pictures to help with communication.
Nerves that help the bowels work smoothly can be damaged after a stroke. Have a routine. Once you find a bowel routine that works, stick to it:
- Pick a regular time, such as after a meal or a warm bath, to try to have a bowel movement.
- Be patient. It may take 15 to 45 minutes to have bowel movements.
- Try gently rubbing your stomach to help stool move through your colon.
- Drink more fluids.
- Stay active or become more active as much as possible.
- Eat foods with lots of fiber.
Ask your provider about medicines you are taking that may cause constipation (such as medicines for depression, pain, bladder control, and muscle spasms).
Tips for Taking Medicines
Have all of your prescriptions filled before you go home. It is very important that you take your medicines the way your provider told you to. DO NOT take any other drugs, supplements, vitamins, or herbs without asking your provider about them first.
You may be given one or more of the following medicines. These are meant to control your blood pressure or cholesterol, and to keep your blood from clotting. They may help prevent another stroke:
- Antiplatelet medicines (aspirin or clopidogrel) help keep your blood from clotting.
- Beta blockers, diuretics (water pills), and ACE inhibitor medicines control your blood pressure and protect your heart.
- Statins lower your cholesterol.
- If you have diabetes, control your blood sugar at the level your provider recommends.
DO NOT stop taking any of these medicines.
If you are taking a blood thinner, such as warfarin (Coumadin), you may need to have extra blood tests done.
If you have problems with swallowing, you must learn to follow a special diet that makes eating safer. The signs of swallowing problems are choking or coughing when eating. Learn tips to make feeding and swallowing easier and safer.
Avoid salty and fatty foods and stay away from fast food restaurants to make your heart and blood vessels healthier.
Limit how much alcohol you drink to a maximum of 1 drink a day if you are a woman and 2 drinks a day if you are a man. Ask your provider if it is OK for you to drink alcohol.
Keep up to date with your vaccinations. Get a flu shot every year. Ask your doctor if you need a pneumonia shot.
DO NOT smoke. Ask your provider for help quitting if you need to. DO NOT let anybody smoke in your home.
Try to stay away from stressful situations. If you feel stressed all the time or feel very sad, talk with your provider.
If you feel sad or depressed at times, talk to family or friends about this. Ask your provider about seeking professional help.
When to Call the Doctor
Call your provider if you have:
- Problems taking drugs for muscle spasms
- Problems moving your joints (joint contracture)
- Problems moving around or getting out of your bed or chair
- Skin sores or redness
- Pain that is becoming worse
- Recent falls
- Choking or coughing when eating
- Signs of a bladder infection (fever, burning when you urinate, or frequent urination)
Call 911 or the local emergency number if the following symptoms develop suddenly or are new:
- Numbness or weakness of the face, arm, or leg
- Blurry or decreased vision
- Not able to speak or understand
- Dizziness, loss of balance, or falling
- Severe headache
Dobkin BH. Rehabilitation and recovery of the patient with stroke. In: Grotta JC, Albers GW, Broderick JP, et al, eds. Stroke: Pathophysiology, Diagnosis, and Management. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 58.
Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160-2236. PMID: 24788967
National Institutes of Health. National Institute of Neurological Disorders and Stroke website. Post-stroke rehabilitation fact sheet.
Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98-e169. PMID: 27145936
Last reviewed on: 7/29/2018
Reviewed by: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist & Assistant Professor of Clinical Neurology, Stony Brook University School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 03/26/2020.