Which safety measures would the nurse implement for a patient immediately after a right brain stroke

The largest portion of the brain — the cerebral cortex — has two halves (hemispheres). The right hemisphere of the brain controls cognition (thinking), emotions, and spatial orientation (sense of body position). The left hemisphere of the brain controls a person’s expressive language skills (ability to talk) and receptive language skills (ability to understand what others are saying).

Right-brain stroke and communication difficulties

Right-brain communication difficulties may be hard to notice at first. These difficulties can include poor attention and decreased perception. A right-brain stroke survivor may have a hard time with processing information (visual and verbal) and decreased cognitive (thinking) skills such as poor judgment, short attention span, and short-term memory loss.

Caregivers can take steps to help stroke survivors deal with limitations of right-brain injury, once their limitations are recognized. The following are some tips:

• Keep a safe environment. All items that have the potential to be dangerous (like poisons, cleaning chemicals, and sharp objects) should be kept in a secured place.
• Encourage the stroke survivor to fully scan (turn their head from side to side to see) their surroundings to compensate for any loss in their field of vision or left-side neglect.
• Acknowledge the affected part of their body as still part of the stroke survivor.
• Offer help, and encourage the stroke survivor to accept help when offered.
• Be sensitive to the stroke survivor’s visual and sensory difficulties. For instance, place items the person may need to their right side if they have trouble seeing or sensing things on their left side.
• Minimize environmental clutter and distractions. Too much visual or auditory (sound) stimulation in the environment may be dangerous and may be confusing. Calm and quiet surroundings can help a person focus on a given task.
• Help prevent injuries that may result from an inability to determine depth and distance.
• Make sure that pointed edges on things such as furniture and doorways are clearly marked or protected.

Stroke survivors with right-brain injuries frequently have speech and communication problems. Many of these individuals have a hard time pronouncing speech sounds properly because of the weakness or lack of control in the muscles on the left side of the mouth and face. This is called “dysarthria.”

Left-brain stroke and communication difficulties

Left-brain stroke survivors may experience communication problems and paralysis (loss of use) on the right side. Communication problems can affect the survivor’s receptive abilities (understanding) or expressive abilities (getting the words out). This is referred to as “aphasia.” They may also have slurred speech from the right sided face and/or mouth weakness which is referred to as “dysarthria.”

When communicating with a stroke survivor who has communication problems (aphasia), it is helpful to:

• Be patient.
• Eliminate distractions. Turn off the TV, limit extraneous noise.
• Keep the questions simple, so that the survivor may reply using yes or no.
• Keep commands and directions simple.
• Speak in a normal voice at normal loudness.
• Allow the person time to process the information, as well as form a response to questions or commands.
• Do not rush the survivor to answer your questions or comments.
• Resist the temptation to answer questions for him or her.

Stroke survivors may have difficulty with their communication skills following a stroke. Communication problems can be classified into two basic categories: aphasia and motor speech disorders.

Aphasia

Simply defined, aphasia is the loss of ability to communicate normally resulting from damage, typically to the left side of the brain, which houses the communication center.

The condition can affect a person's ability to understand what is being said to them or asked of them (auditory comprehension).

Aphasia may also affect the ability to read, write, and deal with numbers. Your speech pathologist can provide you with additional information on aphasia and motor speech disorders.

Motor speech disorders

Some stroke survivors may have slurred or garbled speech as a result of muscle weakness (dysarthria) or difficulty with motor programming and coordination of the speech muscles (apraxia).

A speech-language pathologist may be asked to assess the patient’s communication skills and discuss with the family ways to help improve communication with the stroke survivor. The speech-language pathologist will also recommend any further follow-up after discharge from the hospital.

Additional information regarding aphasia can also be obtained from the following websites:

• American Speech-Language Hearing Association (ASHA)
• American Stroke Association

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