Recovery
“In fact, in my experience, the best outcome and recovery takes place when there is committed highly educated and skilled family member with strong positive attitude” — Dr. Ramsis F. Ghaly
Patient will remain in the hospital until no need for hospital care. Usually 1-2 days in the neuro-ICU, then regular neuro-ward. During hospitalization, frequent monitoring of all the vital signs include blood pressure (BP), respiration (RR), heart rate (HR), temperature and oxygen saturation (O2Sat). Total intake of fluid and output (Is and Os) are counted for, daily weight, complete physical and neurologic examination followed by limited examination directed for the area of interest. Hospitals developed various “protocols” to standardize, manage common medical problems and prevent common issues. These protocols may include tight stocking and pneumatic compression boots applied at the legs and subcutaneous heparin/ levonox to prevent deep venous thrombosis, laxatives to prevent constipation, O2 therapy to treat poor oxygenation “hypoxemia”, electrolyte protocols to treat low serum minerals like sodium, potassium and magnesium, insulin sliding scale to treat high blood sugar “above 120-150mg/l”, morphine or hydromorphine patient controlled analgesia to control pain.
Many other services called ancillary services that will care for the patient in entirety include physical therapy (extremity exercises and walking), occupational therapy (hands and daily activity tasks), speech therapy (cognitive function and swallow study), respiratory therapy (lung exercises and respiration), nutritionist (dietary consult), social worker, case manager, discharge planner, patient advocate and spiritual healer.
When patient is ready for discharge from the hospital arrangement will have been processed over the last days in the hospital and all recommendations with each physician name, address and contact information are written with prescriptions and physical recommendation with “follow –up plan of care”. A 24 hour/ 7 days a week supervision and care giver preferably by a close family member is highly recommended. In fact, in my experience, the best outcome and recovery takes place when there is committed highly educated and skilled family member with strong positive attitude. Instruction is given to the patient and what to look for, briefly fever, increase headache, numbness or tingling in the arms or legs, confusion, black out “syncope”, wound drainage, persistent nausea, vomiting, difficulty ambulation, difficulty urination, abdominal distension, persistent constipation, shortness of breath, chest pain, skin rashes or new symptoms or physical appearance of concerns. Notification to the physician and attendance to urgent care or emergency care center is recommended according to the condition.
Patient will then go to home with or without home health services. Home health services may include nursing, nursing aid, and other ancillary services and home equipment. Patient may not be ready to go home , then rehabilitation consult will be placed to go to “acute rehabilitation unit” if patient is able to participate at least in 3 hours daily, subacute rehabilitation, ventilator rehabilitation, nursing home according to the what the patient needs and insurance availability. The incision should be healed in two weeks and pain medications are being weaned off. Once stable, patient may attend outpatient physical and occupational therapy and allowed for gradual return to daily activity and graduation to work.
Patient will remain in the hospital until no need for hospital care. Usually 1-2 days in the neuro-ICU, then regular neuro-ward. During hospitalization, frequent monitoring of all the vital signs include blood pressure (BP), respiration (RR), heart rate (HR), temperature and oxygen saturation (O2Sat). Total intake of fluid and output (Is and Os) are counted for, daily weight, complete physical and neurologic examination followed by limited examination directed for the area of interest. Hospitals developed various “protocols” to standardize, manage common medical problems and prevent common issues. These protocols may include tight stocking and pneumatic compression boots applied at the legs and subcutaneous heparin/ levonox to prevent deep venous thrombosis, laxatives to prevent constipation, O2 therapy to treat poor oxygenation “hypoxemia”, electrolyte protocols to treat low serum minerals like sodium, potassium and magnesium, insulin sliding scale to treat high blood sugar “above 120-150mg/l”, morphine or hydromorphine patient controlled analgesia to control pain.
Many other services called ancillary services that will care for the patient in entirety include physical therapy (extremity exercises and walking), occupational therapy (hands and daily activity tasks), speech therapy (cognitive function and swallow study), respiratory therapy (lung exercises and respiration), nutritionist (dietary consult), social worker, case manager, discharge planner, patient advocate and spiritual healer.
When patient is ready for discharge from the hospital arrangement will have been processed over the last days in the hospital and all recommendations with each physician name, address and contact information are written with prescriptions and physical recommendation with “follow –up plan of care”. A 24 hour/ 7 days a week supervision and care giver preferably by a close family member is highly recommended. In fact, in my experience, the best outcome and recovery takes place when there is committed highly educated and skilled family member with strong positive attitude. Instruction is given to the patient and what to look for, briefly fever, increase headache, numbness or tingling in the arms or legs, confusion, black out “syncope”, wound drainage, persistent nausea, vomiting, difficulty ambulation, difficulty urination, abdominal distension, persistent constipation, shortness of breath, chest pain, skin rashes or new symptoms or physical appearance of concerns. Notification to the physician and attendance to urgent care or emergency care center is recommended according to the condition.
Patient will then go to home with or without home health services. Home health services may include nursing, nursing aid, and other ancillary services and home equipment. Patient may not be ready to go home , then rehabilitation consult will be placed to go to “acute rehabilitation unit” if patient is able to participate at least in 3 hours daily, subacute rehabilitation, ventilator rehabilitation, nursing home according to the what the patient needs and insurance availability. The incision should be healed in two weeks and pain medications are being weaned off. Once stable, patient may attend outpatient physical and occupational therapy and allowed for gradual return to daily activity and graduation to work.