After a Stroke: The First Days to Weeks

Quick summary

After your parent moves from the ER to the hospital, doctors will deal with any complications and help prevent future strokes. Here's what to expect during your parent's hospital stay, and how to prepare for his care and recovery after he gets out.

From ER to hospital bed: The inpatient period

Once your parent's stroke has been evaluated and his condition has been stabilized, he'll be transferred out of the ER and into a hospital bed. How long your parent spends in the hospital depends on a number of factors, including the type and severity of his stroke, what medical complications arise, and the extent of his disability. But it's unlikely that he'll be in the hospital for long. According to the National Center for Health Statistics, the average length of hospitalization for stroke in 2005 was 5.2 days.

What you can expect after a stroke

Even though your parent is out of the ER, serious complications may still arise. An estimated one out of five stroke patients dies during his hospital stay.

Your parent's treatment team has two main goals: To prevent another stroke from occurring and to minimize and respond to any complications.

To this end, your parent will undergo more testing to determine the cause of this stroke. Although the doctors should know what type of stroke your parent had, they'll still need to pinpoint the exact cause. They may perform one or more of the following tests:

• Carotid ultrasound to determine if either carotid artery is narrowed or blocked. This test is noninvasive and painless: A technician applies jelly to your parent's neck, then slides an ultrasound wand over the skin covering his carotid artery.

• Transcranial Doppler test for blockages in the large brain arteries. This test is similar to the carotid ultrasound, although the sound waves go through your parent's skull instead of his neck.

• Cerebral angiogram to look for atherosclerosis or a brain aneurysm. Your parent will be sedated to minimize his anxiety and discomfort during this procedure. A long, thin catheter, or tube, is inserted into a large artery in his groin, then maneuvered all the way through blood vessels into his chest. Once the tube reaches your parent's carotid artery, dye is injected, which travels through the artery into the brain. Then a series of X-rays is taken to spot any abnormalities in the blood vessels of the brain. Because this procedure carries a slight risk of causing another stroke, it will be performed only if other tests are inconclusive.

Treatment to prevent future strokes.

Depending on your parent's test results, his doctors will treat him to reduce his risk of having another stroke:

• For an ischemic stroke, your parent may be given anticlotting drugs, have a procedure known as a carotid endarectomy, or both.

• For a hemorrhagic stroke, your parent may need to have a torn brain artery or aneurysm repaired, both of which require major surgery.

• No matter what type of stroke your parent had, risk factors such as high blood pressure, high cholesterol, and diabetes will be evaluated and treated.

Monitoring for stroke complications.

Complications could include brain swelling, seizures, clots in his legs, aspiration due to difficulty swallowing, arrhythmias, bleeding stomach ulcers, and pressure sores. Your parent's doctors will be on the lookout for these serious and potentially fatal complications.

What you can do to help

Your parent's hospital stay may be even more stressful for you than his stroke and time in the ER. Now that you're no longer in crisis mode, you have more time to think -- and worry -- about the future. But try to use that time to prepare for life after your parent's discharge instead:

• Figure out how much care your parent will need. The extent of your parent's stroke-related disability may not be immediately obvious, but it will become clearer as his recovery progresses. Talk to his rehabilitation team about how much care he'll need immediately after discharge, then discuss options for his care with your family. Will he be able to return to his own home or to a family member's home? Or will he need more short-term or long-term attention and care? For more information about this decision-making process, see How Much Care Will Your Parent Need After a Stroke?

• Make necessary changes to your or your parent's home. If it looks like your parent might be able to return to his or another family member's home, this is the time to start making that home more comfortable and accessible. To get started, see Making Your Parent's Home Safer After a Stroke.

• Gather your resources. No matter what the outcome, you're going to need all the help and support you can get during your parent's stroke recovery period. The Family Caregiver Alliance is one resource to investigate, and family and friends will probably be willing to help. Don't hesitate to gratefully accept their assistance.

• Learn as much as you can from the hospital staff. Believe it or not, your parent's hospital stay is likely to be over before you know it. While he's there, ask questions and make the most of the resources available. Nurses can help train you with such things as performing wheelchair transfers, dealing with bowel or bladder incontinence, and avoiding pressure sores. A nutritionist can help you plan for any special dietary needs, especially if your parent has difficulty swallowing. Don't be afraid to ask for help -- that's what the hospital staff is there for.

• Try to be patient. It can be very upsetting to see your parent in the throes of poststroke complications, and he may actually get worse before he gets better. His brain may need time to recover from circulation problems or swelling before the extent of his disability -- or his lack thereof -- will become clear. In other words, you may not be able to see any improvement at this point, but that doesn't mean things aren't going to get better. Stay positive.

• Focus on recovery. Although it may not seem that way, your parent's stroke recovery begins in the hospital. Most spontaneous recovery actually occurs during the first days to weeks after a stroke. Your parent should begin working with the hospital rehabilitation team as soon as he's stable. Your encouragement and support will be especially important as he begins the difficult work of recovery.