Hemorrhagic Stroke: Patient Care and End-of-Life Options

Q: Hemorrhagic Stroke: Patient Care and End-of-Life Options

Hello： The purpose of surgery for a hemorrhagic stroke in an 80-year-old patient is a significant consideration. <br>Have your family members thought about it? If you are unwilling to accept the possibility of paralysis and bed confinement, then the family must take on the respon

Cerebral hemorrhage stroke

Dear Doctor: The patient suffered a stroke due to a cerebral hemorrhage, resulting in complete paralysis on the left side.
It has been half a month since then, and the patient has been transferred from the intensive care unit to a general ward.
The patient's memory is sometimes clear and sometimes vague, and there are instances of self-talk.
Due to an inability to swallow, the patient is being fed via a nasogastric tube.
The attending physician does not recommend surgery for the patient, who is over 80 years old, and has explained that the patient's condition will only worsen, with almost no chance of recovery.
The family has already signed a do-not-resuscitate consent form.
I would like to ask the doctor: 1.
What does it mean that the condition will only worsen, and to what extent will it deteriorate? 2.
Given the patient's advanced age, the family is reluctant to see the patient bedridden and paralyzed.
What options do the family have to ensure the patient passes away peacefully and with dignity?

Didi, 60~69 year old female. Ask Date: 2014/09/03

Dr. Xie Bojun reply Neurosurgery

Hello: The purpose of surgery for a hemorrhagic stroke in an 80-year-old patient is a significant consideration.
Have your family members thought about it? If you are unwilling to accept the possibility of paralysis and bed confinement, then the family must take on the responsibility of maintaining the patient's daily living functions (such as nutrition, personal hygiene, etc.).
If the caregiver is unable to assist, this is what the physician means when they say the situation will only worsen.
As for how severe it will become, that is no longer a matter for discussion, as the patient is already at the end of life.
It is akin to the fact that one cannot stop or change the process of aging.
What you should be asking about is palliative care, rather than the issues that arise from not operating on the hemorrhagic stroke.

Reply Date: 2014/09/03

More Info

When dealing with a patient who has suffered a hemorrhagic stroke, especially in the context of end-of-life care, it is crucial to approach the situation with compassion and a clear understanding of the medical implications. In this case, the patient, who is over 80 years old, has experienced significant neurological deficits, including left-sided paralysis and difficulty swallowing, which necessitates feeding through a nasogastric tube. The attending physician has indicated that surgical intervention is not advisable due to the patient's age and deteriorating condition, leading to a situation where the family has signed a do-not-resuscitate (DNR) order.

1. Understanding the Prognosis: The phrase "the condition will only worsen" typically refers to the progressive nature of neurological decline following a hemorrhagic stroke. In elderly patients, especially those with significant comorbidities, the likelihood of recovery diminishes. The deterioration can manifest in various ways, including increased dependence on caregivers, potential development of pressure ulcers, aspiration pneumonia due to swallowing difficulties, and ultimately, multi-organ failure. The timeline for this progression can vary widely, but in many cases, patients may experience a gradual decline over weeks to months, depending on their overall health status and the extent of the brain injury.
2. Facilitating a Peaceful and Dignified Passing: For families grappling with the emotional weight of a loved one’s impending death, it is essential to focus on palliative care measures that prioritize comfort and dignity. Here are several strategies that can be employed:
- Palliative Care Consultation: Engaging a palliative care team can provide specialized support in managing symptoms such as pain, anxiety, and agitation. This team can also assist in navigating difficult conversations about end-of-life care and help ensure that the patient’s wishes are respected.

- Creating a Comfortable Environment: Ensuring that the patient is in a peaceful and familiar setting can greatly enhance their comfort. This may involve arranging the room with personal items, playing soothing music, or ensuring that family members can be present.

- Managing Symptoms: Medications may be prescribed to alleviate discomfort, anxiety, or agitation. This includes pain management and medications to help with any distressing symptoms the patient may experience as they approach the end of life.

- Emotional and Spiritual Support: Providing emotional support to both the patient and family members is crucial. This can include counseling services, support groups, or spiritual care from clergy or chaplains, depending on the family's beliefs and preferences.

- Open Communication: Encouraging open dialogue among family members about their feelings, fears, and wishes can foster a supportive environment. It’s also important to communicate with healthcare providers about the patient’s condition and care preferences.

- Advance Directives: If not already in place, discussing advance directives with the family can clarify the patient’s wishes regarding end-of-life care, ensuring that their preferences are honored.

In conclusion, the journey through end-of-life care for a patient with a hemorrhagic stroke is fraught with emotional and ethical complexities. It is essential to prioritize the patient’s comfort and dignity while providing support to the family during this challenging time. Engaging with healthcare professionals who specialize in palliative care can significantly enhance the quality of care and support provided to both the patient and their loved ones.

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