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Stroke powerpoint

Transcript: Stroke M&G orientation program for fresh graduates ASU 12A RN Ida Wong RN Mandy Lam 27/04/2021 Introduction of stroke and stroke team Introduction of stroke ~87% Introduction of stroke ~13% WHO Definition: rapid developing of clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin (WHO, 1980). 1. Ischemic Stroke 2. Hemorrhagic Stroke (American Stroke Association, 2021) warning sign of stroke! ASU service Journey of a stroke patient Hyperacute Acute Rehabilitation Community service - ICDS - Nurse-led clinic - GDH, community day care centre - Home care service - Transport support service - Respite care ASU team - 12A: mixed ward with 16 ASU beds (Officially 2 tPA beds) - Multidisciplinary approach - Weekly case conference - Protoccol-driven workflow and guideline (O et al., 2020) Neurological observation Neurological observation Best motor response Glasgow Coma Scale (GCS) Eyes opening * If eyes closed due to severe swelling, record "C" Pain stimuli Peripheral Central Apply to core of body Apply to extremities Tends to give a spinal reflex Better in assessing eyes opening To assess the cortex Better in assessing motor response Ask questions 1. Name 2. Time 3. Place 4. People Best verbal response * Score "T" when patient is on endotracheal tube or tracheostomy Flexion withdrawal (M4) - no purposeful movement to remove stimuli - without rotating the wrist - no stiffness associated with the movement Flexion response (M3) - slow movement - elbow flexes rigidly - wrists rotate in a spastic-type posture - legs are not assessed for 'flexing' as bending the knees and flexing are indistinguishable (Braine & Cook, 2016) (Royal College of Physicians and Surgeons of Glasgow, 2021) Click to edit text Click to edit text All motor responses - Testing CNIII - Use of penlight torch, avoid using LED light - Shine the pupil at a direction - Record pupil sizes before stimuli - Equality and reactivity Pupillary response (Braine & Cook, 2016) (Royal College of Physicians and Surgeons of Glasgow, 2021) Atypical/Abnormal pupils Limb Power Left Right Upper limb Upper limb Lower limb Lower limb (Florence et al., 1992) Swallowing test Swallowing Test Techniques Pre-assessment Indications: - Etiologies which would impair swallow - Decreased level of consciousness - Apparent signs or complaints in swallowing difficulty - Known history of dysphagia - Apparent signs of aspiration (Martino et al., 2013) Why need nursing swallowing assessment? - Non-invasive - Not possible to perform instrumental examination on every patient with suspected dysphagia Clinical observation before the test: - Poor conscious level - Presence of tracheostomy - Difficulty in managing oral secretions (e.g choking of saliva/severe drooling) - Moist, wet, gurgly voice quality - Follow commands? Co-operative? Either one observed: -Keep NPO and refer ST!! Pre-assessment: 1. Check oral cavity (unfit dentures?) 2. Ask patient to stick out the tongue (any deviation?) 3. Ask patient to open mouth, say "ah" (use penlight to check palate and uvula) 4. Ask patient to swallow saliva first Preparation Tools: Position: - Stand on patient's dominant side - Patient sitting upright with head support, with SpO2 monitoring Implementation: Part A: Feed patient 5ml of water into patient's oral cavity by teaspoon for 3 times Part B: Sip from a cup in 10ml portion, for 3 trials Continuous observe for 2 more minutes to see any choking or desaturation for problematic clinical signs for NO problematic clinical signs * If any shaded items , stop the test immediately, withhold feeding, inform doctor and refer ST. * If pass the test, start with puree diet first. *Once ST orders diet, only ST can change the diet order. (American Association of Neuroscience Nurses, 2017) Limitations Evaluation - NO straw or feeding syringe use unless ST prescribes - Avoid dry foods, sticky foods, foods of mixed consistencies *The degree of swallowing impairment fluctuates after stroke. Ongoing assessment is needed for poststroke dysphagia (Fedder, 2017). - Cannot detect silent aspiration - Results only tell patient's tolerance on thin liquids Precautions Complications prevention Complications prevention -Hinder recovery -Associated with poorer outcomes independent of stroke severity and age - Arise within the first few weeks of stroke, i.e. during hospital and rehab stays - PREVENTABLE!! Head-to-toe assessment Head-to-toe assessment Dehydration Dehydration -Dysphagia after stroke episode - Change of food texture, limitation in limb mobility and swallowing ability will result in decrease fluid intake - Increases risk of venous thromboembolism Nursing Intervention 1. Monitor urine output 2. Administer IV fluid (0.9%NS) 3. Fluid round (also implemented in 12A) Pneumonia Pneumonia - The most common cause of fever within first 48 hours after acute stroke -Failed to manage oral secretion, Fall

Brush Stroke of Genius

Transcript: Caillebotte, G. (1893). Chrysanthemums in the Garden at Petit-Gennevilliers [oil on canvas; 98 x 59.8 cm]. Retrieved from In K. McLeish (Ed.), Bloomsbury guide to human thought. London, United Kingdom: Bloomsbury. Retrieved from Daubigny, C. (1852). Attic [oil on canvas; 57.8 x 92.7 cm]. Retrieved from Kleiner, F.S. (2014). Gardner’s art through the ages: The Western perspective (14th ed., Vol. II, p. 689-697). Boston, MA: Wadsworth, Cengage Learning. References (Continued): By: Jules Bastien-Lepage The artists at the time were more concerned with the use of light and dark, in place of great detail, which was the style from the movement that preceded Impressionism. To put it plainly, Impressionism artists, "painted everyday subjects, they avoided the vulgar and ugly, seeking visual realism by extraordinary stylistic means." [Impressionism, in painting. (2015). In Columbia University and P. Lagasse, The Columbia Encyclopedia. New York, NY: Columbia University Press. Retrieved from In this piece, "Circus Sideshow (Parade de Cirque), by Georges Seurat, a use of pointilism is employed to aid with the Impressionism style. Up close the use of dark points/dots next to lighter points/dots creates the imagery that the subject of the piece is taking place in the evening. Seurat uses darker tones to show a later poiint in the day, as well as displaying lights to show it may be darker and harder to see in natural light. Additionally, the pointilism is used to create gradations when viewed both up close and from afar. Because of the points, the transitions from lights to darks look more seamless, the further a viewer is from the work. Degas, E. (1873). A Woman Ironing [oil on canvas; 54.3 x 39.4 cm]. Retrieved from By: Vincent van Gogh Circus Sideshow (Parade de Cirque) By: Gustave Caillebotte The piece, "Joan of Arc," by Jules Bastien-Lepage, is a good example of impressionism coupled with intricate detail. Even though this was not a technique that was synonymous with the Impressionism movement, it lends itself well to supply contrast and a clear foreground and background to the piece. Because Joan of Arc is very detailed, the eye is instantly drawn to her first. Also because the background is a loose impressionistic brush stroke style, the details of Joan are more pronounced. With the detail in the foreground, it almost creates a feel of a photograph, where the focus is up front, and as a result the back ground is somewhat blurred slightly in order to give way to the forefront imagery. The drastic use of light and dark on the landscape creates a very detailed area, when viewed from a distance. Impressionism. (2014). In The Hutchinson unabridged encyclopedia with atlas and weather guide. Abington, United Kingdom: Helicon. Retrieved from "The Hamlet of Optevoz," by Charles-Francois Daubigny, is easily one of my favorite pieces of Impressionism art. I have stared and analyzed this for probably an hour straight, and I still pick up new details and nuances everytime I see it. Again, up close, the painting keeps consistent with the style that goes with Impressionism, but as you pull away from the piece, more details emerge. Once far enough away the piece begins to take on a feel of photo-realistic. Once again, the artist uses light and dark to create depth and contrast between shapes and images in the painting. The slight use of light at the top of the trees creates a feel of sunset, or sunrise in the town. Finally, the water, and the reflection is loose when up close, but further out creates a near perfect mirror of the landscape that is above it. This gives the eye a focal point, which is the house in the middle and draws the eye out and onto the rest of the work. This piece, by Edgar Degas, is a prime example of the loose style used by artists in this movement. a viewer has trouble pulling out detail on the painting, with the exception of the large subjects, such as the woman, table and window. But as a viewer takes in the piece with more distance, more details become apparent. These details include the iron in her hand, the clothing hanging by the wall, and the bowl sitting on the table. It also displays Impressionism by the stroke style. Upon observation of the piece, the brush stroke is visible and give the entire work depth and perspective. By: Edgar Degas Caillebotte, G. (1893). Chrysanthemums in the Garden at Petit-Gennevilliers [oil on canvas; 98 x 59.8 cm]. Retrieved from

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