Proper control of risk factors, coupled with recommendations for lifestyle changes, can prevent up to 90% of stroke cases. These elements, together with the pharmacological treatments prescribed by the specialist, can also reduce the risk of recurrence and first episodes of other cardiovascular diseases with common risk factors.

These measures also benefit other aspects of health if followed in your daily life.

Modifiable risk factors

• Proper monitoring of tension lowers the chances of suffering a stroke and other cardiovascular diseases. Hypertension is, in fact, the main risk factor for stroke after age (it is estimated to be the cause in between 25 and 50% of cases).
• Follow a healthy diet, limiting salt and fats, processed meats, and industrial pastries. The Mediterranean diet is a good choice because, as well as being balanced and providing the necessary nutrients, it has a low content of saturated fatty acids, is rich in antioxidants and reduces the possibility of obesity, bad cholesterol (a risk factor for stroke) and diabetes. It is also advisable to eat fish, legumes, fibre, fruit and vegetables on a regular basis.
• Doing sport on a regular basis helps avoid obesity and diabetes and prevents cardiovascular disease. Everyone is advised, where possible, to do 30-60 minutes of moderate (walking quickly) or intense (running) aerobic physical exercise five days a week.
• Proper monitoring and treatment of diseases such as diabetes may decrease the risk of stroke and other vascular diseases. While chronic microvascular complications involved in diabetes (retinopathy, nephropathy, and neuropathy) are associated with poor long-term glycaemic control, macrovascular complications (ischemic heart disease and stroke) are determined mainly by other cardiovascular risk factors. We also need to monitor weight and obesity, which promotes high blood pressure, dyslipidaemia and diabetes.
• Nicotine causes cholesterol plaques in the arteries and can cause them to clog, so it is recommended to give up smoking.
• Excessive alcohol consumption is also harmful: it causes hypertension and cardiovascular disease. This is why you are also advised to limit alcoholic beverages.
• Controlling heart disease, specifically atrial fibrillation: changes in heart rate, as is the case in atrial fibrillation, may cause thromboembolism in the brain (a type of stroke) or in other organs.
• Take your pulse is a campaign run by the Department for Health of the Generalitat de Catalunya, la Fundació Ictus (Stroke Foundation) and the Consell de Col·legis de Farmacèutics de Catalunya (Council of Associations of Pharmacists of Catalonia). If you feel strong, rapid palpitations without having done any previous physical activity, you are recommended to go to the doctor.

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What do you need to bear in mind if you have shingles?

One measure to prevent the appearance of new cases of this virus among people living near a sufferer is the disinfection of objects contaminated with nasopharyngeal secretions or skin lesions in patients with chicken pox. It is therefore important to wash your hands before and after coming into contact with infected people or objects.

To improve the itching and discomfort of this virus, apply:

• Cold and wet compresses on the affected skin
• Soothing ointments and lotions, such as colloidal oat creams.

It is easy for people with shingles to pass it on to others, so when skin wounds are open and pussy avoid any contact with people who have not had chicken pox, especially pregnant women, new born babies and immunodeficient people.

What do you need to bear in mind if you have flu or you are caring for someone who does?

Flu is transmitted easily in three different ways:

• By small drops released when coughing or sneezing (airborne).
• Through skin or oral contact with people who have flu.
• By touching or sharing utensils (cutlery, glasses, etc.) and other objects that have not been cleaned properly.

There are a series of hygiene measures that help to prevent flu:

• Cover your mouth and nose with a disposable tissue when coughing or sneezing, and then throw it away.
• It is essential to wash your hands regularly with water and soap for 15-30 seconds and to dry them properly (especially after touching shared surfaces such as handrails, door handles, computer keyboards and mice, telephones, supports on public transport and after sneezing and blowing your nose), or with alcohol solutions by rubbing your hands for 15-30 seconds.
• Enclosed spaces should be kept ventilated.
• Avoid close contact with people who have flu and do not share food or utensils with them (such as cutlery, glasses, serviettes and napkins) or other objects without cleaning them properly.
• If you get symptoms of flu or the doctor has diagnosed you with the illness, you should make sure not to share enclosed spaces with people for the first 3-5 days, especially people who are ill in hospital and community care workers.

What do you need to bear in mind if you have multiple sclerosis or you are caring for someone who does?

Current evidence is insufficient to give advice on preventing multiple sclerosis. It is, however, advised that your have a healthy lifestyle and carry out activities as normal. Multiple sclerosis affects women more than men, often appears in young adults and is the second biggest cause of non-traumatic disability.

When agreeing with the patient to start them on a drug to treat symptoms or multiple sclerosis itself:

• They should be given very specific education about the action of the medication, the possible side effects, as well as how to administer and store it in order to guarantee that the treatment plan is followed and stuck to.
• Although the establishment of background treatment as soon as possible allows good control of the evolution of the illness, sometimes outbreaks sometimes occur that need to be assessed and, where required, treated at a day hospital for three days, completing the appropriate follow-up to check recovery.

Symptoms

The symptoms of multiple sclerosis can vary greatly, so you are advised to consult specialists when you feel:

• Fatigue. If it appears, it is a good idea to plan moments of activity with moments of rest.
• Sensitivity to temperature changes.You are advised to avoid extreme temperatures and, if you get a fever, lower it as soon as possible.

Although there is no scientific evidence that allows us to make concrete recommendations to prevent or change the course of the illness, there is a whole host of advice about diet, habits and physical exercise that patients and, in general, the entire population, should bear in mind:

• You need to have a healthy lifestyle.
• You should have a balanced and varied diet.
• Exercise.
• Do not smoke, as tobacco is associated with worsening in the progression of the illness.

You are also advised, should you suffer fatigue, to continue daily activity and stay active, combining moments of activity with moments of relaxation as well as to seek energy-saving strategies.

Vitamin D has an important role to play in relation to the illness, which is being researched intensively. Often, people affected present a deficiency of this vitamin, so you are advised to take a supplement under instructions and supervision by your specialist.

Multiple sclerosis is a complex and chronic illness, so it is recommended that those around the person affected are given adequate and comprehensive information. It is also a good idea to have access to ongoing advice whenever necessary.

The family or professional carer, where necessary, may need training and practical advice on topics such as diet, hygiene and the patient’s mobility.

Other related health information

Health education in the diagnosis, at the beginning of the treatment and for the mobilisation of the disabled patient.

What do you need to bear in mind if you have ampullary epidermolysis or you are caring for someone who does?

The best thing is if the patients, their families and their caregivers receive comprehensive health education, especially when they are first diagnosed, during the baby’s first few days, when skin lesions can already begin to occur.

The education aimed at preventing the evolution and complications of the disease will be given by professionals from the following disciplines:

• Dermatology
• Plastic surgery
• Nutrition
• Paediatrics
• Rehabilitation and occupational therapy
• Community and hospital nursing
• Psychiatry
• Psychology

Skin affected by ampullary epidermolysis is very sensitive to the slightest pressure or friction, which then causes a blister to form. To avoid damage, bear in mind the following recommendations:

• Do not apply any adhesive products to the skin, such as plasters, stitches, electrodes, adhesive dressings, etc.
• Intravenous channels should be attached using gauze and cohesive bandage on top, without touching the skin, or with a silicone plaster. If pressure needs to be applied, Vaseline should be placed on the pressure point.
• The patient should always be lifted with open hands, without causing any friction or pressure.
• Their surroundings should be protected, adding cushions and pillows to avoid unnecessary blows.
• A water mattress may be used with a foam, latex or memory foam support.
• Nappies should not be too tight, and the skin should be protected from fiction using gauze or cotton.
• Clothes should preferably be cotton, as it breathes more easily and is easier to put on. Avoid rubber, zips, labels and other details that may rub the skin. Seams should be put on inside out.
• The skin should be protected from sunlight and keep an eye out for spots and freckles.
• Keep the skin as hydrated as possible.

Other related health information

• Treatment of injuries (dressings and healing materials)
• Treatment of skin complications
• Treatment and decontamination
• Treatment of nutritional and gastrointestinal complications
• Treatment of pain
• Infection control
• Rehabilitation treatment

What do you need to bear in mind if you have amyotrophic lateral sclerosis or you are caring for someone who does?

In order to improve the respiratory difficulties in patients, ventilation therapy can be used through non-invasive ventilation.

Ventilation therapy refers to breathing support using a ventilator, usually at night during sleep, to achieve:

• A decrease in respiratory effort (feeling of fatigue)
• Improved quality of life for patients with ALS

Ventilation is carried out non-invasively, by means of a patient-adjusted mask (nasal or full face) connected by a tube to the ventilator or respirator.

When patients need this therapy, the place and time it is started, whether outpatient or hospital admission, is planned in a personalised way with the consent of the patient and the person caring for them.

Education for the patient and their main carer should begin as soon as possible, both from the point of view of managing secretions and the resulting care, as well as the emotional support they need to receive. This means that during the patient’s admission or outpatient visit, the patient and their carer will be trained in:

• Correct use of a respirator
• Fitting and adjusting the mask
• Care to prevent possible skin sores
• Hygiene
• Looking after the respirator

The patient and the carer must take care to keep the airway in good condition to allow secretions to be managed. It is important to preserve the ability to cough where possible, but if coughing is no longer effective, the patient and carer will need to start learning how to use mechanical aids (cough assist or mechanically assisted cough). In certain cases secretion suction may also be used.

To improve the quality of life of patients it is important to follow the advice below:

• Nocturnal ventilation: to be carried out daily, but gradual adaptation should be permitted until the patient is able to sleep through.
• After eating, wait between one and two hours before ventilation.
• Assisted cough should be done every day in order to maintain the skills learned by the patient and their carer, which will facilitate quick resolution of the situation if required.
• All scheduled appointments should be attended where any doubts raised will be resolved.
• Possible infections should be prevented: with flu and pneumococcal vaccinations according to medical advice, by going out in the sunniest hours of the day during the winter and the least sunny in the summer, and contact with people with respiratory infections should be avoided.
  • If signs or symptoms of respiratory infection appear (fever, increase or change in secretions, breathlessness, etc.) you should consult the healthcare team immediately.

Other related health information

• Emotional support to patients and carers in ALS
• Advice for preventing sores
• Advice for patients with a tracheotomy
• Advice for patients with problems swallowing
• Documenting the patient’s wishes

What do you need to bear in mind if you have diphtheria or you are caring for someone who does?

Diphtheria is transmitted via the respiratory tract, mainly, and also by direct contact with a sick person or a healthy carrier of the bacteria. The illness may affect the tonsils, pharynx, the larynx, the nasal mucous membrane and, much less frequently, the skin or other mucous membranes. The bacteria forms a thick grey membrane with a dark red swollen area around it, which in the case of the nose and throat may obstruct the respiratory tract.

Some people may carry the bacteria in their nose or throat. If these people are vaccinated they will not develop the illness, but they may transmit the bacterium to other people via droplets produced when they sneeze or cough. The existence of carriers in countries with no cases of the illness is very rare.

What do you need to bear in mind if you have to self-test for glucose or you need to measure the blood sugar level of someone in your care?

To find out if blood glucose levels are correct, too high or too low, writing them down in your log book allows you to get to know the trends at different times of day, in order to adjust the doses of insulin in the best way possible.

To measure capillary blood glucose it is very important to keep all your equipment in perfect condition and follow the instructions for each piece of equipment to measure blood glucose and prick yourself correctly.

What do I need?

• Lancing device and lancets
• Measuring equipment
• Cotton or paper handkerchiefs
• Water and soap
• Log book to note down results

Hygiene measures

• Wash your hands and the area you are going to prick with water and soap (if possible hot water, as it makes it easier to get a drop of blood).
• It is preferable to wash your hands rather than use alcohol, as frequent alcohol use hardens the skin.
• If you do not have water and soap, you can use alcohol. Always make sure you have allowed the alcohol to evaporate before pricking.

Pricking areas and pricks

• Preferably, choose the sides of the fingers; if possible, thumb or ring finger as they have a greater density of blood vessels.
• Avoid the middle of the finger tip, as it is more sensitive to pain.
• To encourage a drop of blood to come out, gently massage the finger. Put your hand face down and place it below heart height.
• Sometimes, you can use an ear lobe, toe or heel (as long as you do not have any kind of foot illness).

Capillary blood glucose test

1. The measuring equipment and test strips must be in perfect condition.
2. Place the lancing device on the chosen area and press according to the guidelines of each device.
3. Place the blood drop onto a test strip. In some cases, the drop should be put on top; in others, it must be placed on the side (suction system).
4. Follow the instructions of the particular device you are using.
5. Note down the blood glucose result in your log book and, next to it, factors that affected the results (changes in carbohydrate levels, physical activity, time, etc.)

What do you need to bear in mind if you need to inject yourself with insulin or you look after someone who does?

Hygiene

You do not need to disinfect the skin around the area you are going to inject with alcohol, but you do need to maintain good body hygiene and wash your hands first.

If you are using alcohol, let it evaporate before you inject, as it may be more painful otherwise.

Thickness of subcutaneous tissue

Insulin must be injected into the subcutaneous tissue. It will then slowly make its way into the blood and start to act.

• If injecting directly into muscle. Absorption is quicker and may cause hypoglycaemia.
• If injecting just under the skin, the absorption is slower, more painful and may lead to an immunological reaction.

Injection areas

• Arms: in the upper external part. Leave a space of 4 fingers above the elbow and 4 below the shoulder. If you cannot pinch your arm when injecting, be careful to avoid intramuscular administration.
• Abdomen: leave a distance of 4 fingers around the navel. It is a good idea to divide the injection zone into four imaginary parts and rotate the injection zones on a weekly basis.
• Thighs: upper outside, 4 fingers below the groin and 4 fingers about the knee.
• Buttocks: leave 4 fingers below the hips.

Repeated pricks in the same area over time may cause lipodystrophy or deformations in the subcutaneous tissue due to inflammation or reduction. It can be easily identified as bruises appear beneath the skin.

If you do have lipodystrophy, either: do not inject that area for a while until the lipodystrophy goes away; or change needles more often.

Needle length

Research recommends 5 mm needles for everyone, as there is not thought to be much difference between the thickness of subcutaneous tissue, regardless of the person’s physical constitution.

Pinching

The correct pinch is done using the index and middle fingers and the thumb. Grab the skin and subcutaneous tissue, without lifting the muscle. Once the insulin has been injected, wait a few seconds before withdrawing the needle and letting go of your skin.

A stroke is a clinical syndrome characterised by rapid development of signs of neurological involvement lasting more than 24 hours. Vascular in origin, a stroke is considered a medical emergency that requires immediate diagnosis and treatment.

The person who has suffered a stroke usually needs further rehabilitation but, in general, it is important to respect their initiative and autonomy, even if it takes them longer, and to avoid overprotection.

Recommendations and treatment for relatives and carers

Communication

• Speak naturally, using simple words and short sentences, without shouting.
• In the first phase after a stroke, ask short, yes/no questions.
• Promote conversations about every-day life and familiar situations to stimulate the patient’s language.
• If necessary, accompany conversations with gestures to facilitate understanding.
• Items such as the radio or television should be turned off to avoid distractions.
• Respect the response time: avoid showing impatience or cutting off the patient.
• In serious cases, you can use alternative means of communication, such as boards with everyday images on them. There are also mobile apps that can help.

Movement

• Do the exercises recommended by the physiotherapist.
• Move joints and avoid incorrect positions.
• When moving a patient, never touch the affected side.
• It is important that the patient be out of bed for as long as possible.
• Pillows should be used to protect zones of friction and position should be changed every four hours.
• Before the patient drives again, a specialist should be consulted.

Sleep and rest

• It is recommended to sleep seven or eight hours a day.
• Provide a quiet environment and provide a point of light, so the patient can orient themselves during the night.
• Create a day atmosphere (more active, bright) and a different, night atmosphere (quieter, darker). This helps in understanding the sleep pattern.
• Avoid letting them sleep during the day, except for a short afternoon nap.
• After a stroke, the patient may find themself more tired for a while. It is important to become more active but without forcing it.

Hygiene

• Encourage the patient to collaborate in their personal hygiene.
• Whenever possible, use a shower, instead of the bathtub, with a chair inside and a handle on the wall.
• The soap should be neutral and free of alcohol, as this can dry the skin.
• The skin should be dried properly, taking special care with folds. It should then be hydrated and protected.
• Maintain proper oral hygiene.
• Watch bony prominences to prevent pressure sores.

Getting dressed

• Wear comfortable clothes that are easy to put on and take off, such as sportswear with elastic and no buttons.
• Start dressing the patient on the affected side and undressing them on the side that is not affected. It is preferable to be seated.
• To put on trousers (pants), especially if the patient is in bed, it is easier to gather up the trousers, insert one leg at a time and then pull them up.
• Shoes should be closed, with no laces and non-slip soles, which fit the foot well. Shoehorns can make it easier to put on shoes.
• The patient feels the same degree of cold and heat as the carer, so do not give them too many layers.

Physical obstacles

• Remove obstacles such as carpets or chairs to avoid tripping.
• Adapt the home to the new situation: install bars, a taller toilet or shower, etc.
• Adapt the home to improve patient autonomy and prevent falls. For example: have a high bed (70 cm) to make it easier for the patient to get up and down comfortably.

Leisure and recreational activities

• Maintaining social life and hobbies, while respecting the limitations of the patient, improves self-esteem and avoids isolation.
• Incorporate leisure activities gradually, according to the degree of autonomy and in consensus with the patient.

Sex

• Immediately after a stroke, sexual desire may decrease, but it will gradually recover. If in doubt, consult a doctor.
• Paralysis may make sex trickier, but not impossible.
• Fear of suffering another stroke during sex is generally unfounded.
• It is important to talk to your partner about any fears or worries that may arise.

Return to work

• The return to work must be planned, together with the company, so it is gradual, both in terms of demands and time.
• After re-joining the workplace, the situation should be re-evaluated in case changes or adaptations need to be made to improve patient performance and ability.

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