1. Stroke Care: A Nursing Perspective BY: LESLIE CAMPBELL, RN & HILLARY MCCOY, RN, SCRN

2. 56 year old female presents to the emergency department at 1845 with new onset right sided weakness. Per husband’s report, patient was eating dinner at 1800 when she suddenly could no longer hold her fork and had trouble finding her words. He brought her immediately to the E.R.

3. What’s going on?  Triage  Diagnostics  NIHSS  CT, CTA, CT perfusion  Hemorrhagic vs Ischemic  Decision  Treatment

5. Patient is immediately taken to the CT scanner. Initial results show no evidence of an intracerebral bleed. Additional imaging is collected. Her symptoms are still prominent and her NIHSS score is 9. Neurology is present. IV tPA is initiated and patient sent to the ICU. Imaging did not demonstrate a large vessel occlusion so patient is not a candidate for Interventional treatment.

6. Vital signs to watch  Respiratory status  Blood pressure parameters  Core body temperature  Oxygen saturations  Pain

7. How often do we check neuro status?  Q15, Q30, Q1hr, Q4hr

8. Heads up!  Measures to prevent increased intracranial pressure yet enhance perfusion  Body alignment  Decreased stimulation  Neuro protective precautions

9. The patient is now craving a cheeseburger and French fries. Speech therapy has determined the safest diet is dental soft with nectar thick liquids.

10. Where in the brain?  Visual fields  Right vs Left  Neglect  Sensation vs motor  Communication  Memory

11. Decreasing common complications associated with stroke  DVT  Skin breakdown  Infection  Partial dislocation of the shoulder  Hemorrhage  Falls

12. Education. Education. Education.  Stroke book  Decrease patient/family anxiety  Therapies  Rehabilitation and expectations

13.  The patient has been evaluated by all therapies and is to be discharged today to a local inpatient rehabilitation center. Discharge education is completed and all core measures are addressed.

14. CORE MEASURES