Every 45 seconds, someone in the United States has a stroke (cerebrovascular accident). Every 3 to 4 minutes, someone dies from a stroke. Of those over 65 who survive, 60% need assistance to walk, and 26% are in a nursing home 6 months afterward.
Fortunately, recent research has identified ways to minimize the effects of strokes and reduce their recurrence. To help you and your colleagues assist stroke victims, follow these evidence-based guidelines:
- Rapidly assess for signs and symptoms of stroke.
- Apply the NIH Stroke Scale. [LINK: http://www.strokecenter.org/trials/scales/nihss.html]
- Send the patient for noncontrast computed tomography or magnetic resonance imaging of the brain, as ordered, to determine the type of stroke.
- Collaborate with the physician to estimate the time since symptom onset and determine patient eligibility for thrombolytic therapy. In an ischemic stroke, consult the thrombolytic drug information sheet for eligibility.
- Monitor the blood pressure. Expect to treat a systolic blood pressure above 220 mm Hg or a mean blood pressure above 120 mm Hg with the appropriate medications.
- Monitor for signs and symptoms of increased intracranial pressure, such as decreased level of consciousness, headache, slurred speech, nausea, and vomiting.
- Screen for dysphagia within 24 hours. As ordered, keep the patient NPO.
- If ordered, monitor coagulation test results and report the results to the physician.
Planning and Implementation:
- Administer supplemental oxygen as prescribed.
- Maintain a patent airway.
- Apply an intermittent pneumatic compression device to the legs as ordered.
- Administer a thrombolytic as prescribed. Monitor for adverse reactions, such as bleeding and angioedema.
- Give aspirin within 48 hours of an ischemic stroke as prescribed.
- Prevent aspiration of food and drinks: Elevate the head of the bed. Provide thickened fluids and semi-solid food with a homogenous texture. Avoid thin liquids and extremely hot or cold food and drinks.
- Promote early activity, such as range-of-motion and rehabilitation exercises as ordered.
- Prepare the patient and family for discharge. Stress the need to:
- Seek help early for signs and symptoms of stroke.
- Modify risk factors: Stop smoking. Avoid excessive alcohol intake. Avoid a sedentary lifestyle. Follow medication regimens to control hypertension, high cholesterol, and diabetes mellitus.
- Maintain the rehabilitation and physical activity schedule.
By discharge, the patient should:
- Display no signs of bleeding or infection.
- Describe strategies for modifying risk factors.
- Have a referral for rehabilitation therapy.
For more on managing stroke, check out the Evidence-Based Nursing Monographs: Cerebrovascular Accident (CVA) course in Mosby’s Nursing Consult.