Know Your Noggin
What are the two main types of stroke?
Ischemic & Hemorrhagic
What does BEFASTT stand for?
Balance, eyes, face, arm, speech, terrible headache, time
Name one non-modifiable risk factor for stroke
Age, gender, race, or family hx
What is “Last Known Well”?
Last time patient at baseline/seen normal
What does BP need to be lower than in order to administer TNK?
<185/110
After identification of a suspected stroke, what are your next steps?
Notify provider, CT & place Suspected Stroke Order Set
What are the 2 most common areas where bleeding occurs in a hemorrhagic stroke?
Intracerebral & Subarachnoid space
Why is rapid neuro assessment critical in suspected stroke?
To identify eligibility for time-sensitive treatments TNK, MT
Name two modifiable risk factors for stroke
HTN, DM, Smoking, Obesity, Elev Chol, AFib
What is the time window for thrombolytics in ischemic stroke?
<4.5 hours or up to 9 hours depending on CTP
What 2 items must be documented within 15 mins prior to giving TNK?
BP & NIH
What assessment must be done at every handoff with receiving RN
NIHSS
What is the penumbra?
Tissue not yet permanently damaged
What imaging is first used to rule out a hemorrhagic stroke?
Non-Contrast Head CT
What lifestyle changes can reduce stroke risk?
Smoking cessation, exercise, healthy diet, wt. Loss, BP control, DM control
What is arrival to CT Goal?
10 Minutes
How often are VS & NC done after TNK?
Q15 mins x 2 hrs, Q30 mins x 6 hrs, Qhour x 16 hrs
(use Timer)
What medication route should be used for oral medication if the patient has a NGT?
NGT
What is the primary pathophysiological problem in an ischemic stroke?
Lack of blood flow and oxygen - cell death
How is the initial CT scan ordered?
Non-Contrast Head CT-per Stroke Alert
What is the the number one most significant modifiable risk factor for stroke?
Hypertension
What is arrival to Thrombolytic Goal?
Less than 45 minutes
What is a major complication to monitor for after thrombolytic therapy?
Bleeding, especially intracranial hemorrhage
What medications should the potential stroke patient be discharged home on?
Antithrombotic, High Intensity Statin & Anticoagulant (if afib)
What is the most common way for a right hemisphere stroke to present?
Left sided weakness, neglect, impulsive behavior
What can show up on a CTA Head/Neck that is an emergency?
LVO
What cardiac rhythm disorder greatly increases the risk of embolic stroke?
AFib
If a patient arrives with stroke like symptoms but last known well time is unknown. What is the most important next step?
Rapid evaluation & CT imaging
What is a sign of hemorrhagic transformation?
Decreased LOC, Headache, Vomiting, Acute HTN, Neuro Decline
What common mistake should nurses avoid when performing the NIH?
Coaching or helping the patient
What is the most common way for a left hemisphere stroke to present?
Right sided weakness, paralysis, aphasia
What imaging can evaluate cerebral blood flow, volume, and perfusion to identify the ischemic penumbra?
CTP
Why must POC glucose be obtained in suspected stroke?
Hypoglycemia can mimic stroke symptoms
What is the biggest cause of delay in stroke treatment?
Delayed recognition
What medications should be readily available post TNK?
Angioedema Protocols/Treatments
What key times must be documented for a stroke alert?
Arrival time, Specific LKW, CT start Time, TNK Time
Why is permissive hypertension allowed in ischemic stroke patients who are not receiving TNK?
To maintain cerebral perfusion in ischemic tissue
What diagnostic test is done after stroke to find the source of emboli?
ECHO
What is a precursor for Stroke, where 1 out of 3 will have a stroke within 90 days?
TIA
Approximately how many neurons are lost per minute in an untreated stroke?
2 million
How can you ensure accurate time tracking post TNK?
TNK Timer
What is the time frame used to qualify a patient as a stroke alert?
Anyone whose LKW is unknown or 24 hours or less, even with the resolution of symptoms
What location of a stroke leads to breathing and heart rate changes?
Brainstem
What should the nurse do if stroke symptoms resolve before imaging?
Continue process; possible TIA still requires eval & treatment
Too much of this "bad cholesterol" can build up in your arteries and increase your stroke risk.
LDL Cholesterol
After identification of a suspected stroke, what are your next steps?
Notify provider, CT & place Suspected Stroke Order Set
Name the primary 2 medications used to decrease BP prior to TNK administration?
Cardene or Labetolol
Patient arrives with stroke like symptoms but last known well time is unknown. What is the most important next step?
Rapid evaluation & CT imaging