Stroke Assessment
Stroke Intervention
Stroke Diagnostics
Stroke Education
Stroke Measures
100
Patient presenting with aphasia, right hemiparesis, right hemisensory loss, right visual deficit, left gaze deviation
Left Dominant Hemisphere LVO
100
Action taken for a Stroke patient presenting with labored respirations & decreased LOC
Airway intervention with RSI
100
In addition to paging the Neurologist on call, stroke patients presenting to the ED with signs of an acute stroke will have this test ordered.
What is a stat CT brain WITHOUT contrast?
100
This is widely defined as an increase in serum creatinine by 0.5 mg/dl or 25% above baseline within three days of contrast administration and without an alternative etiology.
What is contrast-induced nephropathy?
100
For Ischemic stroke patients, this must be administered by the end of day 2 if they did not receive TPA.
What is an antithrombotic?
200
Patient presenting with right gaze deviation, left hemi-inattention & hemiparesis, left hemisensory, left visual field defect
right nondominant hemisphere LVO
200
3 Actions taken if patient displays drowsiness, severe headaches, Nausea & vomiting, acute hypertension during IV t-pa administration/infusion
Stop the IV t-PA infusion Contact the the Physician Order and transport patient for STAT Non Contrast Ct scan
200
A patient presenting with an acute stroke has an NIHSS of 18. In addition to a Ct scan you would expect this test to be ordered per protocol
What is a CTA/CTP
200
Stroke is the leading cause of serious, long-term disability in the United States. What is the intervals in seconds that a stroke occurs?
What is every 40 seconds? Additionally, approximately 800,ooo people per year have a stroke.
200
Ischemic stroke patients with current or previous history of Afib/Aflutter must be discharged with this class of medication.
What is Anticoagulant?
300
Patient presenting with Eye movement abnormalities, Nausea & Vomiting, vertigo, tinnitus, dysphagia & decreased consciousness
Brainstem Infarction
300
4 Actions Taken if the patient develops tongue/lips swelling, difficulty breathing during the infusion of IV t-PA
Discontinue the infusion Notify the emergency physician/neurologist/intensivists Administer Benadryl, Ranitidine, and Steroids for management Prepare for airway intervention
300
a.Prestroke mRS score 0 to 1,b. Acute ischemic stroke receiving intravenous r-tPA within 4.5 hours of onset c. Causative occlusion of the ICA or proximal MCA (M1) d. Age > 18 years, e. NIHSS score > 6, f. ASPECTS of > 6 and g. Treatment can be initiated within 6 hours of symptom onset. These are all the criteria to be met for patients to undergo what intervention?
Endovascular therapy with a stent retriever
300
The acronym FAST stands for these four components of stroke assessment.
What is: Facial drooping Arm weakness Speech difficulty Time to call 911
300
We are required by The Joint Commission to use this neurologic examination stroke scale to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.
What is the NIHSS?
400
Patient presenting with sudden onset headache, nausea & vomiting, neck stiffness, intolerance to light
Symptoms suggestive of Subarachnoid hemorrhage
400
Time intervals for monitoring vitals signs & neuro assessment with an acute stroke who is not a candidate fot IV t-PA
Q 1 hour unless change in status requires more frequent monitoring
400
A hyperdense MCA sign on a Non contrast Ct Scan might be indicative of what ?
Large vessel occlusion and very severe stroke
400
BRRH formulates its clinical practice guidelines for the treatment of Stroke patients from these two organizations.
What are the 1) AHA/ASA (American Heart Association/American Stroke Association) 2) NINDS (National Institute of Neurological Disorders and Stroke)
400
Patient with acute stroke has a slight right facial. Prior to PO intake what 2 nursing actions should be taken
1.)Patient remains NPO - Automatic fail for swallow risk assessment 2.) Speech Therapy Evaluation
500
Patient presents with right sided ataxia
Right Cerebellar Hemisphere Stroke
500
4 Nursing Actions taken for all patients presenting with signs of acute stroke
Place patient on continuous ECG Monitoring Monitor Blood Pressure Perform NIHSS Perform Dysphagia Screening
500
The Non contrast Ct Scan on an acute stroke patient (Code Grey/Stroke Alert) shows an intracerebral hemorrhage. The patient is on Xarelto. This reversal agent could be issued emergently per policy.
PCC (Kcentra) 50 units/kg IV x1
500
This is the approximate % of stroke survivors who experience a second stroke in the first year following a stroke.
What is 14%
500
These are the 5 elements of education we are required to provide our stroke patients and their families.
What are 1. Signs and symptoms 2. Discharge Medications 3. Individual risk factors 4. Follow up appointments 5. When to call EMS
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