Understanding the Bleed
This type of stroke occurs when a blood vessel ruptures and causes bleeding within the brain or around the brain
What is a hemorrhagic stroke
Tight blood pressure control is critical to prevent this complication
hematoma expansion, or increased bleed
This vital sign requires rapid management to reduce bleeding expansion
What is Blood pressure
Where can I find a stroke timeline sheet (bright Yellow sheet)
In each zone, on the pole with all the documents.
True or False: Your patient is neuro intact, with no focal deficits and their Head CT, shows a new intracranial hemorrhage. Since you know they are neuro intact, you know longer need to complete any neuro assessments.
FALSE! This patient has a confirmed ICH, they should be getting Q15 VS x 1 hour, and Q15 neuro Assessements x 1 hour.
This is the most common cause (risk factor) of hemorrhagic stroke, and ER nurses spend half their shift fighting it
Uncontrolled Hypertension
Frequent neurologic assessments are performed to identify this early change
What is neurologic deterioration? This is why we are performing neuro assessments Q15 min x1 hour, and then Q1H after
What is our time goal for blood pressure management?
Arrival to Blood Pressure control- 60 minutes!
Where can you go to document the serial neuro assessments within narrator
Stroke Narrator-- "hemorrhagic Stroke Neuro Reassessment"
Your patient has a new ICH (confirmed on CT), their blood pressure is 198/110, you have given two pushes of labetalol (10mg x2), and the blood pressure came down to 185/105, what medication should be started next.
Bonus Question: what would you start the medication at.
Nicardipine gtt. our arrival to blood pressure control is 60 minutes.
start at 5mg/hr
There are two categories of hemorrhagic stroke, do we classify "A blood vessel ruptures and causes bleeding wihin the brain, as a Intracerebral Hemorrhage or Subarachnoid Hemorrhage?
Intracerebral Hemorrhage
These types of medications may need reversal immediately when a patient presents with a hemorrhage
What are anticoagulants or antiplatelets
What frequency should VS be assessed/documented, when hemorrhagic stroke is confirmed
Q 15min x 1 hour, and then Q1H after
True or False: the Bright yellow stroke timeline can also be used for hemorrhagic strokes
TRUE! the back page has a tool to help you make sure you are meeting all the documentation requirements
VS Q15 x1 hour and Neuro Assessments Q15 x 1 hour
For your new hemorrhagic stroke patient, Choose one to delegate, one to address, and one come back to.
1. Blood Pressure is 205/100
2. Keppra ordered for Antiseizure phrophylaxis
3. Coags ordered and need to be drawn
1) Blood pressure- address
2) Delegate someone to draw coags
3) come back to keppra once BP is under control-- if the patient is not having active seizures, this does not be a priority
Rapid expansion of a brain bleed most often occurs within this time frame
within the first few hours, hence the goal to treat and reduce BP and reverse coagulopathy in 60-90 minutes
In hemorrhagic stroke patients the Head of bed should typically be elevated to this degree unless contraindicated
What is 30 degrees
When a hemorrhagic stroke is confirmed, as an ED nurse, where should you go to document your neuro assessments
Stroke Narrator>>> "hemorrhagic stroke neuro reassessment"
True or False: If it's not a stroke alert, and my MD tells me my patient has a new ICH on CT, I don't need to use the bright yellow sheet.
False: You should utilize the bright yellow sheet, to help as a guide for your charting of patients with hemorrhagic stroke. Not all hemorrhagic strokes will be stroke alerted.
A patient with a new ICH has a GCS of 14 on arrival, and with your last neuro assessment the GCS is 11
notify provider immediately, treat this as neurological deterioration
There are two categories of hemorrhagic stroke, do we classify "A blood vessel ruptures, such as an aneurysm, and causes bleeding around the brain, as a Intracerebral Hemorrhage or Subarachnoid Hemorrhage?
Subarachnoid Hemorrhage
What is the timeframe goal we aim for reversal of anticoagulants or antiplatelets
60- 90 minutes from patient arrival.
What needs to be completed prior to any PO intake for any patient suspected or confirmed stroke?
A swallow evaluation/screen
This blood pressure target helps limit ongoing bleeding in many patients with ICH.
SBP 130-150
Worsening headache, vomiting, and declining LOC may indicate this emergency complication
What is increased intracranial pressure or herniation. Why we are doing Q15 min neuro assessments on these patients.