Goals
What is the blood pressure goal prior to TNK administration?
What is less than 185/105.
Your patient just received TNK and is non ambulatory at this time. What should you ensure is in place for this patient?
What is DVT prophylaxis's- SCD Pumps on patient and documented.
Stroke patient's should have DVT prophylaxis's in place within 48 hours of admission.
Examples: SCD pumps, SQ heparin, Lovenox, AC
Mr. Jone's had a CT angiogram of his head and neck, the imaging shows a blockage in the left middle cerebral artery. Mr. Jones symptoms started 1 hour ago. Mr. Jones would be eligible for the following treatment options.
What are TNK and thrombectomy.
TNK- medication administered for ischemic stroke to alleviate blocked blood vessel and re-establish blood flow to brain tissue.
Thrombectomy - a procedure in which a neurosurgeon goes into a patients artery and utilizes special equipment to attempt clot retrieval and restore blood flow to brain .
You ask the patient to perform heel to shin testing and finger to nose. You are testing for ____.
What is ataxia?
Ataxia test's for coordination of movement's. If ataxia is noted it would indicate the thought process of an issue in the cerebellum.
Atrial fibrillation increases risk of stroke due to blood pooling in this area.
What is the left atrial appendage.
The left atrial appendage is located in the left atrium of the heart and is considered a pouch where a clot can form and travel due to blood pooling. This is a mechanism for stroke with people who have a history of atrial fibrillation and the reason why anticoagulation is recommended. If patient is not a good candidate for AC example fall risk or GI bleed the patient can be considered a candidate for a Watch Man procedure.
What is the AHA guideline for blood pressure goal for patient with ICH?
What is 130-150?
You admit a stroke patient from the ED. Your patient is dysarthric and has a slight facial droop. What are the next steps you should take?
What is check and see if stroke swallow screen was performed.
All stroke patients and stroke work up patients are required to have a stroke swallow screen performed before administering anything PO- food or medications. If a swallow screen was not performed in the ED then you as the ICU nurse should complete one. This patient should fail swallow screen automatically for slurred speech and facial droop. This patient should remain NPO including medications until speech therapy evaluates the patient.
A CT perfusion shows area of salvageable tissue surrounding stroke location.
What is the Penumbra.
You are performing an NIHSS on Mrs. Curtis. She is intubated and on light sedation. You call her name out loud and she does not answer. You then rub her chest to have her open her eyes to stimuli. What should her LOC score be?
LOC: 2
LOC 2- Not alert, requires repeated stimulation to arouse.
This brain lobe is responsible for reasoning, memory, impulsivity, and voluntary eye movements.
What is the frontal lobe.
What is the max dose for TNK?
What is 25 MG (5 ML)?
Your patient received TNK at 10:00 AM. The time is now 12PM when they arrive to the unit. How often should the patient have NIHSS and VS documented.
What is : every 30 min for 6 hours and then every hour up to 23 hour mark of TNK. The ED RN should have already completed the every 15 min for 2 hour series of NIHSS and VS prior to arrival.
You are performing an echocardiogram with bubble study. Upon administering the agitated saline flush and looking at the US screen, you note bubbles passing from the right to left atrium.
What is a PFO.
Patent Foramen Ovalle- A hole in the middle of the atriums connecting the right and left atrium.
You are caring for a patient who is intubated and deeply sedated. You are performing an NIHSS however you are unable to assess the patients extremities due to them being sedated and not following commands. What should you score their extremities for NIH assessment?
What is 4, no movement. If the patient cannot produce at least a withdrawal to noxious stimuli, they may be judged as a comatose patient.
*Limb Ataxia and Dysarthria are scored an automatic 0 if the patient is unable to participate. All other components should be performed to the best of the examiner and patient's ability.
_____ is critical to managing and preventing hematoma expansion in an ICH.
What is blood pressure.
Blood pressure management is a large risk factor that increases risk of ICH. During the acute hospital phase of patient's with ICH monitoring and managing blood pressure's per protocol is critical to prevent expansion of bleed.
You have a patient with a large ICH. What are important assessments to perform?
What are: Monitoring blood pressures with BP goals maintained, monitoring pupils, NIHSS, GCS.
IF on AC ensure discussions are in place about reversal.
Your patient has an ICH. What is important information as the primary nurse for this patient that you should seek from the providers?
What is - blood pressure goal.
Patients with ICH need very tight blood pressure management to prevent hematoma expansion. As the primary nurse you should ensure a goal blood pressure is ordered and that the BP parameters in your MAR match the blood pressure goal.
This diagnostic imaging provides detailed imaging related to size and location of stroke.
What is MRI.
Tell me how you would test for inattention or extinction in your stroke patient?
What is: Have the patient close their eyes and then have them identify you touching; 1. the right arm or leg, 2. left arm or leg, 3. both right arm/leg and right arm/leg.
If you are touching both extremities and the patient only identifies you touching one side then this would qualify for scoring of inattention/extinction.
A patient presents with a visual field deficit and may have a stroke in this area of the brain.
What is occipital lobe.
What does the care of an EVT patient look like?
What is: VS+ NIH per protocol
Assess sheath site and perform full peripheral neurovascular assessment with proper timely documentation.
SCD pumps, swallow screen prior to PO intake and medications.
What are stroke core measures that you should ensure are ordered for your stroke patient?
What is: NIH assessment's, DVT prophylaxis, HA1C, Lipid Panel and statin if LDL > 70, PT/OT/ST, Blood pressure goal in orders for ICH, Antiplatelet therapy if indicated for ischemic stroke, Anticoagulation if indicated for PE/AFIB/DVT
Non invasive bedside testing to evaluate for cerebral vasospasm.
What are trans-cranial doppler study.
Trans-cranial doppler study is performed utilizing US probes over cranial artery's in which the velocity (speed) of blood flow is measured. If the velocity is high it could indicate a patient experiencing a vasospasm mostly seen in your SAH. If a vasospasm is noted this is an emergent situation placing risk of further brain ischemia.
Your patient is reading the NIH visual card and is having difficulty identifying the objects along with difficulty explaining the picture of the mom washing dishes and kids trying to steal cookies. This patient is experiencing what?
What is aphasia.
Up to this percentage of stroke are preventable.
What is 80%?