Neuro Check
What is a neuro check?
What is an assessment to assess someone's neurological condition or the like? What is to assess someone's nervous system responses?
What is, yes? (and what should you do if you are not certified yet, but need to perform the score?)
True or False? A nursing swallow screen must be done on every stroke patient. This includes ischemic strokes, TIAs, and Bleeds.
What is true?
What is the name of the clot buster medication used to treat suspected ischemic stroke to patients at Sentara Healthcare?
Tenecteplase, IV Bolus
True or False? You need an order to perform parts of the stroke assessment, including, neuro check, NIHSS, and/ or nursing dysphagia screen?
What is, false?
When do you perform a neuro check if you are not giving Tenecteplase?
Non stroke alerts- baseline and then Q4 minimum, unless ordered differently.
Thrombectomy Candidate- baseline then Q1 until transfer, unless ordered differently.
ICH/SAH- Q15 x 1hr, then if stable, Q1 until admit/transfer, unless ordered differently.
When do you perform a NIHSS?
Where can you document a nursing swallow screen?
Where is under the stroke ED narrator? Where is under the "stroke assessment" or "1090" flowsheet? Where is the note section as a last resort?
What imaging scan must be negative in order to treat with Tenecteplase? and What is the goal standard time to get this scan from admission?
What is NON contrast Head CT? What is 20 minutes?
What is our goal time from admission to transfer patients out for either thrombectomy for LVO or Neurosurgery for ICH/SAH?
What is, 120 minutes or 2 hours?
Can you still assess muscle strength on an amputee?
Is it possible to have a stroke if the NIHSS is zero?
What is, yes!
The NIHSS is a heavily weighted anterior stroke predictor. Several posterior symptoms are not captured in this exam.
True or False? If the NIHSS is zero, 0, I do not need to perform a nursing swallow screen.
What is false?
What is post monitoring for Tenecteplase and how often is it performed?
What is VS and Neuro checks.
What is Q15 for 2 hours, Q30 for 6 hours, Q1 for 16 hours.
LOOK at the TIME, not the occurrences.
What is the goal time to treat with Tenecteplase, Door to Needle?
What is 45 minutes?
What is 75% of cases have to be less than 60 minutes.
What is 50% of cases have to be less than 45 minutes.
Why won't hand grips count as muscle strength?
What is, because, hand grips test motor function, while we want to test the entire extremity for each extremity? Hand grips also leave out the lower extremities.
True/false? It is appropriate to enter a comment next to the item if I am unable to assess a certain item while performing the NIHSS.
What is, NEVER! You must ALWAYS get a score. Do your best. Report your findings. It is ok to enter a comment to help explain your reasoning. Look at instructions, look at tip sheet for difficult to assess.
True or false? If my patients only symptom is dizziness, it is not necessary to perform a nursing swallow screen.
What is false? Order for Meclizine, do your screen!
What is the dosing for Tenecteplase for STROKE?
What is 0.25./kg? MAX Dose 25mg.
What imaging scan helps detect if there is salvageable penumbra?
What is a CTP or CT Perfusion?
Name the seven minimal requirements of the neurological check, according to Sentara Healthcare Policy.
What are Level of Consciousness, Speech, Orientation, Face, Pupil equality, Pupil reaction, muscle strength (all extremities?)
What neurological items are left out of the NIHSS, that are required for the neuro check? (Why we can't use the NIHSS alone for the neuro check.)
What are, orientation, pupils, and muscle strength?
Do you need to perform a swallow screen if your patient is being intubated?
Best practice is "yes." This way, their will be a hard stop for the providers to remind them that the patient is NPO. This will alert the provider to enter a different route for medications.
What is angioedema and who is at risk for this? What drug should you avoid if possible and why?
Who are people receive IV Tenecteplase, on ACE inhibitors, allergic to Tenecteplase or have had previous angioedema, African American?
Epinephrine- causes vasoconstriction, could worsen the stroke and prevent blood flow. Increased risk of bleeding.
True or False? If your patient's only symptom is a terrible headache, they have had for two days, you do not need to notify the provider immediately.
FALSE. This could be a bleed. Even if the Last Known Well is greater than 24 hours, they may need immediate neurosurgical intervention.