CPGs and Best Practices
Core Measures
Clots and Bleeds
Interventions
Stroke Etcetera
100
Name the SmartPhrase required on all stroke patients as Stroke Best Practice for bedside hand-off.
.ABCDEF SmartPhrase
100
Name two (2) criteria that results in an AUTOMATIC FAIL when performing a swallow (dysphagia) screen?
1. Dysarthria
2. Facial droop
100
Diagnostic imaging used to determine thrombolytic eligibility on a Wake-Up protocol?
MRI (Note: some neurologist may use CTP)
100
Name two (2) interventions referred to as the Gold Standard treatment of an Acute Ischemic Stroke within 4.5 hours from LKWT and the presence of a large vessel occlusion?
Thrombolytic and Thrombectomy
100
Once you activate Tier-1 notification within 10 minutes of symptom recognition of a suspected stroke patient with BEFAST, name at least three (3) things that you should do while waiting for the neurologist to call back.
1)Check blood sugar
2)Connect patient to a transport monitor with BP capability
3)Document in KPHC patient’s weight in kilograms
4)Obtain Vital Signs
5)Obtain Last Known Well Time (LKWT)
6)Remember Symptom Recognition Time (SRT)
7)Check if PT/INR, PTT were resulted recently (same day)
8)Prepare to transport patient to CT
200
Name two (2) sources of location where you would find Stroke Resources such as CPGs?
1. Stroke SharePoint Resources site
2. Stroke Purple binder
200
How many Hemorrhagic stroke care plans are there?
Two:
1. Intracerebral Hemorrhage (ICH)
2. Subarachnoid Hemorrhage (SAH)
200
What type of stroke is shown in this imaging?
Hemorrhagic Stroke (ICH)
200
What are the three (3) observations that the nurse should assess for 24 hours s/p thrombolytic therapy?
1) Orolingual angioedema
2) Bleeding (headache)
3) Anaphylaxis
200
What is the maximum NIHSS score on a stroke patient?
40
300
How do nurses adhere to the Stroke Clinical Practice Guidelines and/or Scientific Statements?
By following the Stroke Order Set
300
How many total Stroke Core Measures (STK only) are there?
8
1. VTE Prophylaxis
2. Discharged on Antithrombotic Therapy
3. Discharged on Anticogulant if w/ A-FIB/A-Flutter
4. Thrombolytic Therapy
5. Antithrombotic therapy by end of hospital day 2
6. Discharged on Statin medication
7. Stroke Education
8. Assessed for Rehab
300
Name the severity score used on a stroke patient with SUBARACHNOID Hemorrhage.
Hunt and Hess Scale
300
Name two (2) treatment options for a stroke patient with an aneurysmal subarachnoid hemorrhage?
1. Surgical Clipping/Craniotomy
2. Endovascular Coiling/Flow diverting stents
300
Name the SPANISH acronym for stroke signs and symptom recognition (hint: NOT BEFAST).
RAPIDO
400
Name at least one AHA CPG and/or Scientific Statement recently adopted at KP LAMC in 2023.
1. 2023 Aneurysmal Subarachnoid Hemorrhage CPG
2. 2023 Strategies to Reduce and Ethnic Inequities in Stroke Scientific Statement
400
Name at least (4) items that must be included in the Discharge AVS of a stroke patient.
1. Patient instruction on type of stroke (i.e. .pistroke).
2. .stkedu for BEFAST.
3. .strokeenglishinstruction for stroke support group.
4. .nxtdosedue
5. INCLUDE interventions (thrombolytic, thrombectomy, IR procedures)
400
Name at least three (3) Stroke Delirium PREVENTATIVE measures.
1. Risk factor assessment
2. Orientation disorder prevention
3. Maintain sleeping patterns
4. Sensory interventions
5. Prevention constipation and dehydration
6. Preventing hypoxia
7. Infection prevention
8. Pain management
9. Maintain appropriate nutrition
400
Treatment option for Delayed Cerebral Ischemia.
Intra-arterial Verapamil
400
Name three (3) items that you would monitor and document ALONG WITH ITS FREQUENCY on S/P Thrombolytic patient downgraded to your unit under the LOW NIHSS Thrombolytic Patients Workflow?
1)NIHSS q2 hours until the 24th hour s/p Thrombolytic bolus administration, then qShift and as needed.
2) Complex Neuro/GCS qShift until the 24th hour s/p Thrombolytic bolus administration, then per order.
3) Vital Signs q4h hours until the 24th hour s/p Thrombolytic bolus administration, then per order.
500
List the three (3) objectives that the scientific statement, FeSS, observes?
1. Fever
2. Sugar (hyperglycemia)
3. Swallowing (dysphagia)
500
What are the four (4) STROKE EDUCATIONAL categories that must be provided and documented qShift?
1. Overview/Treatment Plan (medication/intervention).
2. Modifiable Risk Factors.
3. Self-Management.
4. One of ADDED POINTS (BEFAST, Krames, Mediterranean Diet)
500
Which cerebral artery is the stroke located in this image? (hint: vision loss on opposite side)
Posterior Cerebral Artery
500
The only non-surgical treatment for an ICH stroke victim administered within 2 hours of onset (hint: an active stroke clinical research)
Recombinant factor VIIa for acute hemorrhagic stroke administered within 2 hours of onset
500
What are the six (6) components of the .ABCDEF SmartPhrase?
1. Assessment of Neuro status
2. Blood Pressure Control
3. Consults - PT, OT, ST
4. DVT Prophylaxis
5. Education/Learning Assessment
6. Focus/Individualized Patient Plan