Signs, Symptoms, and Risks
What are the signs of a stroke?
BEFAST - Balance, Eyes, Facial droop, Arm drift, Slurred speech, Time
Who can call a stroke alert, and how?
Anyone can call it. Call 5555
By when should antithrombotic medication be given?
By the end of hospital day 2
How often do we educate our patients?
Every shift
How often do you do neuro checks and vital signs?
Every 4 hours (0800, 1200, 1600, 2000, 0000, 0400)
What are the signs/symptoms of a hemorrhagic stroke?
Sudden, severe, worst headache of your life; change in LOC
Also could include vomiting, elevated BP, agitation, seizures, neck pain, photophobia, eye gaze impairment, pupillary changes
When is a stroke alert activated
With any stroke-like symptoms (BEFAST). Increase in NIHSS in patients admitted with stroke
What medications are classified as antithrombotic?
Aspirin, Plavix, Brilinta
How do you provide stroke education?
The patient or family is provided a stroke handbook on the day of admission and then it is referenced throughout the admission. Stroke one-pager is available in multiple languages. Use Mytonomy
What resource can we use to make sure we've completed all required documentation?
"pink sheet"
What are the signs/symptoms of a posterior stroke?
Five D's - dizziness, dysarthria, dysphagia, diplopia, dystaxia
Who is the stroke team for inpatient stroke alerts?
MD, STAR RN or ICU Charge RN, stroke coordinator (when in-house)
When can a patient get Tenecteplase?
Up to 4.5 hours of last known well
What topics do stroke patients need to be educated on?
Activation of emergency medical system, follow up after discharge, medications prescribed at discharge, risk factors for stroke, warning signs and symptoms of a stroke
When do you assess NIHSS?
Admission, Q shift, transfer, any clinical changes, discharge
What are some non-modifiable risk factors for ischemic stroke?
Prior stroke, age, a-fib, cardiac valve disease, diabetes, patent foramen ovale
What is the goal for door to CT?
Less than 10 minutes
What is the IFOH Tenecteplase time goal?
Give within 30 minutes or less
True or false: education should be personalized for the patient
True
What if a patient does not need PT/OT or LSP services?
–Option 1 – PT or OT can evaluate the patient and document that they are at baseline and that services are not needed
–Option 2 – MD can document in their note that the patient is at baseline and PT/OT/SLP services are not needed
True or false: older adults have a higher risk of having a hemorrhagic stroke than younger adults
True
What are the four priority actions after calling a stroke alert?
Obtain vital signs, obtain blood glucose, last known well time, prepare to transport to CT
What type of medication should a patient be prescribed if they have a history of a-fib or a-flutter?
Anticoagulation
What kind of stroke education do you, as the inpatient nurse, receive every year?
Stroke bundle in HealthStream which includes NIHSS
Do all stroke patients get a dysphagia screen on admission?
Yes, unless they were already seen by SLP in the emergency department