Know Your Noggin'
What are the two main types of stroke?
Ischemic & Hemorrhagic
Name one non-modifiable risk factor for stroke
Age, gender, race, or family hx
What does BEFASTT stand for?
Balance, eyes, face, arm, speech, terrible headache, time
When should a swallow screen be performed in stroke patients?
Before ANY oral intake
What imaging is first used to rule out a hemorrhagic stroke?
Non-Contrast Head CT
What is the time window for thrombolytics in ischemic stroke?
<4.5 hours
What type of evaluation must be performed prior to discharge?
PT, OT, and/or SLP
What is the most common cause of ischemic stroke?
Thrombus or embolus causing cerebral artery occlusion
Name two modifiable risk factors for stroke
HTN, DM, Smoking, Obesity, Elev Chol, AFib
What are some symptoms of a left hemisphere stroke?
Right sided weakness, paralysis, aphasia
What is a major complication to monitor for after thrombolytic therapy?
Bleeding, especially intracranial hemorrhage
Why must POC glucose be obtained in suspected stroke?
Hypoglycemia can mimic stroke symptoms
Who can activate a stroke alert?
ED, ICU or RRT member
What assessment must be done at every handoff with receiving RN?
NIH
In a hemorrhagic stroke, bleeding most commonly occurs in which two areas?
Intracerebral & Subarachnoid space
What is the the number one most significant modifiable risk factor for stroke?
Hypertension
What are some symptoms of a right hemisphere stroke?
Left sided weakness, neglect, impulsive behavior
What is “Last Known Well”?
Last time patient at baseline/seen normal
What vascular imaging can identify a large vessel occlusion?
CTA
What should the nurse do if stroke symptoms resolve before imaging?
Continue process; possible TIA still requires eval & treatment
What common mistake should nurses avoid when performing the NIH?
Coaching or helping the patient
What is the penumbra?
Tissue not yet permanently damaged
What cardiac rhythm disorder greatly increases the risk of embolic stroke?
AFib
How should the NIH be performed/assessed?
At handoff with the oncoming RN
Why is permissive hypertension allowed in ischemic stroke patients who are not receiving TNK?
To maintain cerebral perfusion in ischemic tissue
What imaging can evaluate cerebral blood flow, volume, and perfusion to identify the ischemic penumbra?
CTP
Alert to CT Goal?
10 minutes
What type of education must be completed prior to discharge on stroke and TIA patients?
Stroke Education, Diabetic Education and Social Habits Education
What is the primary pathophysiological problem in an ischemic stroke?
Lack of blood flow and oxygen - cell death
What lifestyle changes can reduce stroke risk?
Smoking cessation, exercise, healthy diet, wt. Loss, BP control, DM control
Why is rapid neuro assessment critical in suspected stroke?
To identify eligibility for time-sensitive treatments TNK, MT
What 2 items must be charted/done before midnight on the second hospital day?
VTE Prophylaxis & Early Antithrombotics
What diagnostic test is done after stroke to find the source of emboli?
ECHO
Alert to Thrombolytic Goal?
Less than 45 minutes
What is the most common cause of fever post-stroke, and how does it affect outcomes?
Aspiration pneumonia & it worsens neurological outcomes
What location of a stroke leads to breathing and heart rate changes?
Brainstem
What medications should the potential stroke patient be discharged home on?
Antithrombotic, High Intensity Statin & Anticoagulant (ifAFib/AFlutter)
How often does the NIH need to be performed?
On admission, at shift change throughout entire hospitalization, as needed with any neurological change and at discharge
What medication route should be used for oral medication if the patient has a NGT?
NGT
What should the nurse do if stroke symptoms resolve before imaging?
Continue process; possible TIA still requires eval & treatment
How many brain cells are lost per minute during a stroke?
2 million
Why should hypotonic fluids be avoided in acute stroke management?
They worsen cerebral edema
What is a precursor for Stroke, where 1 out of 3 will have a stroke within 90 days?
TIA
This group helps ensure stroke patients have the resources, rehab plans, and support needed before discharge.
Case Management
What is the time frame used to qualify a patient as a stroke alert?
Anyone whose LKW is unknown or 24 hours or less, even with the resolution of symptoms
Why must stroke patients be kept NPO until BSS?
To prevent aspiration pneumonia
What is the nurse's first action after recognizing possible stroke symptoms
Call #3333, activate RRT, RRT member will initiate stroke alert
What is the biggest cause of delay in stroke treatment?
Delayed recognition
What is the earliest sign of increased intracranial pressure (ICP)?
Change in level of consciousness