Stroke Alert
Last Known Well date and time.
What is an important question to ask a patient or family regarding the onset of stroke symptoms?
3 ounces
What is the amount of water that is swallowed for a dysphagia screening?
The month and patient age.
What are LOC Questions?
25 mg
What is the max dose of TNK that should be given?
This core measure includes the use of chemical prophylaxis such as Lovenox, Heparin and Eliquis and mechanical prophylaxis such as SCD's for stroke patients who are admitted.
What is VTE Prophylaxis? STK 1
Recent within 3 months intracranial or spinal surgery/Head trauma/GI bleed
What are exclusion criteria for TNK?
Yale Swallow Protocol
What is the name of the dysphagia screening used at Geisinger?
This part of the NIHSS tests the patient's peripheral vision.
What is visual field testing?
This is completed in the clean medication preparation area in the med room.
What is where TNK is mixed?
A medication a patient with stroke diagnosis should be taking to assist in prevention of another stroke and lowering their LDL.
What is a high dose statin?
Non contrast CT scan.
What should be completed before an IV is placed in a stroke alert patient?
This should occur when a patient fails a dysphagia screening.
What is communication to hospitalist for speech therapy consult and NPO orders?
This part of the NIHSS scores for ataxia.
What is having the patient perform finger to nose and heel to shin testing?
Headache, vomiting, decreased LOC.
What are sign and symptoms of possible head bleeding or neurological change post TNK?
This STK core measure has been shown to reduce morbidity, mortality and recurrent strokes in patients when ordered at discharge.
What is STK 2 discharge on Antithrombotic?
Dysphagia screening (even if NPO) and NIHSS
What 2 assessments an RN should document on all stroke alerts (even cancelled)?
Head of bed in Semi-Fowler's position (30 degrees) or higher.
What is the preferred position for patients with dysphagia?
Ask (or use pantomime to encourage) the patient to show teeth or raise eyebrows and close eyes.
What is Facial Palsy?
An Emergency Department RN
Who can give IV push TNK at GJSH/GMCM?
Patients discharged on these medications have been shown to reduce stroke reoccurrences in patients with afib/aflutter.
What are anticoagulants?
< 30 minutes!
What is the goal door to Tenecteplase time?
A patient completes an uninterrupted drinking of all 3-oz of water without overt signs of aspiration.
What is a PASSing of the dysphagia screening?
Ask patient to describe what is happening in the picture, name items, and read from a list of sentences.
What is Best Language/Aphagia?
This must be below 185/110 prior to the administration of Tenecteplase.
What is the patients' blood pressure?
Stroke education must be documented in EPIC as this method.
What is learners, readiness, method, response?