Strokes
What is the most common type of stroke?
Ischemic stroke (87%)
If a patient receives tPA or has a thrombectomy, what unit do they go to?
ICU for at least 24 hours
A commonly ordered test to determine if a stroke has occurred and what kind of stroke...hint: the first test ordered in the ED to rule out a bleed
CT of the head without contrast
How often do we document the NIHSS?
On admission, then q4h x 72 hours, BID after
What is the preferred position for patients with dysphagia?
Semi-Fowler's position (30 degrees) or higher.
Anticoagulants and thrombotics increase the risk of this type of stroke...
Intracerebral Hemorrhage
How does SLP get involved with the patient?
In the CVA order set; Consulted and prioritized when patient fails a BSS.
A commonly ordered test that gives very accurate images that show the presence and location of a stroke- but also the size of aneurysms.
MRI
How often do we document vital signs on stroke patients?
on arrival to the floor, then 8-12-4 schedule. More often as needed
This assessment must be completed prior to giving any PO medications.
Dysphagia screen/ bedside swallow
The most common cause of intracerebral hemorrhagic stroke...
Hypertension
How are you competent to take care of stroke patients?
Receive 8 hours of education annually. Certified to do NIHSS; Educated on Clinical Practice Guidelines and Policy and Procedures; UBC and stroke review class; Stroke foundations
This clot-busting drug must be given within 3- 4.5 hours or onset of stroke symptoms.
alteplase (tPA)
What two IPOCs are required for Stroke patients?
Abnormal Neurological Function & Teachback Stroke
Name two stroke core measures
-NIHSS within 12 hours of arrival; antithrombotics by day 2; VTE prophylaxis; Rehab assessment; anticoags for a.fib/ a.flutter, dysphagia screen, statin on discharge...
Name 5 s/s of stroke
B= Balance
E= Eyes/ vision
F= Facial drooping
A= Arm weakness
S= Speech difficulty
T= time ( to call 911!)
What do you do when you miss a scheduled VS or Neuro Assessment? What do you do if the patient is off the floor?
Do one immediately then go back to scheduled routine
What is a CTA?
Why do we document SCDs and how often?
Every shift; prevents blood clots
What are the BP goals for ischemic and hemorrhagic strokes? What is permissive HTN?
Ischemic: follow orders- usually <200/100
Hemorragic: 140 +-15
Allowing for high blood pressure in stroke population so do not extend infarct
The two most common causes of subarachnoid hemorrhages...
Head trauma and aneurysms
Explain the importance of the discharge process for both the patient and the hospital.
Improves patient’s outcomes both in managing this stroke, and in prevention for future. Helps prevent readmissions. Decreases cost for both patient and hospital.
Why do we check blood glucose for CVA rule outs?
Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. In patients treated with thrombolysis, hyperglycemia is associated with an increased risk of hemorrhagic transformation of infarcts.
This assessment must be completed prior to giving any PO medications. & Why do we do it?
dysphagia screen/ bedside swallow; Stroke patients are at a high risk for aspiration
How are patients and families educated on stroke?
Warning Signs for Stroke
Risk Factors for Stroke
EMS Notification for stroke symptoms
Importance of Keeping F/U Apts
Discharge medications
Provide: Stroke Survivor D/C Instructions
PCARE