Stroke Code

Complete the Definition: 

Stroke: Loss of blood flow to part of the brain, wish damaging brain tissue. 

TIA: transient ischemic attack wish is a mini stroke that can be reversible. 

Neglect Syndrome:  malfunction of one hemisphere of the brain/ can't see the opposite side. 

Aphasia(Dysphasia):  impairment of language, affecting the production or comprehension of speech and reading. 

• Receptive: unable to comprehend speech (Wernike’s area) able to speak and use long sentences but not make sense. 
• Expressive: comprehends speech but can’t respond back with speech ( Broca’s area)
• Mixed: combination of the two. limited in their comprehension of speech and do not read or write beyond elementary level. 
• Global: most severe form of aphasia/ complete inability to understand speech or produce it. 
• Dysarthria: unable to speak clearly due to weak muscles (hard to understand)
• Apraxia: can’t perform voluntary movements even though muscle function is normal 
• Agraphia: loss the ability to write
• Alexia: loss the ability to read.. doesn’t understand or see the words
• Agnosia: doesn’t  understand sensations or recognize known objects or people 
• Dysphagia: issues swallowing
• Hemiparesis: loss of strength on one side of the body
• Hemianopia:  limited vision in half of the visual field 

What are the 2 main types of stroke? Explain the causes of each type. 

1. Hemorrhagic strokes: caused by a blood vessel rupture and characterized by bleeding in the brain
2. Ischemic strokes: caused by a blockage of one of the cerebral blood vessels. 

 

What is TIA? Why does it happen?

Transient ischemic attack: caused by a temporary clot, often called a mini stroke. 

 

Describe what you will see in patients when they have Right-brain damage vs Left-brain damage?

1. Rt. brain damage:

• left side hemiplegia
• left side neglect
• spatial-perceptual deficits. 
• tends to deny or minimize problems
• rapid performance, short attention span
• impulsive, safety problems
• impaired judgment and time concepts

1. Lt. brain damage: 

• right side hemiplegia
• impaired speech and language aphasias
• impaired rt/lt discrimination
• slow performance, cautious
• aware of deficits; depression, anxiety
• impaired comprehension related to language and math

What are the risk factors of stroke? [Strokes Happen]

S: Smoking (causes HTN)

T:  Thinners (blood vessels)

R: Rhythm changes (A. fib)

O: Oral contraceptives

K: kin ( family history)

E: Excessive weight

S: Senior citizens

H: Hypertention

A: Atherosclerosis

P: Physical inactivity

P: Previous TIA

E: Elevated glucose (DM: stuck blood vessel)

N: Aneurysm brain

 

Tell me about the symptoms of CVS: BE/ FAST

B: Balance (loss of balance, HA or dizziness

E: Eyes: blurred vision

 

F: Facial dropping

A: Arms weakness

S: Speech difficulty

T: Time

 

Explain the stroke algorithm: 

• What is included in your initial assessment?

           FAST: assessment should be quickly done by using FAST tools. 

• What assessment tools can you use?

           FAST tools and NIHSS scale

• How do you distinguish between the two main types of STROKEs?

           CT/ MRI: distinguish if there is a hemorrhage or not. 

• How is the blockage of stroke treated?

           tPA (tissue plasminogen activator in 3 hrs. / dissolve the clot by activating the protein       

           that causes fibrinolysis

• What is the criteria for using rTPA including neurological signs?

          ischemic stroke causing measurable neurologic deficit/ onset of symptoms within 3 to 

          4 and half hrs., 

• What is the criteria for using aspirin?

         an initial aspirin dose of 325 mg within 24 to 48 hrs of the onset of symptoms

          When the patient is not candidate of rTPA, using aspirin,

 

Explain your nursing management for acute stroke [BRAIN ATTACK]

B: blood pressure (labetalol, nicardipine)

R: respiration (oxygen-target SaO2>94%)

A: airway

I: imaging (CT/ MRI)

N: Normoglycemia (glucose target: 140-180)

A: antiplatelets / Aspirin

T: temperature (target 37~+/ =0.5)

T: thrombolysis (rTPA) for ischemic stroke

A: assess swallowing, nutrition and hydration

C: continence ( Avoid indwelling catheters) 

K: keep up to date with patient positioning (head-end elevation)

 

Take a look at the DPP and answer the following questions: 

• What is the meaning of door to needle time? How long should it be?

           the time btw hospital arrival and IVT administration (intravenous thrombolytic therapy)

• What is the definition of stroke code activation?

           initiating a bundle of care that ensures rapid recognition of acute stroke patients in the  

            triage desk 

• What is the Stroke Code Activation Criteria? 

           Less than or equal to 80 years old

           Symptom onset less than 6 hrs

           Measurable neuro deficit: aphasia(language difficulty, expressive or receptive)/ severe    

           dysarthria ( slurring of speech)/ unilateral weakness/ unilateral numbness/ severe 

            ataxia, unilateral dysmetria/ imbalance of one side

           Visual field deficit/ blinding in one eye

           Patient should not bedridden or demented before stroke

• What is included in the Stroke Code Order (lab + nursing interventions)

         CT head with CT angiogram (stroke protocol)/ CBS, Chem, CPK, PT, PTT or INR/ point 

         of blood sugar level, urine pregnancy test

         NI: completion of the stroke activation form/ Keep NPO/ Cardiac monitoring/ Foley       

          catheter, IV access, O2 apply

 

After assessment of the patients, you find out that the patient is not having a stroke, but has another neurological disorder. What will you do next?

The stroke team will refer patient to neurology consult team or on call neurology physician team will make appropriate neurological plan