Ischemic (CVA) Stroke Labs

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Chance Reaves
MSN-Ed,RN
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Included In This Lesson

Study Tools For Ischemic (CVA) Stroke Labs

Stroke Assessments (Mnemonic)
Stroke Pathochart (Cheatsheet)
Stroke Locations (Cheatsheet)
Cerebral Circulation (Image)
Overview Of Nervous System (Image)
Brain MRI (Image)
Unequal Pupils (Image)
Cerebral Blood Flow Scan (Image)
Intraparenchymal Hemorrhage (Image)
NIHSS Image (Image)
Picture Board For Aphasia (Image)
Communiation Board For Aphasia (Image)
63 Must Know Lab Values (Book)
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Outline

Overview

  1. Ischemic stroke
    1. Labs to consider for disease process
    2. Lab purposes
    3. Special Considerations

Nursing Points

General

  1. Ischemic stroke
    1. Labs to consider for disease process
      1. Comprehensive/Basic metabolic panel
      2. Capillary Blood Glucose (CBG)
      3. Lipids
      4. Complete blood count
      5. Coagulation studies
    2. Lab purposes
      1. Comprehensive/Basic metabolic panel
        1. Organ function
        2. Electrolytes
          1. Sodium
            1. Low sodium causes cerebral edema
      2. Capillary Blood Glucose
        1. Bedside testing
          1. Quick testing
          2. Hypoglycemia mimics stroke
          3. Rule out at bedside
      3. Lipids
        1. Determines risk for arteriosclerosis
        2. Increased risk of ischemic stroke
      4. Complete Blood Count
        1. Anemia
        2. Infection
        3. Platelets
          1. Anticoagulation therapy based on platelet counts
            1. tPA
      5. Coagulation studies
        1. Monitoring therapy of other anticoagulants
    3. Special considerations
      1. CMP/BMP
        1. Green top
      2. CBG
        1. Bedside blood sugar  testing
      3. Lipid panel
        1. Green top
      4. CBC
        1. Lavender top
      5. Coagulation studies
        1. Blue top

Nursing Concepts

  1. Intracranial Regulation
  2. Perfusion
  3. Lab Values

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Transcript

All right in this lesson we’re going to take a look at the labs associated with ischemic stroke

Similar to that some of the other lessons, what we’ve done is we’ve gotten together a framework of the potential labs that you may end up seeing for your patients with particular illnesses, diseases, or injuries. This is not an all-inclusive list, but I want you to understand that our goal here is to give you some sort of idea of the labs that you may potentially run into so that you know why we do them.

What we’re dealing with patients with ischemic strokes, it’s a really common admission. The goal here is to number one, access them quickly which is why we do some of the labs that we do. We need to differentiate between an ischemic stroke and a hemorrhagic stroke because the treatments are vastly different. Once we figure out what’s going on with our patient then we can develop an a plan of care focused on what’s going on with them.

The first test you’ll probably see is some form of imaging. This is most commonly a CT scan and sometimes MRIs. But we’ll go into that a little bit. Other tests that you’re going to see our comprehensive or a basic metabolic panel and also cbgs, or capillary blood glucoses. It’s not uncommon to get lipid panels on these guys and also to do complete blood counts and coagulation studies

The reasons why we do these are very very important. Aside from all the imaging associated with it these are the labs that you’re most likely going to run into.

With the comprehensive or basic metabolic panel, we’re looking at organ function. We want to get an idea of what’s going on inside of our patient. The other thing that we pay attention to particular really early electrolytes mostly sodium. Low sodium causes cerebral edema, so we want to make sure that our sodium levels are good.

Your the thing you’re going to do is probably a capillary blood glucose or bedside glucose testing. The reason you do it for a couple of reasons. First it’s quick, and it gives you pretty immediate results. Secondly, hypoglycemia mimics stroke. The treatment for low blood sugar is so much easier than treating a patient is having an ischemic stroke. So identifying that it’s not actually low blood sugar and then it actually is a stroke helps us to take the correct steps.

The other thing that we’re going to take a look at is CBC. The reason we take a look at CBC is because we want to keep an eye on those platelets. Platelets play a role in how we use TPA to break up those clots. There’s a great lesson on ischemic strokes I encourage you to check it out and it goes more into depth about treatment options, but this is why you need to pay attention to it. The other reason we want to check the CBC out as to check for any sources of infection or potential anemia.

When we do a lipid panel is what we’re looking for a risk for plaques. High levels of lipid deposits in a blood like cholesterol and LDL can contribute to risk for ischemic stroke.

And lastly we want to pay attention to those coagulation studies. If we’re going to put our patient on any sort of anticoagulants in the future, we need to know where we start from the beginning.

So what do you need to know about whenever you’re submitting your Labs? First off know that your metabolic panel and your electrolytes are going to go in a green top tube. Your CBC is going to go in the lavender top tube, and your coags are going to go into your blue top tube. Also your lipids go into your green top tube as well.

Well you do have a glucose that comes back with your metabolic panel, you’re also going to be using your bedside glucometer to check your cbgs on your patient.
For patients that have an ischemic stroke, are nursing Concepts focus on lab values, intracranial regulation and perfusion.
So let’s recap.

Imaging is one of the first steps that you’re going to see for a patient that suspicious of an ischemic stroke. You need to see if there’s an active lead or if there’s ischemia. We need to figure out what’s going on so that we make the correct steps to treat it.

You’re going to check out my metabolic panel is to look at organ function and electrolytes particularly sodium.

You’re going to be doing CGBs of the bedside, mainly because they quickly realized hypoglycemia which mimics and ischemic stroke.

Your patients will also probably getting lipid panels to identify risks of plaques and arteriosclerosis.

Finally your patient will probably be getting some coagulation studies just to check for monitoring problems and you need to do you.

And that’s all I sent for patients that had ischemic stroke and the labs that you may see for them. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

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Study Plan Lessons

Burn Injuries
Burn Injuries
Burn Injury Case Study (60 min)
Burns for Certified Emergency Nursing (CEN)
Fluid Shifts (Ascites) (Pleural Effusion)
Electrolyte Imbalances for Progressive Care Certified Nurse (PCCN)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Head Trauma & Traumatic Brain Injury
Cold Temperature-related Emergencies for Certified Emergency Nursing (CEN)
Increased Intracranial Pressure (ICP) for Certified Emergency Nursing (CEN)
Nursing Care Plan (NCP) for Skull Fractures
Nursing Case Study for Head Injury
07.01 CVA (Cerebrovascular Accident/Stroke) for CCRN Review
Ischemic (CVA) Stroke Labs
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Nursing Care Plan (NCP) for Stroke (CVA)
Stroke Assessment (CVA)
Stroke for Progressive Care Certified Nurse (PCCN)
Transient Ischemic Attack (TIA) for Certified Emergency Nursing (CEN)
03.02 Diabetes Insipidus for CCRN Review
03.04 DKA vs HHNK for CCRN Review
07.01 CVA (Cerebrovascular Accident/Stroke) for CCRN Review
07.06 Increased Intracranial Pressure (ICP) for CCRN Review
07.07 Cerebral Perfusion Pressure for CCRN Review
02.13 Myocardial Infarction – Anterior Septal Wall for CCRN Review
02.12 Myocardial Infarction- Inferior Wall for CCRN Review
03.04 DKA vs HHNK for CCRN Review
Diabetic Ketoacidosis (DKA) Case Study (45 min)
Diabetic Emergencies for Certified Emergency Nursing (CEN)
DKA Treatment Nursing Mnemonic (KING UFC)
Fluid Volume Deficit
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Diabetic Ketoacidosis (DKA)
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Complications of Spinal Cord Injuries Nursing Mnemonic (ABCDEFG)
Head and Spinal Cord Trauma for Certified Emergency Nursing (CEN)
Neurological Fractures
Nursing Care Plan (NCP) for Skull Fractures
Nursing Care Plan (NCP) for Spinal Cord Injury
Spinal Cord Injury
Spinal Cord Injury Case Study (60 min)
Increased Intracranial Pressure (ICP) for Certified Emergency Nursing (CEN)
Disasters & Bioterrorism