Stroke for Certified Emergency Nursing (CEN)
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Outline
Stroke
Definition/Etiology:
I know that you know this, but a stroke occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts. In either case, parts of the brain become damaged or die.
Risk factors for stroke include, but are not limited to:
Hypertension, hyperlipidemia, A-fib, Diabetes, smoking, oral contraceptives, cardiac disease, and recent neck trauma.
Pathophysiology:
As we know, there are 2 types of strokes: Ischemic and hemorrhagic. We could get really deep into the patho behind each, but here is the important point: Ischemic stroke is caused by deficient blood and oxygen supply to the brain; hemorrhagic stroke is caused by bleeding or leaky blood vessels.
Clinical Presentation:
Signs of ischemic stroke –
Sudden onset of:
- Unilateral facial weakness
- Unilateral weakness of the arm or leg
- Expressive or receptive aphasia, or both
- Headache, nausea, vomiting
- Vertigo, ataxia
- Visual disturbances
- Numbness or tingling
Hemorrhagic stroke signs:
- The above as well as
- Rapidly decreasing level of consciousness – leading to possible coma
- HTN
Findings more common with a bleed: N/V, photophobia, phonophobia
Collaborative Management:
- CODE STROKE (or whatever your facility calls it)
- Need immediate CT to determine type and location of stroke
- Lab work – CBC, CMP, Coags, cardiac enzymes if cardiac related
- Blood Glucose
- Neuro or neurosurge involvement
- NIHSS
- Determine need for TPA
- If GCS <8, intubate?
- 2 large bore IV
- O2
Evaluation | Patient Monitoring | Education:
- Frequent, frequent, frequent neuro checks
- NIHSS
- GCS
- Determine effectiveness of TPA – follow hospital protocols
- Antihypertensive meds – Do not drop too low. Maintain SBP <185 and DBP <110
Linchpins: (Key Points)
- Time is brain
- What type
- Frequent reassessments
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Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2022). Emergency Nursing Orientation 3.0. Cambridge, MA: Elsevier, Inc.
- Sheehy, S. B., Hammond, B. B., & Zimmerman, P. G. (2013). Sheehy’s manual of emergency care (Vol. 7th Edition). St. Louis, MO: Elsevier/Mosby.
- ✓Full lesson outlines
- ✓NCLEX simulator (SIMCLEX)
- ✓6,500+ practice questions
- ✓2,000+ lesson videos
- ✓300+ cheatsheets
200% NCLEX Pass Guarantee.
No Contract. Cancel Anytime.
med surg
Concepts Covered:
- Cardiac Disorders
- Cardiovascular
- Emergency Care of the Cardiac Patient
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Central Nervous System Disorders – Brain
- Neurological
- Noninfectious Respiratory Disorder
- Respiratory
- Hematologic Disorders
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Factors Influencing Community Health
- Immunological Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Medication Administration
- Vascular Disorders
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Gastrointestinal Disorders
- Newborn Complications
- Peripheral Nervous System Disorders
- Studying
- Integumentary Disorders
- Communication
- Microbiology
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Integumentary Disorders
- Musculoskeletal Disorders
- Circulatory System
- EENT Disorders
- Postoperative Nursing
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Fundamentals of Emergency Nursing
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Tissues and Glands
- Urinary System
- Emergency Care of the Neurological Patient
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Nervous System
- Respiratory Disorders
- Respiratory System
- Infectious Disease Disorders
- EENT Disorders
- Emergency Care of the Respiratory Patient