Stroke for Certified Emergency Nursing (CEN)

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