Collaborative care

• Goals of stroke prevention include health promotion and management of modifiable risk factors such as HTN or diabetes
• Drug therapy prevention

  • antiplatelet drugs (aspirin or plavix) are usually the chosen treatment to prevent strokes with pts with previous ischemic strokes or TIAs
  • oral anticoagulants if atrial fibrillation
  • statins if non cardio embolic ischemic stroke or TIA = decrease lipid level and plaque formation
• Surgical preventive interventions for pts with TIAs

  • transluminal angioplasty (open blocked artery)
  • stenting
  • carotid endarterectomy (remove atherosclerotic plaque)
• Signs of stroke:

  F: face is drooped

  A: arm drifts down

  S: speech is slurred

  T: time is crucial
• First diagnostic study performed is a non contrast brain CT scan to distinguish between and ischemic and hemorrhagic stroke
• Other diagnostic studies

  • MRI
  • cerebral angiography (image or artery)
  • carotid duplex scanning (carotid artery ultrasound)
  • echocardiography (clot in heart)
• Acute care goals

  • preserve life
  • prevent further brain damage
  • reduce disability
• Treatment for stroke differs according to type of stroke and time of onset (most important info)
• Time is function

  • rapid reperfusion can restore function to surrounding tissue
  • 4.5 hour window: treatment with thrombolytics (lyse clot) to achieve maximum recovery of cell function
  • 6 hour window: thrombectomy to remove clot
• Inclusion criteria for thrombolytics

  • acute ischemic stroke
  • disabling stroke
  • risks and benefits are within the goals of care
  • life expectancy of over 3 months
  • pt is over 18 years old
• Absolute exclusion criteria for thromolytics:

  • active hemorrhage
  • risk of major hemorrhage
  • hemorrhage on brain imaging
• Relative exclusion criteria for thrombolytics

  • major surgery in last 14 days
  • arterial puncture in last 7 days at non compressible site
  • history of intracranial hemorrhage
• Ongoing monitoring

  • VS
  • patient airway (no obstruction)
  • LOC
  • motor and sensory function
  • pupillary response
• Goals when stroke is stabilized, done through rehabilitation

  • lessen disability
  • attaining optimal functioning
• Platelet inhibitors and anticoagulants may be used in patients with stroke caused by thrombi and emboli when stroke is stabilized