Stroke

• Sign of Stroke

  • Face uneven
  • Arm hanging down
  • Slurred Speech
  • Time to call 911
• Stroke is when there is ischemia or hemorrhage in the brain. Risk factors include age, male, African-American, hypertension, metabolic syndrome, alcohol, heart disease, smoking and diabetes
• Types of Stroke

  • Transient Ischemic Stroke
  • last less than 1 hour and easy to recover from. Person will experience vision difficulty, hemiparesis, diplopia, dysphagia, ataxia, vertigo and dysarthria
  • Treatments include platelet inhibitor, aspirin and anticoagulants
  • Ischemic Stroke: atherosclerosis is the number one cause. Can be thrombotic where the clot stays in one part of the brain or embolic where the clot moves around the brain
  • Hemorrhagic Stroke: hypertension is the number one cause. Symptoms include worst headache of their life, hypertension, decrease LOC, nausea and vomiting
• • NIHSS Stroke scale measures level of consciousness
  • Other test include cerebellar function (aka balance test), DTR, and GCS
• hemiparesis is weakness on one side of the body
• hemiplegia is paralysis on one side of the body
• Dysphagia is impaired swallowing
• Akinesia is loss of voluntary movement
• Aphasia is loss of speech
• Dysarthria is impaired muscle of speech
• Global Aphasia is loss of speech and comprehension
• Expressive (Broca's) Aphasia is loss of speech production, while receptive (Wernicke's) aphasia is loss of comprehension
• Apraxia is being unable to complete lots of command at a time
• Agnosia is being unable to recognise objects
• The golden diagnostic test for a stroke is CAT scan which is done within 25 minutes of ED arrival
• Use drugs to lower blood pressure only if MAP is >130 or SBP is >220
• Thrombolytics are for ischemic strokes only and are given within 4.5 hours of symptoms but best in less than 60 munites
• Nursing management after a stroke

  • Neuro checks hourly
  • Before 48 hours after a stroke check VS Q 1 hour then Q 2 hour and after 48 hours check VS Q 4 hours
  • Put Trochanter roller at hip to prevent external rotation
  • ROM exercises
  • Arm support with slings