Episode Details

Core Concepts & Emergency Recognition A stroke is an emergency where cell death occurs due to ischemia (inadequate blood flow, 87% of cases) or hemorrhage (bleeding, 13%). Interruption of blood flow alters brain metabolism in 30 seconds, stops it in 2 minutes, and causes cell death in 5 minutes. The FAST protocol is critical for rapid recognition: Face drooping, Arm weakness/drift, Speech difficulties, and Time of symptom onset (critical for determining treatment eligibility).

Pathophysiology & Classification

• Ischemic Stroke: Divided into Thrombotic (60% of cases; associated with hypertension, diabetes, and atherosclerosis; symptoms develop slowly/stepwise) and Embolic (clot from the heart, often due to atrial fibrillation, travels and occludes a cerebral artery; onset is sudden with severe deficits).
• Hemorrhagic Stroke: Includes Intracerebral (bleeding into brain tissue, mostly caused by hypertension) and Subarachnoid (SAH) (bleeding into CSF-filled space, often from ruptured aneurysms). SAH can trigger severe vasospasms, peaking 6–10 days post-bleed.

Key Diagnostics & Triage Immediate noncontrast head CT or MRI is mandatory to rapidly differentiate ischemic from hemorrhage. The NIH Stroke Scale (NIHSS) (scores 0–42) is the primary clinical tool to document baseline severity and track neurologic changes.

Acute Interventions & Hemodynamic Targets

• Ischemic: IV tPA must be given within 3 to 4.5 hours of symptom onset after screening out hemorrhage, active bleeding, or recent trauma. Endovascular therapy with stent retrievers is highly effective. Keep BP <185/110 mmHg before tPA, and <180/105 mmHg for 24 hours after. If ineligible for tPA, lower BP only if SBP >220 or DBP >120 mmHg.
• Hemorrhagic: Anticoagulants and antiplatelets are strictly contraindicated. Manage hypertension to maintain SBP <160 mmHg. For SAH, administer the calcium channel blocker nimodipine to prevent vasospasm.

High-Priority Nursing ADPIE Actions

1. Airway & Aspiration: Keep the patient NPO until a formal swallowing screen is completed within 24 hours to prevent aspiration pneumonia.
2. ICP Management: Elevate the head of bed 30°, keep head/neck in midline, and avoid hip flexion to maximize venous drainage and reduce intracranial pressure.
3. Safety & Pattern Recognition: Left-brain stroke causes right hemiplegia, aphasia, slow/cautious behavior, and depression. Right-brain stroke causes left hemiplegia, spatial-perceptual neglect, and highly impulsive, safety-compromising behavior. Protect from injury and address one-sided neglect.
4. VTE Prophylaxis: Implement passive/active range of motion, sequential compression devices, and low-molecular-weight heparin.