5 Ways Nurses Can Recognize If A Patient Is Having a Stroke

Imagine you are on shift and it’s time for your 4 AM neuro assessment. You notice that your patient is displaying neurological changes. What actions should you take, and what should you anticipate for the plan of care for your patient?

You should ask yourself, “Is my patient having a stroke?” Remember: time is brain!

Here are five steps every nurse should take when you’re trying to determine whether or not your patient is having a stroke:

1. Notify  your provider and activate a code stroke if possible in your facility.  A code stroke activates a Neurology resident, a Rapid Response Nurse, and clears the CT scanner for a head CT.
2. Perform a thorough neuro exam (NIHSS), get updated vitals, ensure hemodynamics are ok, and airway is patent.  Check your patient’s blood glucose.
3. Aim to have a non-contrast head CT within 20 minutes and get it read within 45 minutes.
4. The team will  need to determine if the stroke is ischemic or hemorrhagic.
5. Plan for frequent neuro checks and blood pressure management which will vary depending on which type of stroke your patient has. 

Check out the table below for potential treatment plans for ischemic vs hemorrhagic strokes:

The National Institute of Health Stroke Scale (NIHSS), used to quantify the impairment caused by stroke, can be found HERE.

As you can see, the higher the stroke score, the more likely it is that your patient has a severe stroke.

As we recognize National Stroke Awareness Month this May, it’s the perfect time to sharpen your stroke assessment skills and deepen your understanding of neurologic care. Whether you’re a new ICU nurse or a seasoned clinician, ongoing education is essential to providing high-quality, evidence-based care for patients experiencing stroke.

Nicole Kupchik Consulting offers a range of valuable resources to support your professional growth:

• Stroke Review Boot Camp: Case Studies in Optimizing Care – A case-based course designed to enhance stroke recognition, assessment, and prevention.
• CCRN Online Course and Book Bundle – Study resources that include sections on both neuro and stroke education
• Critical Care Survival Guide – A must-have for ICU nurses, featuring a robust neurologic section

Explore these resources and take the next step in becoming a more informed, prepared, and empowered nurse in the cases of stroke!

References:

https://reference.medscape.com/calculator/273/nih-stroke-scale-score-nihss

https://emedicine.medscape.com/article/1916852-treatment#d19

https://emedicine.medscape.com/article/1916662-overview?_gl=1*1w6gyzu*_gcl_au*MTM0MDM1NDI0MC4xNzQ0OTI5MDA3

https://www-uptodate-com.offcampus.lib.washington.edu/contents/initial-assessment-and-management-of-acute-stroke?search=Initial%20assessment%20and%20management%20of%20acute%20stroke&source=search_result&selectedTitle=1%7E150&usage_type=default&display_rank=1