Stroke Management
Outline your priorities of care for Martin on his arrival in the emergency department at your major metropolitan hospital.
Kirkness explains that priority should be given to airway management and oxygenation. Generally, all patients should be placed on oxygen. The head of the bed should be slightly elevated, and a cardiac monitor and intravenous access established. Unless there is hypotension, fluids should be administered judiciously to prevent cerebral edema. 2 Primary assessments are focused on cardiac and respiratory status and neurological assessment. The nursing history is obtained as follows: 1) description of the current illness with attention to initial symptoms, including onset and duration, nature (intermittent or continuous) and changes. 2) History of similar symptoms previously experienced. 3) Current medications. 4) History of risk factors and other illnesses such as hypertension and 5) family history of stroke or cardiovascular disease (2000 p.1526).
Miller & Elmore explain the following guidelines for responding to a stroke;
Within 10 minute of arrival:
- Asses patient’s ABCs and vital signs
- Provide oxygen by nasal cannula
- Establish IV access
- Collect blood sample
- Perform a 12-lead electrocardiogram and attach patient to a cardiac monitor
- Perform general neurological screening, including motor function, strength and equality
Within 25 minutes of arrival:
- Review patient’s history
- Establish the time of stroke onset
- Perform physical examination
- Determine patient’s level of consciousness using the Glasgow coma scale, and stroke severity
Smith, Johnston and Easton further add that clinical examination should be focused on the peripheral and cervical vascular system (carotid auscultation for bruits, blood pressure and pressure comparison between arms), the heart (dysrhythmia, murmurs), extremities (peripheral emboli), and retina. A neurological examination is performed to localise the site of the stroke, imaging
Kirkness explains that priority should be given to airway management and oxygenation. Generally, all patients should be placed on oxygen. The head of the bed should be slightly elevated, and a cardiac monitor and intravenous access established. Unless there is hypotension, fluids should be administered judiciously to prevent cerebral edema. 2 Primary assessments are focused on cardiac and respiratory status and neurological assessment. The nursing history is obtained as follows: 1) description of the current illness with attention to initial symptoms, including onset and duration, nature (intermittent or continuous) and changes. 2) History of similar symptoms previously experienced. 3) Current medications. 4) History of risk factors and other illnesses such as hypertension and 5) family history of stroke or cardiovascular disease (2000 p.1526).
Miller & Elmore explain the following guidelines for responding to a stroke;
Within 10 minute of arrival:
- Asses patient’s ABCs and vital signs
- Provide oxygen by nasal cannula
- Establish IV access
- Collect blood sample
- Perform a 12-lead electrocardiogram and attach patient to a cardiac monitor
- Perform general neurological screening, including motor function, strength and equality
Within 25 minutes of arrival:
- Review patient’s history
- Establish the time of stroke onset
- Perform physical examination
- Determine patient’s level of consciousness using the Glasgow coma scale, and stroke severity
Smith, Johnston and Easton further add that clinical examination should be focused on the peripheral and cervical vascular system (carotid auscultation for bruits, blood pressure and pressure comparison between arms), the heart (dysrhythmia, murmurs), extremities (peripheral emboli), and retina. A neurological examination is performed to localise the site of the stroke, imaging
References: Kirkness (2000) in Medical Surgical Nursing; assessment and management of clinical problems Edited by S, M Lewis M, Mclean S, R Pirksen Walsh, M (2002) Watson’s Clinical Nursing and Related Sciences Elsevier Science Ltd. W, Wisselink. T, F Panetta (2000) Primary Care; Chapter 58 Stroke, Transient Ischemic Attacks and Carotid Stenosis. W, S Smith. J Claibourne Johnston. D, Easton (2001) Harrisons Internal Medicine; Chapter 349 Cerebrovascular Disease. A, M Karch (2000) Lippincotts Nursing Drug Guide Lippincott.