AANN Comprehensive Review for Stroke Nursing, 2nd Edition, Ch. 3 Hyperacute Care: Digital Version-Stroke Chapter 3

Stroke Chapter 3

Pdf Summary

Hyperacute stroke care is time-critical: rapid recognition, EMS activation, effective prehospital–hospital communication, and coordinated interdisciplinary response reduce brain injury and disability. Initial assessment prioritizes airway, breathing, circulation, vital signs, blood glucose, cardiac monitoring, symptom onset or last-known-well time, and neurologic status. Stroke scales such as CPSS and LAPSS help identify stroke before arrival; severity tools can flag possible large-vessel occlusion (LVO). In hospital, the NIH Stroke Scale (NIHSS) documents deficit severity, while the Glasgow Coma Scale assesses consciousness.<br /><br />Urgent noncontrast head CT distinguishes ischemic from hemorrhagic stroke and must precede thrombolysis. CT angiography identifies vessel occlusions and other vascular lesions; perfusion imaging may identify salvageable tissue for thrombectomy decisions. Additional imaging should not delay eligible intravenous thrombolysis. Stroke mimics—including seizures, migraine, hypoglycemia, and metabolic disorders—should also be considered.<br /><br />For eligible acute ischemic stroke patients, alteplase is administered promptly after contraindications are reviewed; tenecteplase may be an alternative in selected circumstances. Close blood-pressure, vital-sign, and neurologic monitoring is required during and after treatment, with urgent imaging if deterioration suggests bleeding. Mechanical thrombectomy is an option for selected LVO patients, including some treated up to 24 hours after last known well. Post-procedure care includes neurologic and blood-pressure monitoring and assessment of the arterial access site.<br /><br />General nursing care supports oxygenation and euvolemia, manages glucose, temperature, and blood pressure, and keeps patients NPO until swallowing is screened. Hemorrhagic stroke management may require blood-pressure control, anticoagulant reversal, intracranial-pressure treatment, ventricular drainage, or surgery. Patients should be stabilized and admitted or transferred to an appropriate stroke-capable center.

Keywords

hyperacute stroke care

rapid recognition

EMS activation

NIH Stroke Scale

Glasgow Coma Scale

noncontrast head CT

CT angiography

alteplase

mechanical thrombectomy

hemorrhagic stroke management