AANN Comprehensive Review for Stroke Nursing, 2nd Edition, Ch. 5 Acute Care: Digital Version-Stroke Chapter 5

Stroke Chapter 5

Pdf Summary

Acute stroke care covers the period after initial emergency treatment: generally 24–72 hours after ischemic stroke or until discharge, and from hospital presentation through discharge for intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Patients may deteriorate rapidly, so nurses should perform serial, stroke-focused neurologic assessments and promptly report changes. Scales such as the NIH Stroke Scale, Glasgow Coma Scale, FOUR Score, ICH score, and SAH grading scales support assessment, risk estimation, and care planning, but should not replace a comprehensive examination.<br /><br />Diagnostic evaluation may include CT, MRI, vascular imaging, cardiac studies, and laboratory tests. Specialized stroke units and interdisciplinary collaboration help detect complications, coordinate treatment, and support recovery. Core care includes monitoring vital signs and cardiac rhythm; maintaining oxygenation, appropriate glucose and temperature; assessing pain; and preventing aspiration, falls, seizures, skin injury, infection, and venous thromboembolism. Screen swallowing before any oral intake, promote safe positioning and mobilization when stable, support nutrition and elimination, and address psychosocial, spiritual, educational, and functional needs.<br /><br />For ischemic stroke, blood-pressure targets depend on treatment: permissive hypertension is generally allowed unless pressure is very high or alteplase is planned. After alteplase or thrombectomy, close neurologic, blood-pressure, and bleeding monitoring is essential. Nurses also monitor access sites and distal circulation after endovascular procedures and watch for reperfusion complications.<br /><br />ICH care emphasizes blood-pressure control, assessment and reversal of coagulopathy when indicated, and prevention of hematoma expansion and complications. SAH care includes securing the aneurysm, monitoring for delayed cerebral ischemia and vasospasm, administering nimodipine, and maintaining euvolemia. Raised intracranial pressure may require head elevation, neutral alignment, osmotherapy, cerebrospinal-fluid drainage, or surgery.<br /><br />The chapter also reviews less common stroke-related conditions, including transient ischemic attack, cerebral venous thrombosis, arterial dissection, moyamoya disease, hypercoagulable disorders, vasculitis, and vascular malformations.

Keywords

acute stroke care

ischemic stroke

intracerebral hemorrhage

subarachnoid hemorrhage

neurologic assessment

NIH Stroke Scale

blood pressure control

swallowing screening

vasospasm

cerebral venous thrombosis