AANN Core Curriculum, 7th Edition, Ch. 17 Ischemic Stroke: Digital Version-Chapter 17

Chapter 17

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Ischemic stroke results from reduced cerebral blood flow, most often due to thrombosis, embolism, or small-vessel disease. Other causes include arterial dissection, hypercoagulability, and sickle cell disease. The affected brain region determines symptoms, which may include weakness or numbness, speech or swallowing problems, visual loss, imbalance, and cognitive or perceptual changes. Major risks include hypertension, diabetes, high cholesterol, atrial fibrillation, carotid disease, smoking, inactivity, and prior stroke or TIA; prevention focuses on managing medical and lifestyle risks.<br /><br />Rapid assessment is essential. Record symptom onset, perform neurological examination and NIHSS scoring, check glucose and oxygenation, and obtain urgent noncontrast CT or MRI to exclude hemorrhage. CT/MR angiography and perfusion imaging can identify vessel occlusion and salvageable tissue. Eligible patients may receive IV alteplase within the approved treatment window; selected patients with large-vessel occlusion may undergo mechanical thrombectomy, in some cases up to 24 hours after last known well. Blood pressure targets depend on treatment, and hypotension should be avoided.<br /><br />Nursing priorities include frequent neurological and vital-sign monitoring, prompt recognition of bleeding or deterioration after thrombolysis, cardiac monitoring, glucose and blood-pressure management, hydration, and assessment for airway compromise and swallowing safety. Prevent aspiration, immobility complications, skin injury, and falls; promote early mobilization, rehabilitation, and communication support.<br /><br />A transient ischemic attack (TIA) causes temporary focal neurological symptoms without acute infarction, but signals substantial future stroke risk. Evaluate symptoms and risk factors promptly, use the ABCD2 score to support disposition decisions, and complete urgent neuroimaging and vascular/cardiac assessment. Prevention may include antiplatelet or anticoagulant therapy according to the cause, risk-factor treatment, and carotid revascularization for appropriate symptomatic stenosis. Carotid endarterectomy is generally preferred for suitable candidates; stenting may be considered when surgery is unsuitable.

Keywords

ischemic stroke

cerebral blood flow

thrombosis

embolism

neurological assessment

NIHSS

thrombolysis

mechanical thrombectomy

transient ischemic attack

carotid endarterectomy