Neuro 101 Toolkit-Acute Ischemic Stroke Posthyperacute and Prehospital Discharge

Acute Ischemic Stroke Posthyperacute and Prehospital Discharge

Pdf Summary

This American Heart Association scientific statement updates recommendations for nursing and interprofessional care of adults hospitalized with acute ischemic stroke after the hyperacute phase and before discharge. It emphasizes admission to a dedicated stroke unit, where coordinated specialist care is associated with lower mortality, better function, and greater likelihood of returning home. Patients with strokes occurring in hospital or admitted to other wards should receive equally prompt, protocol-driven assessment and treatment.<br /><br />Nurses should conduct ongoing neurological and vital-sign assessments, including use of the full NIH Stroke Scale, and monitor oxygenation, blood pressure, temperature, and blood glucose. Evidence-based “Fever, Sugar, Swallowing” (FeSS) protocols—timely fever and hyperglycemia treatment and early swallowing screening—can improve outcomes. Patients should remain without oral food, fluids, or medication until a trained clinician screens swallowing; those who fail screening need formal assessment and an individualized nutrition and safety plan.<br /><br />The statement also highlights prevention, early detection, and management of complications, including neurological deterioration, cardiac events, pneumonia, urinary and gastrointestinal problems, cognitive and mood disorders, delirium, falls, pressure injuries, pain, and venous thromboembolism. Rehabilitation should be tailored to patient tolerance; short, frequent mobilization is encouraged, while high-dose mobilization very early after stroke should be avoided.<br /><br />Discharge planning should begin before hospitalization ends and involve patients, families, and the interprofessional team. It should address rehabilitation and support needs, medication and risk-factor management, secondary prevention, self-management education, caregiver preparation, follow-up, and community resources. Shared decision-making and culturally respectful goals-of-care discussions are essential. Nurse-led transitional support and appropriate telehealth may help continuity and reduce readmissions.<br /><br />The statement concludes that evidence-based nursing care can reduce complications and improve recovery, but important gaps remain—particularly in defining specialized stroke nursing and establishing how nursing expertise and certification affect patient and family outcomes. Further nurse-led research is needed.

Keywords

acute ischemic stroke

stroke unit

nursing care

NIH Stroke Scale

FeSS protocol

swallowing screening

complication prevention

rehabilitation

discharge planning

secondary prevention