Review of Acute Stroke Treatment Goals – Stroke Nursing Care in ER

00:01 Hi. Welcome to our series on neurological disorders.

00:05 Now this one is going to be so fun.

00:07 We're going to talk about the hands-on nursing care of a stroke patient in ER.

00:12 But first, let's go with a little bit of a background.

00:15 So, I know there's a lot of you out there that are super excited to get into being an ER nurse.

00:21 But all of us need to understand what goes on in the ER as you're treating these patients.

00:26 So, this patient, if we come in with a suspected stroke, this patient is going to be seen very quickly.

00:33 So let's talk about what our main priorities are.

00:36 Now I know you hate that word, priorities, because we usually use it in nursing school, meaning, "Hey, here's a multiple choice exam with 4 answers, and they're all correct.

00:47 So we need you to pick the priority." So I know you're super frustrated with that word, but trust me, this is where priorities really matter.

00:57 This is when we pick what's most important is going to keep our patient the safest.

01:01 So, we'll walk through this together and it'll become very clear to you what you would do in this situation in an ER setting with a patient having neurological symptoms.

01:11 Okay, so first of all, hey, it doesn't matter what system we're talking about.

01:16 Our goal is always to maintain medical stability of a patient's ABCs.

01:23 So we're starting with something that's very familiar with you.

01:25 But you always want to work with the patient's airway, breathing, and circulation.

01:31 So no matter what the crisis, or what's going on, if you're keeping up with a patient's ABCs, you've got some time to think through the next step.

01:41 So whenever you walk in a room, automatically, that's your first thought, ABCs.

01:46 If that's okay, then we've got some time to deal.

01:49 Okay, so you want rapid assessment identification of a stroke, whether it's a stroke or it's a heart attack, and we're talking about blood supply to an important organ, and they're all important.

02:00 But we're talking about something like blood supply to my brain or to my heart.

02:05 The quicker you identify these patients, assess them, and know that they're at risk, we can get treatment started more quickly.

02:12 So, part of the goal would be to rule out all other possible causes.

02:17 Sometimes people do weird neuro things when their blood sugar's low.

02:21 Sometimes, elderly people can have a UTI, and they're acting 4 shades of crazy, but they're not having a stroke.

02:28 It'll look like they're having a stroke, but they're just disoriented from the infection.

02:34 So, get them in, watch their ABCs, then we're going to rapidly identify that this person could be possibly having a stroke.

02:42 Then we're going to work quickly to rule out other causes that could be doing these weird, kind of, neuro things in the patient.

02:48 So, very top priority is CT or an MRI.

02:52 We want to get that patient to brain imaging so we can figure out if they're having an ischemic or a hemorrhagic stroke, and we'll talk about the differences between the 2.

03:03 Ischemic means, hey, oxygen has been cut off to that part of the brain or interrupted to that brain.

03:08 Hemorrhagic means that patient is bleeding in their head.

03:12 Both are emergencies, but we treat them very differently.

03:16 Okay, so you've rolled into ER. We know we get -- take care of ABCs.

03:20 We want to identify and assess them very quickly, rule out other causes and get them to CT or MRI.

03:27 Now, lots of big hospitals have this very close, if not in the same unit, as ER so they can rapidly get the patient to that testing.

03:36 Because see, our goal is we want to preserve the function the patient has, and minimize any further neurological damage or problems.

03:44 Now, all this would make sense, right? Think of this as if we were walking through this experience with someone you really cared about, someone that is close to you.

03:55 What are the priorities that you would want the nurse to do? See, that's why we should treat every patient.

04:00 If this was someone who was important to us personally, what would we want done for them? And we want to do the same thing for all our patients.

04:07 So we want to preserve the function they have, and minimize any further problems.

04:12 We're going to figure out what's the best treatment option? Are we going to do thrombolytic therapy? Are we going to do a thrombectomy? What needs to be done? And finally, if the patient is a candidate for thrombolytic therapy, we want to make sure within 4-5 hours, and really closer to 4, that we get that medication to them safely from the onset of their symptoms.

04:34 Okay, so, you gathering an accurate history from the family members, from the people who bring the patient to the hospital, and for the physician, so they know our best guess of when these symptoms started.

04:47 Okay, so that's it. This is a great summary slide that says that's what our priorities are.

04:53 We're going to walk you through though, exactly how we accomplish those priorities.

04:58 But remember, time is tissue.

05:01 That's why we need to know as close as possible, what time the symptoms started, because we want to know that for both ischemic and hemorrhagic strokes.

05:12 The earlier we can get to an acute stroke and identify it, the more likely the treatment will minimize the potential deficits the patient's going to have because strokes impact all areas of a patient's daily life.

05:25 Their ability to move, their bowel and bladder function, their ability to swallow, how they think about things, making decisions or executive level functioning, how they communicate or speak with people.

05:38 Their personality can be very different, their mood and their affect and even their spatial perceptual alterations.

05:46 So, there is no area left untouched, possibly with someone who has a stroke.

05:51 Before we just gloss over this list of things, think what it would be like to be a person who had difficulty just doing the basic functions of life.

06:01 You couldn't use the bathroom when you wanted to or how you wanted to or without assistance.

06:07 You had a thought and you wanted to communicate it to somebody, but you couldn't -- find the words.

06:14 So, this is no small thing. We're all busy.

06:19 We all have a lot of responsibilities, but recognizing patients in crisis early is going to impact the rest of the quality of their life.