Stroke Update

Features

Stroke Update

The American Heart Association (AHA) is spreading the slogan “Stroke is a Brain Attack” in an effort to impress upon the public the importance of recognizing the signs of stroke and calling for help immediately.

By Christine Contillo, RN, BSN
Login
to Save

The American Heart Association (AHA) is spreading the slogan “Stroke is a Brain Attack” in an effort to impress upon the public the importance of recognizing the signs of stroke and calling for help immediately. The Center for Disease Control’s figures show that each year 700,000 people in this country will have a new or recurrent stroke and only 10 percent will recover completely. Strokes are the third leading cause of death, taking 160,000 victims annually. The AHA estimated that in 2007 the direct and indirect costs of stroke care was $62.7 billion dollars, with that figure rising by billions each year. Strokes are a major public health problem and for all these reasons it is critical that we understand the risks and help our patients be prepared.

There are two kinds of strokes. The more common is ischemic stroke, caused by a blood clot that plugs a blood vessel in the brain and blocks blood and oxygen delivery beyond that point. The subsequent brain damage depends largely on where the clot is and the amount of obstruction it causes. Less common is hemorrhagic stroke, which is the result of a blood vessel actually breaking, with bleeding into the brain. This type results in more severe damage to the brain tissue. »

Controllable risk factors for either type of stroke are the same: hypertension, diabetes, cigarette smoking, high blood cholesterol, obesity, and heart disease. Helping our patients acknowledge these risks and take measures to change them is one way that nurses can make a significant difference.

It’s critical to recognize the signs of stroke because treatment within three hours can make a significant difference in the functional outcome. Sudden one-sided weakness or numbness in the face, arm or leg, a loss of speech or understanding, or even a severe headache along with sudden unexplained instability in walking can all be indicators of stroke. If you or your patients experience any of these alterations, try to smile in a mirror. If the smile is asymmetrical, call for help immediately. Alternatively, try to raise both arms or repeat a simple sentence like “Where are my shoes?” A sudden loss of strength in one arm or slurred speech is often dismissed as unimportant, but you should help your patients realize they should not be afraid to call for help.

If these symptoms result from an ischemic stroke, time is critical. The victim should be transported to an Emergency Department with the capacity for immediate brain imaging. If a clot can be identified, a clot–busting plasminogen activator (tPA) can be administered immediately. The neurological consequences can thus be reduced or eliminated. Timely and intensive rehabilitation may be initiated to improve the functional outcome following such a stroke.

On the near horizon is similar immediate treatment for the more damaging hemorrhagic stroke, often caused by a ruptured aneurysm or a sub-arachnoid hemorrhage that follows a head injury. Recombinant activated factor VII (rFVIIa) slows bleeding and has already been used in the United States for hemophiliac patients. This past May, the AHA issued new guidelines that suggest the use of rFVIIa for intracerebral hemorrhage may limit bleeding into the brain, thereby reducing the risk of death and possibly improving subsequent outcome.

New AHA guidelines also suggest that magnetic resonance imaging (MRI) may be as useful as the already widely-used CT scans for patient evaluation, though they are neither as fast nor as practical for some patients, for example, those on ventilators.

Since 2000, California has been one of 15 states that have implemented the CDC funded WISEWOMAN (Well-Integrated and Screening Evaluation for Women Across the Nation) program to screen for heart disease and evaluate mainly Latina women for stroke prevention. There are multiple pilot sites in the Los Angeles and San Diego areas, where the focus is to address lifestyle changes in women aged 40 through 60, with the goal of reducing cardiac, chronic disease, and stroke risk.

Studies have found that directing patients to quit smoking can have a beneficial effect in preventing recurrent strokes, but patients are often not given the support needed to stop. Besides offering diet and exercise advice as a way to lower hypertension and cholesterol, consider one-on-one sessions with an Advanced Practice Nurse, followed by group sessions, as a way to prevent a stroke or recurrent strokes in your patients. It is within our ability to direct our patients to the behavioral changes necessary to lower stroke risk and to encourage them to take advantage of the help that is readily available.

Christine Contillo RN, BSN, has worked as a nurse since 1979, and has written extensively for various nursing publications as well as the New York Times.

This article is from workingnurse.com.

You might also like

When Nurses Smoked in Hospitals
RN Resume FAQ

Features

RN Resume FAQ

Advice from Recruiters

RN Networking

Features

RN Networking

Use social media, conferences and daily workplace interactions to connect and enrich your career

View all Features Articles