Evidence-Based Practice in Treating Strokes

Instructor: Justine Fritzel

Justine has been a Registered Nurse for 10 years and has a Bachelor's of Science in Nursing degree.

Each year approximately 700,000 strokes occur in the United States. The majority of these strokes result in permanent disabilities. In this lesson we will learn about strokes and the evidence-based practice in treating them.

Strokes

Clifford is 87 years old and is still pretty active for his age. One day he was visiting his family out of state when he unexpectedly dropped his coffee cup while sitting at the dining room table. He was so embarrassed of the mess he made, but when he went to clean it up he dropped the cup again. His family insisted he sit down and allow them to clean it up. His daughter noticed his face looked strange, almost like it was droopy. Clifford said he felt fine otherwise, but wasn't sure why his arm was so weak. Moments later, his 20 year old granddaughter entered the room and saw what was happening. She remembered seeing commercials about warning signs of a stroke, and recognized that her grandpa was experiencing them. She insisted they call 911 and he was transported to the hospital.

A cerebrovascular accident, more commonly known as a stroke, occurs when an area of the brain doesn't receive enough blood. The decreased blood flow could be due to a clot obstructing the blood vessel feeding that part of the brain, or it could be due to a bleed in the brain. Common symptoms of a stroke include facial drooping on one side of the face, weakness in the arm and leg of one side of the body, and difficulty speaking. A person experiencing these symptoms should seek immediate medical attention.

The majority of strokes are caused by clots, so we will focus on this type of stroke. They can be either embolic or thrombotic strokes. Embolic strokes are when the clot is formed somewhere else in the body and it travels to the brain. Thrombotic strokes are when the clot forms within the brain. Let's look at the evidence-based practice for treatment of these types of stroke.

Testing

Time is valuable when a person is experiencing a stroke. Emergency medical attention is required. Once in the emergency room, nurse and physician assessments will be completed and tests will be ordered.

Tests that would be ordered include a CT scan, possibly magnetic resonance imaging (MRI), blood work, EKG, and blood pressure monitoring. A CT scan of the brain is to help evaluate the cause of the stroke. Using a CT scan, the doctor can identify if the stroke is due to a clot or due to a bleed. It is vital to determine the type of stroke, since the treatment is very different. MRI may be used in specialized stroke centers, but is unreliable in identifying a hemorrhagic stroke, so it is not a first line test option.

Blood work will evaluate clotting times, kidney and liver function, and different blood counts. Glucose levels will be checked and managed because elevated glucose is damaging to the neurons in the brain.

Embolic strokes are often caused by problems with the heart; therefore, monitoring the rhythm of the heart through an EKG is essential in determining the cause of the stroke. Oftentimes, a person experiencing a stroke has elevated blood pressure. It is important to monitor blood pressure to ensure it isn't excessively elevated. However, slightly elevated blood pressure is beneficial to ensure adequate blood flow to the area of the brain that has restricted blood flow.

Treatment

Clifford completes his workup in the emergency room and the doctor diagnoses him with an embolic stroke. The doctor discusses the risks and benefits of treatment and orders tPA to be administered.

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