Calling 9-1-1 at the first symptom of stroke can help you get to the hospital in time for lifesaving stroke care. Show
Your stroke treatment begins the moment emergency medical services (EMS) arrive to take you to the hospital. Once at the hospital, you may receive emergency care, treatment to prevent another stroke, rehabilitation to treat the side effects of stroke, or all three. Learn more about recovering from a stroke. How is stroke treated?On the way to the hospitalIf someone you know shows signs of stroke, call 9-1-1 right away. Do not drive to the hospital or let someone else drive you. The key to stroke treatment and recovery is getting to the hospital quickly. Yet 1 in 3 stroke patients never calls 9-1-1.1 Calling an ambulance means that medical staff can begin life-saving treatment on the way to the emergency room. Stroke patients who are taken to the hospital in an ambulance may get diagnosed and treated more quickly than people who do not arrive in an ambulance.1 This is because emergency treatment starts on the way to the hospital. The emergency workers may take you to a specialized stroke center to ensure that you receive the quickest possible diagnosis and treatment. The emergency workers will also collect valuable information that guides treatment and alert hospital medical staff before you arrive at the emergency room, giving them time to prepare. Learn more about the important role emergency medical services (EMS) plays in improving stroke care. At the hospitalAt the hospital, health professionals will ask about your medical history and the time your symptoms started. Brain scans will show what type of stroke you had. You may also work with a neurologist who treats brain disorders, a neurosurgeon who performs surgery on the brain, or a specialist in another area of medicine. Treating ischemic strokeIf you get to the hospital within 3 hours of the first symptoms of an ischemic stroke, you may get a type of medicine called a thrombolytic (a “clot-busting” drug) to break up blood clots. Tissue plasminogen activator (tPA) is a thrombolytic. tPA improves the chances of recovering from a stroke. Studies show that patients with ischemic strokes who receive tPA are more likely to recover fully or have less disability than patients who do not receive the drug.2,3 Patients treated with tPA are also less likely to need long-term care in a nursing home.4 Unfortunately, many stroke victims don’t get to the hospital in time for tPA treatment. This is why it’s so important to recognize the signs and symptoms of stroke right away and call 9-1-1. Doctors may also treat ischemic stroke with other medicines, such as blood thinners, as well as surgery to remove the clot. Treating Hemorrhagic StrokeOther medicines, surgery, or procedures may be needed to stop the bleeding from hemorrhagic stroke and save brain tissue. For example, Medicine, surgery, or other procedures may be needed to stop the bleeding and save brain tissue. For example:
Learn more about how stroke is treated at the hospital from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. What happens next?If you have had a stroke, you are at high risk for another stroke.
That’s why it’s important to treat the underlying causes of stroke, including heart disease, high blood pressure, atrial fibrillation (fast, irregular heartbeat), high cholesterol, and diabetes. Your doctor may give you medications or tell you to change your diet, exercise, or adopt other healthy lifestyle habits. Surgery may also be helpful in some cases. Recovering from stroke: stroke rehabilitationRehabilitation after a stroke begins in the hospital, often within a day or 2 after the stroke. Rehab helps ease the transition from hospital to home and can help prevent another stroke. Recovery time after a stroke is different for everyone—it can take weeks, months, or even years. Some people recover fully, but others have long-term or lifelong disabilities. Learn more about stroke rehabilitation from the National Institute of Neurological Disorders and Stroke. What to expect after a strokeIf you have had a stroke, you can make great progress in regaining your independence. However, some problems may continue:
What is stroke rehabilitation?Rehab can include working with speech, physical, and occupational therapists.
Therapy and medicine may help with depression or other mental health conditions following a stroke. Joining a patient support group may help you adjust to life after a stroke. Talk with your health care team about local support groups, or check with an area medical center. Support from family and friends can also help relieve fear and anxiety following a stroke. Let your loved ones know how you feel and what they can do to help you. Learn more about stroke rehabilitation from the National Institute of Neurological Disorders and Stroke. How can I prevent another stroke?If you have had a stroke, you are at high risk for another stroke. That’s why it’s important to treat the causes of stroke, including Your doctor may prescribe you medicine or tell you to change your diet, exercise, or adopt other healthy lifestyle habits. Surgery may also be helpful in some cases. More informationCDC
Other OrganizationsThe initial nursing assessment, the first step in the five steps of the nursing process, involves the systematic and continuous collection of data; sorting, analyzing, and organizing that data; and the documentation and communication of the data collected. Critical thinking skills applied during the nursing process provide a decision-making framework to develop and guide a plan of care for the patient incorporating evidence-based practice concepts. This concept of precision education to tailor care based on an individual's unique cultural, spiritual, and physical needs, rather than a trial by error, one size fits all approach results in a more favorable outcome.[1][2][3] The nursing assessment includes gathering information concerning the patient's individual physiological, psychological, sociological, and spiritual needs. It is the first step in the successful evaluation of a patient. Subjective and objective data collection are an integral part of this process. Part of the assessment includes data collection by obtaining vital signs such as temperature, respiratory rate, heart rate, blood pressure, and pain level using an age or condition appropriate pain scale. The assessment identifies current and future care needs of the patient by allowing the formation of a nursing diagnosis. The nurse recognizes normal and abnormal patient physiology and helps prioritize interventions and care.[4][5] Nursing Process
The function of the initial nursing assessment is to identify the assessment parameters and responsibilities needed to plan and deliver appropriate, individualized care to the patient.[6][7][8][9] This includes documenting:
The nurse should strive to complete:
Summary Nursing Admission Assessment
Physical Exam
Initial Assessment[10][11][12] Steps in Evaluating a New Patient
Which provides the diagnosis most often: history, physical, or diagnostic tests?
History Taking Techniques Record chief complaint History of the present illness, presence of pain P-Q-R-S-T Tool to Evaluate Pain
S-A-M-P-L-E
Pain Assessment Pain, or the fifth vital sign, is a crucial component in providing the appropriate care to the patient. Pain assessment may be subjective and difficult to measure. Pain is anything the patient or client states that it is to them. As nurses, you should be aware of the many factors that can influence the patient's pain. Systematic pain assessment, measurement, and reassessment enhance the ability to keep the patient comfortable. Pain scales that are age appropriate assist in the concise measurement and communication of pain among providers. Improvement of communication regarding pain assessment and reassessment during admission and discharge processes facilitate pain management, thus enhancing overall function and quality of life in a trickle-down fashion. According to one performance and improvement outpatient project in 2017, areas for improvement in pain reassessment policies and procedures were identified in a clinic setting. The study concluded compliance rates for the 30-minute time requirement outlined in the clinic policy for pain reassessment were found to be low. Heavy patient load, staff memory rather than documentation, and a lack of standardized procedures in the electronic health record (EHR) design played a role in low compliance with the reassessment of pain. Barriers to pain assessment and reassessment are important benchmarks in quality improvement projects. Key performance indicators (KPIs) to improve pain management goals and overall patient satisfaction, balanced with the challenges of an opioid crisis and oversedation risks, all play a role in future research studies and quality of care projects. Recognition of indicators of pain and comprehensive knowledge in pain assessment will guide care and pain management protocols. Indicators of Pain
Psychosocial Assessment The primary consideration is the health and emotional needs of the patient. Assessment of cognitive function, checking for hallucinations and delusions, evaluating concentration levels, and inquiring into interests and level of activity constitute a mental or emotional health assessment. Asking about how the client feels and their response to those feelings is part of a psychological assessment. Are they agitated, irritable, speaking in loud vocal tones, demanding, depressed, suicidal, unable to talk, have a flat affect, crying, overwhelmed, or are there any signs of substance abuse? The psychological examination may include perceptions, whether justifiable or not, on the part of the patient or client. Religion and cultural beliefs are critical areas to consider. Screening for delirium is essential because symptoms are often subtle and easily overlooked, or explained away as fatigue or depression. Safety Assessment
Therapeutic Communication Techniques Used to Take a Good History Multiple strategies are employed that will include:
What are examples?
Cultural Assessment The cultural competency assessment will identify factors that may impede the implementation of nursing diagnosis and care. Information obtained should include:
Physical Examination Techniques Initial evaluation or the general survey may include:
Secondary Assessment
Techniques Inspection
Palpation
Percussion
Auscultation
What are important things to remember about the physical exam?
Diagnostic Studies Driven by findings on the history and physical examination; options include:
Discharge Planning
Often the initial history and physical examination lead to the identification of life- or limb-threatening conditions that can be stabilized promptly, ensuring better patient outcomes. The sooner the patient is correctly assessed, the more likely a life-altering condition is recognizable, nursing diagnosis formulated, appropriate intervention or treatment initiated, and stabilizing care rendered. Physiological abnormalities manifested by changes in vital signs and level of consciousness often provide early warning signs that patient condition is deteriorating; thus, requiring prompt intervention to forego an adverse outcome, decreasing morbidity and mortality risk. In the fast-paced, resource-challenged healthcare environment today, thorough assessment can pose a challenge for the healthcare provider but is essential to safe, quality care. The importance of a head-to-toe assessment, critical thinking skills guided by research, and therapeutic communication are the mainstays of safe practice. [13][14][15] Assessment findings that include current vital signs, lab values, changes in condition such as decreased urine output, cardiac rhythm, pain level, and mental status, as well as pertinent medical history with recommendations for care, are communicated to the provider by the nurse. Communicating in a concise, efficient manner in rapidly changing situations and deteriorating patient conditions can promote quick solutions during difficult circumstances. Healthcare providers communicate and share in the decision-making process. The SBAR model facilitates this communication between members of the healthcare team and bridges the gap between a narrative, descriptive approach and one armed with exact details. Communication using the SBAR Model
Assessment Tools
Equipment
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