What are the key components of nursing care for stroke patients?

Key Components of Nursing Care for Stroke Patients

Nursing care for stroke patients should focus on rapid evidence-based assessment and management to reduce mortality and disability, with nurses playing a crucial role in facilitating multidisciplinary models of care and improving uptake of evidence-based interventions. 1

Initial Assessment and Monitoring

• Neurological Assessment:

  • Frequent evaluation of neurological status using standardized tools
  • Monitor for signs of neurological deterioration including decreased level of consciousness, worsening deficits, pupil changes, and respiratory status changes 1
  • Up to 30% of stroke patients deteriorate in the first 24 hours, supporting the need for intensive monitoring 1

• Vital Signs Monitoring:

  • Continuous cardiac telemetry for at least 24 hours after admission
  • Blood pressure management according to protocol
  • Glucose monitoring for all patients (crucial and often overlooked) 1
  • Oxygen saturation monitoring (maintain >92%) 2

Prevention of Complications

Dysphagia Management

• Keep patients nil by mouth until swallowing ability is determined 1
• Perform dysphagia screening within 4-24 hours using validated, evidence-based tools 1
• Patients with dysphagia have a 3-fold increased risk of pneumonia 1
• Refer patients who fail swallow screening to speech-language pathologist 1

Mobility and Positioning

• Early mobilization to prevent complications
• Proper positioning to prevent pressure ulcers
• Use of intermittent pneumatic compression (not compression stockings) to reduce deep vein thrombosis risk 1

Infection Prevention

• Implement intensive oral hygiene protocols (e.g., chlorhexidine) to reduce stroke-associated pneumonia risk 1
• Monitor for and promptly treat signs of infection
• Avoid unnecessary urinary catheterization 1

Metabolic Management

• Treat hyperglycemia (glucose levels >8 mmol/L are associated with poor prognosis) 2
• Early treatment of hyperthermia 2
• Maintain fluid and electrolyte balance 3

Multidisciplinary Coordination

• Nurses should coordinate activities of the multidisciplinary team 1
• Implement clinical pathways or physician standing orders to guide team management 1
• Facilitate rapid transfer of patients from emergency department to stroke unit 1
• Ensure appropriate referrals to specialists (speech therapy, physical therapy, occupational therapy) 1

Patient and Family Education

• Educate about:
  • Pathogenesis of stroke
  • Treatment provided
  • Personal risk factors
  • Medications
  • Stroke signs and symptoms
  • Use of emergency medical services
  • Strategies to reduce further stroke risk 1
• Begin self-management teaching in the acute setting before hospital discharge 1

Transition of Care Planning

• Implement discharge planning early
• Coordinate with community services
• Provide medication reconciliation
• Educate on anticipated needs and resources 1
• Consider nurse-led transitional stroke clinics for follow-up 1

Specialized Nursing Considerations

• Nurse-patient ratio should be 1:2 for the first 24 hours post-stroke, then 1:4 if stable 1
• Nurses should be trained in thrombolysis care, bleeding complications, neurological assessment tools, and recognition of increasing intracranial pressure 1
• For patients receiving thrombolytic therapy, monitor for bleeding complications, particularly intracranial hemorrhage (6.4% risk) 1

Quality Improvement

• Participate in quality monitoring activities
• Collect quality data to measure adherence to stroke processes of care
• Use data to drive continuous quality improvement 1

Nurses are essential in stroke care delivery, providing comprehensive, interactive, and holistic approaches for both acute stroke and rehabilitation. Their specialized input is paramount in achieving optimal patient outcomes and high-quality interdisciplinary care 3.