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Prevention of Stroke Canadian Stroke Network

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					Best Practice
Nursing Care
Across the
                 N S
Acute Stroke
Continuum
                 N C
                Module 1
                Prevention of Stroke




                                       1
Prevention of Stroke
Welcome!

 Thissession includes presentations and
 activities to enhance your learning
 The  focus is on working with colleagues to
 discover best ways of using the tools in your
 institutions
 So,   sit back (or stand up) and have fun!!!




                                           10/3/2012   2
Prevention of Stroke
Expectations?

   So, what do you want to get out of this module?




                                                      10/3/2012   3
Prevention of Stroke
Objectives

   Identify the goal of stroke prevention across the stroke care
    continuum
   Identify the impact and cost of stroke in Canada
   Identify signs and symptoms of stroke
   Identify risk factors for stroke
   Review Best Practice Recommendations related to prevention
    of stroke, public awareness and patient education
   Discuss how you can implement these at your institution
   Create a stroke care action plan for prevention of stroke, public
    awareness and patient education

                                                           10/3/2012    4
Prevention of Stroke
Agenda

   Introduction                                         15 min
   Stroke 101 (optional)                                15 min
   Impact & Cost of Stroke in Canada                    20 min
   Signs, Symptoms & Risk Factors                       25 min
   Break                                       15 min
   Canadian Stroke Strategy                             15 min
   Public Awareness & Patient Education BPRs            30 min
   Recommendations for Prevention of Stroke BPRs        30 min
   Putting It All Together                              30 min



                                                     10/3/2012    5
Prevention of Stroke
Continuum of Stroke Care

                     Prevention of stroke
                Public awareness & patient education




                      Hyperacute stroke
                        management



                 Acute inpatient stroke care




                     Stroke rehabilitation
                  & community reintegration
 Prevention of Stroke
  Continuum of Stroke Care
    Should be
 addressed at all        Prevention of stroke
                    Public awareness & patient education
stages across the
   stroke care
   continuum
                          Hyperacute stroke
                            management



                     Acute inpatient stroke care




                         Stroke rehabilitation
                      & community reintegration
Prevention of Stroke
Why Is This Important?

   Healthy lifestyle can reduce incidence
    of initial and subsequent stroke by 30%

   Public awareness of stroke symptoms
    and seeking urgent medical attention to          Early
    take advantage of new therapies such           detection
    as reperfusion                                means better
                                                   outcomes!
   Education facilitates better
    understanding and supports coping and
    self-management
       Simple distribution of pamphlets is not
        sufficient
Stroke 101
Prevention of Stroke
                        Intended only
                        for audiences
                       with no previous
                        knowledge of
                            stroke.

                        10/3/2012         9
Prevention of Stroke

Impact & Cost of Stroke in Canada
20 min




                          10/3/2012   10
Prevention of Stroke
Stroke Risk Round Up

1.   A volunteer begins by reading out her Question card.
     Everyone should have received a Question and Answer card from the Facilitator.

2.   The person who thinks she has the correct Answer card
     must wave it and read the answer aloud.
3.   If correct, it will be her turn to read out the question
     on her Question card.
4.   If not correct, everyone must agree on the correct answer,
     then ask the person with the correct Answer card to read out
     her question.
5.   Play will continue in this manner until all questions have been
     read along with their correct answers.


     WHOLE GROUP ACTIVITY
Prevention of Stroke
Stroke Subtypes

                   Lacunar
                     20%     Thromboembolic
                                  10%
             SAH
             10%                     Cardioembolic
                                          20%
Hemorrhagi                                          Ischemi
  c 20%                                              c 80%
             ICH
             10%
                                Unknown
                                  25%
             Other 5%


                             Adapted from Foulkes MA, et al. Stroke 1988;19:547-554
  REVIEW
Prevention of Stroke
Outcome of Ischemic Stroke




                             Adapted from Stegmayr B, et al. Stroke 1997;28:1367-1374
Prevention of Stroke
Epidemiology of Stroke A Canadian Perspective

   50,000 new stroke patients/year in Canada†

   200,000–300,000 stroke survivors†

   4th leading cause of death in Canada

   The leading cause of adult disability

   28% of stroke patients are under age 65*

   Estimated cost of stroke 3.6 billion annually



                                            †StatisticsCanada
                                            *Kiely DK, et al. Stroke 1993;24:1366-1371
     REVIEW
Prevention of Stroke
Impact of Stroke in Canada

                 ~ 50,000
               strokes/year                      300,000 Canadians
                                                  living with stroke

Someone has a stroke                                     16,000 Canadians
  every 10 minutes                                        die from Stroke
                                                             each year


    20% chance of
    second stroke
     within 2 years
                   For every symptomatic
                  stroke there are 9 ‘silent’            Price Tag:
                strokes resulting in cognitive      $3.6 Billion annually
                         impairment



    REVIEW
Prevention of Stroke

Signs, Symptoms & Risk Factors
25 min




                         10/3/2012   16
Prevention of Stroke
Stroke Jeopardy

   We’ll split into two teams to compete in a game of Stroke
    Jeopardy

   Each team will get the chance to answer key questions about
    the signs, symptoms and risk factors for stroke.

   So let’s see which team is the Stroke Jeopardy Champion




                     PRESS TO START JEOPARDY
Prevention of Stroke
Warning Signs of Stroke

Sudden onset of:

   Weakness or numbness
                                          KEY POINT
   Speech disturbances
                                           Time of the
   Unexplained dizziness                onset of stroke
                                          symptoms is
   Visual changes
                                           critical for
   Sudden severe headache of unknown   consideration of
    cause                                     acute
                                          thrombolytic
                                             therapy.
     REVIEW
Prevention of Stroke
Left & Right Hemisphere Common Presentations

Left Hemisphere                      Right Hemisphere
   Expressive aphasia                  Spatial-perceptual deficits
   Receptive aphasia                   Left sided
   Global aphasia                       weakness/sensory loss

   Right sided                         Neglect of the affected side
    weakness/sensory loss               Distractible
   Intellectual impairment-            Impulsive behavior
    alexia, agraphia, acalulia          Poor judgment
   Slow and cautious behavior          Loss of flow of speech
   Defects in right visual field-      Defects in left visual field-
    homonymous hemianopsia               homonymous hemianopsia
Prevention of Stroke
Stroke Mimics

   These four conditions represent 62% of stroke mimics:

       Postictal deficit (unrecognized seizure)
       Systemic Infection
       Tumour/abscess
       Toxic-metabolic disturbances

   Other mimics:
       Bell’s Palsy, Peripheral Nerve Palsies, Old strokes, Confusion, Head
        Injury




        REVIEW
Prevention of Stroke
Transient Ischemic Attacks: TIA

Anterior Circulation


   Opthalmic Artery             Middle Cerebral Artery
       Amaurosis Fugax              Hemiparesis
       Foggy vision                 Sensory loss
       Shade effect
                                 Anterior Cerebral Artery
                                     Hemiparesis




        REVIEW
Prevention of Stroke
Transient Ischemic Attacks: TIA

Posterior Circulation


   Posterior Cerebral Artery       Cerebellar Arteries
       Dysarthria                      Ataxia
       Dysphagia                       Vertigo
       Diplopia                        Dizziness
       Bilateral Blindness
       Motor/Sensory weakness
       Quadriparesis




        REVIEW
Prevention of Stroke
Types of Stroke

   Thrombotic strokes:
       Blood clot forms in a large (majority) or small artery blocking blood
        flow to the brain

   Embolic strokes:
       Blood clot forms in another part of body and travels to brain blocking
        a blood vessel

   Hemorrhagic strokes:
       Occurs when a blood vessel ruptures within the brain (intracerebral)
        or on brain surface with bleeding into subarachnoid space




        REVIEW
Prevention of Stroke
Carotid & Vertebrobasilar Syndromes

Carotid                     Vertebrobasilar
   Sensory/motor deficit      Diplopia
   Aphasia                    Vertigo
   Cortical sensory loss      Coma at onset
   Apraxia, neglect           Crossed sensory loss
   Visual field deficit       Bilateral motor signs
   Retinal ischemia           Isolated field defect
                               Pure motor and sensory
                                deficit
                               Dysarthria
                               Dysphagia
     REVIEW
Prevention of Stroke
Lacunar Syndromes


Type of Syndrome                          Patient Presentation

Pure motor hemiparesis                    Contralateral hemiparesis of face, arm
Results from an infarct in the internal   and leg, dysarthria
capsule or pons


Pure motor hemiparesis with motor         Hemiparesis of face, arm and leg with
aphasia                                   inability to speak
Results from an infarct of the internal
capsule and adjoining corona radiat

Ataxic hemiparesis                        Paresis of the contralateral leg and side of
Results from an infarct in the pons       the face, ataxia of the contralateral leg and
                                          arm



     REVIEW
Prevention of Stroke
Lacunar Syndromes



 Type of Syndrome                          Patient Presentation

 Dysarthria and clumsy hand syndrome       Dysarthria, dysphagia,contralateral facial
 Results from an infarct in the pons or    and tongue weakness, paresis and
 internal capsule                          clumsiness of the contralateral arm and
                                           hand


 Pure sensory stroke                       Contralateral sensory loss to all modalities
 Results from an infarct in the thalamus   that usually affect the:
                                           Face, upper and lower extremities




    REVIEW
Prevention of Stroke
Dominant Left Hemisphere Stroke

   Aphasia

   Right field defect

   Left gaze preference

   Right upper motor neuron facial
    weakness

   Right hemiparesis

   Right hemisensory loss



     REVIEW
Prevention of Stroke
Non-Dominant Right Hemisphere Stroke

   Left neglect, inattention

   Left field defect

   Right gaze preference

   Left upper motor neuron facial
    weakness

   Left hemiparesis

   Left hemisensory loss, sensory
    extinction


     REVIEW
Prevention of Stroke
Risk Factors


          MODIFIABLE                     NON-MODIFIABLE
- Hypertension                  - Age
- Diabetes                      - Gender
- High cholesterol              - Race
- Cigarette smoking             - Prior stroke/TIA
- Atrial Fibrillation
                                - Heredity
- Cardiac disease
- Hypercoagulative states
- Obesity
- Excessive Alcohol Intake
- Physical Activity
- Stress
- Hormone replacement therapy

   REVIEW
Prevention of Stroke
Risk Factors: Hypertension

   #1 risk factor for primary and recurrent strokes

   Accounts for about ~60% of attributable risk for
    cerebrovascular disease
       MRFIT trial (multiple risk factor intervention trial): 350,000 men from
        1973-1978:
           733 stroke deaths
           8-fold increased risk across systolic BP deciles and 4-fold risk for
            DBP
           Men over 65 with isolated HTN had over 2x risk for ischemic
            stroke and women just < 2x




        REVIEW
Prevention of Stroke
Risk Factors: Hypertension

   A meta-analysis (Lewington, 2002) showed each 2 mmHg
    reduction in systolic blood pressure is associated with a:
       7% reduction in mortality from ischemic
        heart disease
       10% reduction in mortality from stroke




        REVIEW
Prevention of Stroke
CHEP Blood Pressure Recommendations

   Patients who have had a stroke: <140/90 mmHg

   Prevention of first stroke or recurrent stroke:
       Patients with chronic kidney disease: <130/80 mmHg
       Patients with diabetes: <130/80 mmHg

   Prevention of stroke in the general population: <140/90 mmHg

   Visit: www.hypertension.ca




        REVIEW
Prevention of Stroke
Diabetes

   Major risk factor for ischemic stroke

   Potent risk factor in younger patients

   Risk of stroke increased 1.5 to 3 times

   Doubles the risk of stroke recurrence

   Outcomes after stroke significantly worse




     REVIEW
Prevention of Stroke
Risk Factors: Age

       Age is a significant risk factor for
        stroke
           About 75% of strokes occur in
            individuals ≥ 65 yrs
           With each decade after age 65,
            risk of stroke doubles




  REVIEW
Prevention of Stroke
Risk Factors: Concomitant Factors

       People with a history of heart disease
        or TIAs :
           High cholesterol levels, obesity and
            physical inactivity increase risk of heart
            disease and therefore of stroke
           CAD, CHF, LVH, valvular heart disease,
            AF, cardiac thrombosis
           AF increases with age and is more
            prevalent in males
           ~ 15% of AIS caused by AF
           Patients with TIA’s: 10.5% will have a
            stroke within 3 months and of these,5%
            will have a major stroke within 48 hours

  REVIEW
Prevention of Stroke
Risk Factors: Race

       African Americans have 2x risk of death and
        disability from stroke
           May be from higher incidence of smoking,
            hypertension, sickle cell anemia and other
            stroke-related risk factors




  REVIEW
Prevention of Stroke
Risk Factors: Family History

   Patients with large vessel strokes 3x more likely to have a first-
    degree relative who suffered from early stroke or heart attack
       Slightly greater risk for the small vessel stroke patients
       Risk greater if a parent, grandparent, sister or brother has had a
        stroke
       Paternal history of stroke increases the risk by 2.4 times; maternal
        history increases risk by 1.4 times




                                     Jerrard-Dunne, P., & Goldstein, L .(2003). Stroke Risk Often Runs in the Family: genetic
        REVIEW                                                             predisposition linked to 2 types of stroke. Stroke
Prevention of Stroke
Stroke in Women

   Incidence of ischemic stroke, hemorrhagic stroke, and total
    stroke examined over 16 years in the Nurses’ Health Study
       ↑BMI (>27) had significantly increased risk of ischemic stroke
       From age 18 to 76 a weight gain of 11-19.9 kg was associated with
        a RR of 1.69 and a RR of 2.52 for a gain of ≥20kg.
       BMI should be maintained between 18.5 and 24.9
       Waist circumference should be maintained < 88cm




                                                   Adams, PH. (2004). Handbook of Cerebrovascular Diseases
        REVIEW
Let’s take a break…
15 min
Prevention of Stroke

Canadian Stroke Strategy
15 min




                           10/3/2012   41
Prevention of Stroke
Canadian Stroke Strategy

   Joint initiative of the Canadian Stroke Network and the Heart
    and Stroke Foundation of Canada since 2005
       Goal:
           to help support an integrated approach to stroke prevention,
            treatment and rehabilitation in every province and territory by
            2010.




                                                                              42
Prevention of Stroke
Canadian Stroke Strategy

   Provides a framework to facilitate widespread adoption of
    evidence-based best practices across the continuum of stroke
    care focusing on two levels of change:
       At the national level
       At the provincial/territorial level




                                                                   43
 The Canadian Stroke System Model
                               • Decrease burden of stroke
                         • Improve quality and efficiency of care
                      • Establish Canada as an international leader

         Provincial/Territorial/Regional Implementation of Best Practice
   Prevention              Treatment            Rehabilitation
                                                                        Reengagement
   Prevention        Protocols, Stroke Teams    Personal Care
                                                                      Coordinated Support
     Clinics                                        Plans




National Platforms to Support Provincial/Territorial/Regional Strategies

                                 Public Awareness

                            Best Practices and Standards

                             Professional Development

                              Information/Evaluation

                              Coordinated Research
Your Provincial Model
Canadian Stroke Strategy
Best Practices & Standards Platform

   Goal:
       To review and recommend best practices in stroke care appropriate
        to the latest and highest level of evidence, including key system
        drivers and appropriate Canadian context
Prevention of Stroke
Best Practice Recommendations Dissemination

   National release of CSS Best Practice Stroke
    Recommendations in September 2006 and December 2008

   CMAJ publication:
       Lindsay et al.(2008). Toward a more effective approach to stroke:
        Canadian Best Practice Recommendations for Stroke Care.

   Websites:
       www.canadianstrokestrategy.ca
       www.cmaj.ca

   Broad dissemination across provinces, at national and
    international meetings
Prevention of Stroke
2008 Recommendations

   Synthesis of best practice recommendations
    for stroke care across the continuum

   Address critical topic areas

   Commitment to keep current and update
    every two years

   Current update:
       With four new recommendations
       Elaboration of existing ones
       www.cmaj.ca December 2, 2008
Prevention of Stroke
CSS Best Practice Recommendations 2008


 1. Public Awareness and Patient Education (2)
 2. Stroke Prevention (7)
 3. Hyperacute Stroke Care (7)
 4. Acute Inpatient Stroke Management (2)
 5. Stroke Rehab & Community Reintegration (5)
 6. Selected Topics in Stroke Management (4)
Prevention of Stroke
Recommendations for
Public Awareness & Patient Education
20 min




                             10/3/2012   50
Prevention of Stroke
1: Public Awareness and Patient Education
 1.1: Public awareness and responsiveness

    Public should be able to recognize signs and symptoms of
     stroke

    Education should emphasize stroke is a medical emergency

    Education should include that stroke can affect persons of any
     age




     OVERVIEW
Prevention of Stroke
1: Public Awareness and Patient Education
 1.2: Patient and family education

    Integrated and coordinated education should be provided
     across the continuum of stroke care

    For all patients with stroke or at risk of stroke,
     and their families and caregivers




     OVERVIEW
Prevention of Stroke
A Patient’s Guide to the Recommendations

   Basic information for patients and their families

   Includes
       Signs and symptoms
       Emergency response
       Stroke care in hospital
       Rehabilitation
       Prevention
       Education

   Visit: www.canadianstrokestrategy and click on
    A Patient’s Guide to Canadian Best Practice
    Recommendations for Stroke Care
Prevention of Stroke
Patient and Family Education

   Content should be specific to;
       The phase of care
       Patient/caregiver readiness
       Patient/caregiver needs

   Education should be timely, interactive, up to date and provided
    in a variety of formats, languages including aphasia friendly

   Processes should be established by clinical teams for
    education including designating team members for provision
    and documentation of education



        REVIEW                                                         54
Prevention of Stroke
Patient and Family Education

   Education content should include:
       The nature of the stroke and its manifestations
       Signs and symptoms of stroke
       Impairments and their impact on the person
       Caregiver training to manage
       Risk factors
       Post-stroke depression
       Cognitive impairment
       Discharge planning and decision making
       Community resources
       Home adaptations


        REVIEW                                            55
Prevention of Stroke
Recommendations for
Prevention of Stroke
25 min




                       10/3/2012   58
Prevention of Stroke
2: Prevention of Stroke
 2.1: Lifestyle and risk factor management

    Persons at risk of stroke and persons who have had a stroke
     should be assessed for vascular disease factors and lifestyle
     management issues (diet, sodium intake, exercise, weight,
     smoking and alcohol intake)

    They should receive information and counseling about possible
     strategies to modify their lifestyle and risk factors




     OVERVIEW
Prevention of Stroke
2: Prevention of Stroke
 2.2: Blood pressure management

    Hypertension is the single most important modifiable risk factor
     for stroke

    Blood pressure should be monitored in all persons at risk for
     stroke




     OVERVIEW
Prevention of Stroke
2: Prevention of Stroke
 2.3: Lipid management

    Lipid levels should be monitored for all persons at risk for
     stroke




     OVERVIEW
Prevention of Stroke
2: Prevention of Stroke
 2.4: Diabetes management

    All individuals in the general population should be evaluated
     annually for type 2 diabetes on the basis of demographic and
     clinical criteria




     OVERVIEW
Prevention of Stroke
2: Prevention of Stroke
 2.5: Antiplatelet therapy

    All patients with ischemic stroke or TIA should be prescribed
     antiplatelet therapy for secondary prevention of recurrent stroke
     unless there is an indication for anticoagulation




     OVERVIEW
Prevention of Stroke
2: Prevention of Stroke
 2.6: Antithrombotic therapy in atrial fibrillation

    Patients with stroke and atrial fibrillation should be treated with
     warfarin at a target international normalized ratio of 2.5, range
     2.0 to 3.0




     OVERVIEW
Prevention of Stroke
2: Prevention of Stroke
 2.7: Carotid intervention

    Patients with TIA or nondisabling stroke and ipsilateral 70%-
     90% internal carotid artery stenosis should be offered carotid
     endarterectomy within 2 weeks of TIA or stroke unless
     contraindicated




     OVERVIEW
Prevention of Stroke
Goals of Stroke Prevention Clinics
(where these are available)

   Screening, monitoring and assessing of high risk population

   Providing education about risk factors, lifestyle management
    issues (exercise, smoking, diet, weight, alcohol, stress
    management)

   Counseling about possible strategies to modify lifestyle and risk
    factors




     REVIEW
Prevention of Stroke
Role of Nurses in Stroke Prevention

   Screening and monitoring of high risk population

   Assessment and education about risk factors, lifestyle
    management issues (exercise, smoking, diet, salt intake,
    weight, alcohol, stress management)

   Counseling about possible strategies to modify lifestyle and risk
    factors




     REVIEW
Prevention of Stroke
Public Awareness & Education Teachback
1.   Form two groups at your table and have each
     select and prepare a “briefing” on one of the
     sections in Prevention of stroke or Public        Imagine you
     Awareness and Patient Education                 have been asked
                                                       to brief your
2.   Use the worksheet in your PW to help            colleagues back
     structure your briefing and focus on the        home on one of
                                                     the key sections
     following topics:                                in “Prevention
        Rationale for recommendation                   of stroke or
                                                           Public
        System implications of it                    Awareness and
        Performance measures                              Patient
                                                        Education”
3.   When done, each group will present its
     briefing to the other and discuss

     TABLE ACTIVITY                                                     68
Prevention of Stroke
 Recommendations Briefing
1.   Now switch sections with the other group at
     your table and prepare to answer the
     following:                                          Imagine you
        How will this recommendation improve stroke   have been asked
         care at your institution?                       to brief your
                                                       colleagues back
        What role can you play in implementing it?    home on one of
        What barriers or enablers do you see?         the key sections
                                                        in “Prevention
2.   When done, brief the other on these                  of stroke or
                                                             Public
     issues and discuss                                 Awareness and
                                                             Patient
3.   Then, we’ll debrief the whole group to               Education”.
     arrive at some best practices


     TABLE ACTIVITY                                                       69
Prevention of Stroke

PATIENT & FAMILY EDUCATION
15 min




                       10/3/2012   70
From the Patient and Family’s Perspective:
Prevention of Stroke
 Where You Can Make a Difference!

1.   At your tables, discuss
        What would be your role in educating
         and supporting patients and caregivers   Did you know that
         about acute inpatient stroke care?        skills training of
                                                  caregivers makes
2.   When done, we'll debrief the whole           a huge difference
     group to identify some best practices             in patient
                                                  outcomes in areas
                                                   of functionality
                                                   and depression!
Prevention of Stroke




            Check Up Quiz



 QUIZ
Prevention of Stroke
Check Up

               To help support an
            integrated approach to
               What is the goal
               stroke prevention,
                  the Canadian
               oftreatment and
               Stroke Strategy?
             rehabilitation in every
             province and territory
                    by 2010.




                                       74
Prevention of Stroke
Check Up



             How often are the
                Best Practice
              Every two years
             Recommendations
               to be updated?




                                 75
Prevention of Stroke
Check Up



             Education should
                  Medical
              emphasize that
                emergency
               stroke is a…?




                                76
Prevention of Stroke
Check Up




           On what website can you
                the Best Practice
            see www.cmaj.ca
                 Guidelines?




                                     77
Prevention of Stroke
Check Up



              What is the single
              most important
                Hypertension
              modifiable risk
              factor for stroke?




                                   78
Prevention of Stroke
Check Up

            What should all patients
            with ischemic stroke or
            TIA be prescribed for
            secondary prevention of
              Antiplatelet therapy
            recurrent stroke unless
            there is an indication for
            anticoagulation?




                                         79
Prevention of Stroke
Check Up

            To what target
            international normalized
            ratio should patients
               2.5, range 2.0 to 3.0
            with stroke and atrial
            fibrillation be treated
            with warfarin?




                                       80
Prevention of Stroke
Check Up



            Within how many weeks of TIA or stroke
            should patients with TIA or nondisabling
                 Within two weeks
            stroke and ipsilateral 70%-90% internal
            carotid artery stenosis be offered carotid
            endarterectomy unless contraindicated?




                                                         81
Prevention of Stroke
Check Up


            1. The phase of care
           Education content should
            2. Patient/caregiver
           be specific with respect to
               readiness
            3. what three factors?
               Patient/caregiver
               needs




                                         82
Putting It All Together
30 min
Prevention of Stroke
Case Study

1.   Review the case study

2.   With your team, answer the questions on the worksheet at
     the end of the study

3.   We’ll review when done to share some best practices and get
     ready to create a Stroke Care Action Plan




     TABLE ACTIVITY
Prevention of Stroke
Case Study

   Mr. C is a 72 year old right handed man who was well this
    morning when he got up at 9:15am. He was eating breakfast at
    9:30am when his wife noticed that he couldn’t hold his toast
    with his right hand and his speech was slurred.

   She wanted to call 911 but he insisted on going to lie down first.

   At 1100, he was no better and finally agreed to let his wife call
    911.

   He was seen in the ER at 1130am
Prevention of Stroke
Case Study

   Mr. C has a past medical history of coronary artery disease, myocardial
    infarction, pacemaker, atrial fibrillation and hyperlipidemia
   His current medications are: digoxin, nitroglycerin, sotalol, terazosin,aspirin
    and altace.
   He has no known allergies
   On examination in ER, the following were found:
       BP 182/72,P-86, R-16
       No carotid or supraclavicular bruits. Heart sounds regular with no murmurs. No peripheral edema.
        His 12 lead ECK showed a ventricular paced rhythm
       Neurologically he is alert, unable to verbalize but follows simple commands. Unable to formally
        assess mental status due to aphasia.
       Aphasia appears expressive but he is able to get some words out but they are dysarthric
       Right visual field deficit and visual neglect
       Motor exam: dense right upper limb weakness and moderate right lower limb weakness
       NIHSS score: 15
       CNS score: 4.5
Prevention of Stroke
Case Study Questions

   What are Mr. C’s risk factors for stroke?

   What would be the priority teachings for Mr. and Mrs. C at this
    point?
Prevention of Stroke
 Creating a Stroke Care Action Plan

1.   With the case study we just reviewed in mind, create a stroke
     care action plan
        What can you do in your institution to initiate changing Stroke
         Care practices with respect to prevention of stroke and/or public
         awareness and patient education
        Identify 1-2 key learnings from today that you could take back to
         help kick start your change initiatives

2.   Use the Stroke Care Action Plan worksheet in your PW to
     record your plan




     INDIVIDUAL ACTIVITY
Best Practice Nursing Care
Across the Acute Stroke
Continuum
Thank you for your participation!

				
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posted:10/4/2012
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