Hi. Welcome to our series on
Now this one is going to be so fun.
We're going to talk about the hands-on
nursing care of a stroke patient in ER.
But first, let's go with a little
bit of a background.
So, I know there's a lot of you out there
that are super excited to
get into being an ER nurse.
But all of us need to understand
what goes on in the ER
as you're treating these patients.
So, this patient, if we come in
with a suspected stroke,
this patient is going to be
seen very quickly.
So let's talk about what
our main priorities are.
Now I know you hate that word, priorities,
because we usually use it
in nursing school, meaning,
"Hey, here's a multiple choice exam
with 4 answers, and they're all correct.
So we need you to pick the priority."
So I know you're super frustrated
with that word, but trust me,
this is where priorities really matter.
This is when we pick what's most important
is going to keep our patient the safest.
So, we'll walk through this together
and it'll become very clear to you
what you would do in this
situation in an ER setting
with a patient having neurological symptoms.
Okay, so first of all, hey, it doesn't matter
what system we're talking about.
Our goal is always to maintain medical
stability of a patient's ABCs.
So we're starting with something
that's very familiar with you.
But you always want to work with the
patient's airway, breathing, and circulation.
So no matter what the crisis,
or what's going on,
if you're keeping up with a patient's ABCs,
you've got some time to think
through the next step.
So whenever you walk in a room, automatically,
that's your first thought, ABCs.
If that's okay, then we've got
some time to deal.
Okay, so you want rapid assessment
identification of a stroke,
whether it's a stroke or it's a heart
attack, and we're talking about
blood supply to an important organ,
and they're all important.
But we're talking about something like
blood supply to my brain or to my heart.
The quicker you identify these patients,
assess them, and know that they're at risk,
we can get treatment started more quickly.
So, part of the goal would be to
rule out all other possible causes.
Sometimes people do weird neuro things
when their blood sugar's low.
Sometimes, elderly people can have a UTI,
and they're acting 4 shades of crazy,
but they're not having a stroke.
It'll look like they're having a stroke,
but they're just disoriented
from the infection.
So, get them in, watch their ABCs,
then we're going to rapidly identify that this
person could be possibly having a stroke.
Then we're going to work quickly
to rule out other causes
that could be doing these weird,
kind of, neuro things in the patient.
So, very top priority is CT or an MRI.
We want to get that patient
to brain imaging
so we can figure out if they're having
an ischemic or a hemorrhagic stroke,
and we'll talk about the differences
between the 2.
Ischemic means, hey, oxygen has been
cut off to that part of the brain
or interrupted to that brain.
Hemorrhagic means that patient
is bleeding in their head.
Both are emergencies, but we
treat them very differently.
Okay, so you've rolled into ER. We
know we get -- take care of ABCs.
We want to identify and assess
them very quickly,
rule out other causes and get
them to CT or MRI.
Now, lots of big hospitals have this
very close, if not in the same unit,
as ER so they can rapidly get
the patient to that testing.
Because see, our goal is we want to
preserve the function the patient has,
and minimize any further neurological
damage or problems.
Now, all this would make sense, right?
Think of this as if we were
walking through this experience with
someone you really cared about,
someone that is close to you.
What are the priorities that you
would want the nurse to do?
See, that's why we should
treat every patient.
If this was someone who was
important to us personally,
what would we want done for them?
And we want to do the same
thing for all our patients.
So we want to preserve the function they
have, and minimize any further problems.
We're going to figure out what's
the best treatment option?
Are we going to do thrombolytic therapy?
Are we going to do a thrombectomy?
What needs to be done?
And finally, if the patient is a candidate
for thrombolytic therapy,
we want to make sure within 4-5
hours, and really closer to 4,
that we get that medication to them
safely from the onset of their symptoms.
Okay, so, you gathering an accurate
history from the family members,
from the people who bring
the patient to the hospital,
and for the physician, so they know
our best guess of when these
Okay, so that's it. This is a great summary
slide that says that's what our priorities are.
We're going to walk you through though,
exactly how we accomplish those priorities.
But remember, time is tissue.
That's why we need to know
as close as possible,
what time the symptoms started,
because we want to know that for both
ischemic and hemorrhagic strokes.
The earlier we can get to an
acute stroke and identify it,
the more likely the treatment will
minimize the potential deficits
the patient's going to have because strokes
impact all areas of a patient's daily life.
Their ability to move, their bowel and
bladder function, their ability to swallow,
how they think about things, making
decisions or executive level functioning,
how they communicate or speak with people.
Their personality can be very different,
their mood and their affect and even
their spatial perceptual alterations.
So, there is no area left untouched,
possibly with someone who has a stroke.
Before we just gloss over
this list of things,
think what it would be like to be a person
who had difficulty just doing
the basic functions of life.
You couldn't use the bathroom
when you wanted to
or how you wanted to or without assistance.
You had a thought and you wanted
to communicate it to somebody,
but you couldn't -- find the words.
So, this is no small thing. We're all busy.
We all have a lot of responsibilities,
but recognizing patients in crisis
early is going to impact
the rest of the quality of their life.