Acute Transient Ischemic Attack (TIA): Treatment Goals (Nursing)

00:01 Now, here's our goals for Acute TIA treatment.

00:03 This is one of the nurses that you'll meet in ER.

00:06 You'll see him throughout our video series.

00:08 In the trauma emergency center, the main goal is going to do an initial neuro assessment to history, exam, and get them on cardiac monitoring.

00:17 So when that patient rolls in, they go into triage, the triage nurse recognizes this patient needs to be seen very quickly.

00:24 The goal will be an initial neuro assessment, get their history, examine the patient, and get them on cardiac monitoring, so we can keep an eye on them.

00:32 Also, start thinking about other causes of the neuro symptoms that you're seeing and what they're presenting with.

00:38 Now these patients are going to get moved to the front of the line to get to imaging because we're going to want to take a picture of their brain.

00:44 So we're gonna go to CT or MRI.

00:47 We're trying to rule out that ischemic or a hemorrhagic stroke.

00:51 Because when the patient starts showing us these symptoms, that's what we're worried about.

00:55 We want to make sure they're not having an ischemic or a hemorrhagic stroke.

01:00 So first test: CAT scan or MRI.

01:04 Now the neurovascular imaging: MRA, CTA or TCD, is something else that we'll do to assess the arteries as we continue to move through this process.

01:12 We'll do a cardiovascular evaluation and look if there's any cardio sources of the emboli.

01:17 See, it's very common for some type of clot to break off from the heart from inside the heart and travel quickly up to the brain, particularly if the patient is in atrial fib.

01:28 Because, remember, an atrial fib, that atrium instead of contracting fully, it's kind of quivering, right? [quivers] It kind of does that.

01:35 And anytime that atrium doesn't completely compress down and squish all the blood out, that blood ends up hanging out in the right atrium.

01:43 And anywhere blood hangs out, it coagulates and makes clog.

01:48 So, particularly, patients who are in the heart rhythm called atrial fibrillation, that means that their atrium isn't regularly contracting and completely emptying, there's an increase risk for clots to come from that right atrium and go all the way up to the brain.

02:03 We'll also do lab tests.

02:05 We'll try to rule out some other metabolic or other cause of the neuro symptoms that we're seeing.

02:10 So as we're coming in the ER, what's the first test were likely going to do? Right, we're going to do a CAT scan or an MRI.

02:19 So first, we're going to notice that the patient has these neural problems presented into triage.

02:25 They we're gonna recognize that this person gets moved to the front of the line, right? They're going to do a CAT scan or an MRI, then the next test, we'll do look at maybe an MRA, a CTA, a TCD.

02:36 We'll make sure we do a heart eval, a cardiovascular evaluation to see if that might be the source of a clot, and we'll do lab tests to make sure that we rule out metabolic or other causes of these neuro symptoms.

02:48 Because remember that slide with all the possible diagnoses that could be on there, it'd be nice if we just knew exactly what it was when a patient walks in the ER.

02:58 But that's part of the fun of being an ER nurse, it's like being an investigator, you get all these clues and you have to solve the mystery of what's wrong with the patient.

03:07 So I want you to be in the frame of mind that we're talking about a patient that starts initially by showing us some unusual neurological symptoms and how would we walk them right through the system to evaluate and to see exactly what we're dealing with.

03:21 So even with the TIA, we want that patient to get to the ER so they can have all these tests, so we can see what the next best step is.

03:29 Now, we've talked about these tests, let's talk about them a little more.