Review of Acute Stroke Treatment Goals – Stroke Nursing Care in ICU

00:00 Hi. Welcome to our video series on neurological disorders.

00:05 Now, it's okay if you're starting with this point, but I want to give you a little bit of background of the patient that we're following.

00:11 Mr. Johnson came to the ER showing us signs of stroke.

00:14 He was evaluated in the ER, and it was determined that he had an ischemic stroke.

00:19 Now, we're going to pick up Mr. Johnson in intensive care and talk about the hands-on nursing care of a stroke patient in ICU.

00:27 In this graphic, you've got a representation of the ER nurse in the black scrubs, and the ICU nurse in the kind of pink-colored scrubs.

00:35 Now, they're going to exchange report on Mr. Johnson.

00:38 This is a really important skill that you need to practice, but I first want to talk about why Mr. Johnson is going to ICU.

00:46 I mean, we know that he had a stroke, but we gave him medication that, hopefully, is resolving that.

00:50 But after a drug like alteplase, which is a thrombolytic, it really rips apart any clots in the patient's body.

00:58 So, he's going to need very close monitoring.

01:01 That's just not possible on a unit like Med-Surg where there are multiple patients, and you can't visualize the patient.

01:08 In a Critical Care Unit, it's usually very open, you have high visibility, the patient's on a monitor, so they can keep a much closer eye on the patient.

01:17 On a Med-Surg unit, a nurse can have 6, 7, 8 patients at a time.

01:22 In ICU, their patient to nurse ratio is much smaller, usually 1 nurse to 2 patients, maybe 3, depending on how critical they are.

01:32 Mr. Johnson is a new admit. He'll need close monitoring, both his cardiac and his neurological status, so you're going to get report as the ICU nurse -- Now, I want you to think of yourself from that perspective.

01:44 As the ICU nurse, you're going to get report from your colleague from ER.

01:50 Okay, now, here's your goals. You know as an ICU nurse, these 5 things are the things that are going to be your focus for Mr. Johnson coming to the Critical Care Unit.

02:00 First, number 1, doesn't matter what unit you're on, and you'll see me say it over and over again, but your role is always to maintain the stability of the patient's airway, breathing, and circulation.

02:16 Now, we talked about why he's coming to ICU is because of frequent monitoring. And that's a very common reason why people are admitted to a Critical Care bed.

02:25 Hey, those are really expensive beds, and we don't have very many of them.

02:28 So you want to make sure the patients that are admitted to those beds really need it.

02:33 Usually, it's because they need very close monitoring of any of the body systems. In this case, it'll be very close of neuro and cardiovascular.

02:42 That will include their vital signs.

02:44 Now, we want to recognize any signs of Mr. Johnson's condition deteriorating, particularly, his level of consciousness and his mentation.

02:53 ICU nurses, as all nurses are trained in neuro assessment, should recognize any changes. And since there's a lower nurse to patient ratio and a better visualization of the patient, they have the best chance of catching these signs early.

03:08 We also want to look for signs of complication after the stroke or thrombolytic therapy.

03:13 So, if he's showing us any signs of bleeding or any other issues with complications, we'll be right on top of it because he's in a Critical Care Unit, or we can watch him very closely. Because our goal here, all throughout his stay, is to preserve the function that Mr. Johnson has and minimize any further neurological damage or disability he may experience.

03:35 Remember, right now, he's got the facial drooping, he had the arm that was weak, so we want to hopefully resolve that and minimize any future risks.