A.

Critical Thinking Exercise

1) Differentiate ischemic stroke from hemorrhagic stroke.

When blood arteries in the brain become clogged, an ischemic stroke occurs. A
hemorrhagic stroke occurs when blood clots in the brain, impairing its capacity
to function.

2) What are the step-by-step nursing interventions upon receiving the patient in
the Emergency Department?

▪ Examine the patient's breathing, airway, and circulation.

▪ Monitor the patient's spO2 and, if necessary, provide supplementary

oxygen.

▪ Ask the patient’s significant others if when did the symptoms started.

▪ To increase cerebral blood flow, keep the head of the bed flat (unless
contraindicated).

▪ Set up a continuous cardiac monitor for the patient.

▪ To check for arrythmias and other irregularities, have a STAT 12-Lead

ECG.

▪ To assess his glucose level, take a finger-stick blood specimen.

▪ Place at least two large-bore intravenous devices.

▪ Evaluate and document the patient’s vital signs.

▪ Conduct a general neurologic examination, ensuring that strength and

motor function are equal.

▪ Examine his pupils for equality and light sensitivity.

3) Discuss comprehensively the NIH Stroke Scale/Score (NIHSS) and its

importance.
The NIH Stroke Scale is a widely used tool that was built to assess the
cognitive effects of a stroke. In more scientific terms, it provides a quantitative
measure of stroke-related neurologic deficit.

Although the NIHSS was first developed as a clinical tool for research on
stroke patients, it is now used by health professionals to determine the severity
of a stroke. It also helps everyone engaged in the treatment of a stroke patient
build a shared language.

In a treatment setting, the scale has three major purposes:

▪ It evaluates the severity of the stroke

▪ It helps determine the appropriate treatment

▪ It predicts patient outcomes.

For patients, the NIHSS score is critical since it affects the course of action and
therapy after a stroke. First, healthcare professionals use the NIHSS score as
soon as possible following the onset of symptoms, which is usually in a
hospital's emergency room. It will be used on a regular basis and/or whenever
the patient's condition deteriorates.

It’s important to keep a good history of a stroke patient’s NIHSS score because
it allows healthcare professionals to monitor their progress, tailor their
treatment, and quantify their improvement or decline over time.

REFERENCES:

Medscape nurses

Aha journals organization

Lippincot Williams & Wilkins, Inc.