When diagnosing ischemic stroke, speed and timing is very critical.

Diagnosis

Non-contrast CT Scan – Emergent Brain Imaging

 fast and widely availability
 can rule in/out hemorrhagic, major, and minor strokes.
 For diagnosing;
o Visualization of the clot (e.g. hyperdense artery)
o Parenchyma changes of the brain.

Magnetic Resonance Imaging

 Has greater spatial vision than CT scan and has greater sensitivity for a small
volume of ischemic attacks.
 Usually used where there is no time pressure to offer treatment and typically as a
follow-up imaging.
 For diagnosing;
o White areas compared in DWI (diffusion weight imaging)
o Dark areas compared in ADC (apparent diffusion coefficient)

Carotid Duplex Scanning

 Carotid duplex is an ultrasound test that shows how well blood is flowing through
the carotid arteries.
 Usually, the first test is done due to its low risk, and low-cost test, and is used for
the diagnosis of plaque-related diseases. There are criteria to diagnose degree
of stenosis.
 Carotid artery stenosis is also a cause of ischemic stroke and ischemic attacks.
 Disadvantages are:
o Limited visualization
o Technical difficulties

Digital Subtraction Angiograph

 Digital subtraction angiography (DSA) is a fluoroscopic technique used
extensively in interventional radiology for visualizing blood vessels that allows an
evaluation of collaterals of the vessel lumen, thus, one of the reasons as a gold
standard in imaging.
 For diagnosing;
o Primary motor cortex (M1) is occluded therefore the collateral flow of
anterio-cerebral circulation is reduced.
Laboratory Exams

Laboratory tests performed in the diagnosis and evaluation of ischemic stroke

include the following:

 Complete blood count (CBC)

o High hemoglobin/hematocrit (polycythemia)
o High platelet (thrombocytosis)
o Leukemia (high WBC)

 Basic chemistry panel:

o Low/High sugar (Diabetes)
o Low sodium (hyponatremia)
o High albumin & low GFR (Renal Problems)

Other laboratory tests:

 Coagulation studies: May reveal a coagulopathy and are useful when fibrinolytics
or anticoagulants are to be used
 Cardiac biomarkers: Important because of the association of cerebral vascular
disease and coronary artery disease
 Toxicology screening: May assist in identifying intoxicated patients with
symptoms/behavior mimicking stroke syndromes or the use of
sympathomimetics, which can cause hemorrhagic and ischemic strokes
Nursing Interventions/Management
Assessment
 ABC Checking
 Monitor for worsening signs and symptoms
 Monitor Vital Signs
 Assess for swallowing screen
 Quick test of degree of disability:
o Acute and Post Acute Phase
 Speech and spatial perception
 Intercranial pressure (and its SnS)
 Vision
 Hemiparesis
 Sense of touch
 Coordination and walking
 NIHSS

Nursing Diagnosis
 Risk for ineffective cerebral tissue perfusion
 Impaired physical mobility related to neuromuscular impairment and decreased
muscle control
 Impaired verbal communication related to insufficient stimuli as evidence by
difficulty in speaking.
 Acute pain related to hemiplegia
 Ineffective coping related to cognitive perceptual changes
 Self-care deficit related to decreased muscle control
 Risk for impaired swallowing
 Activity intolerance related to cerebrovascular impairment
 Risk for unilateral neglect
 Risk for injury
 Risk for disuse syndrome
 Deficient knowledge related to cognitive limitation

Goals/Evaluation.

The major nursing care planning goals for the patient and family may include:
 Improve mobility.
 Avoidance of shoulder pain.
 Achievement of self-care.
 Relief of sensory and perceptual deprivation.
 Prevention of aspiration.
 Continence of bowel and bladder.
  Improved thought processes.
 Achieving a form of communication.
 Maintaining skin integrity.
 Restore family functioning.
 Improve sexual function.
 Absence of complications.

Nursing Interventions

 Positioning. Position to prevent contractures, relieve pressure, attain

good body alignment, and prevent compressive neuropathies.
 Prevent flexion. Apply splint at night to prevent flexion of the affected
extremity.
 Prevent adduction. Prevent adduction of the affected shoulder with a
pillow placed in the axilla.
 Prevent edema. Elevate affected arm to prevent edema and fibrosis.
 Full range of motion. Provide full range of motion four or five times a day
to maintain joint mobility.
 Prevent venous stasis. Exercise is helpful in preventing venous stasis,
which may predispose the patient to thrombosis and pulmonary embolus.
 Regain balance. Teach patient to maintain balance in a sitting position,
then to balance while standing and begin walking as soon as standing
balance is achieved.
 Personal hygiene. Encourage personal hygiene activities as soon as the
patient can sit up.
 Manage sensory difficulties. Approach patient with a decreased field of
vision on the side where visual perception is intact.
 Visit a speech therapist. Consult with a speech therapist to evaluate gag
reflexes and assist in teaching alternate swallowing techniques.
 Voiding pattern. Analyze voiding pattern and offer urinal or bedpan on
patient’s voiding schedule.
 Be consistent in patient’s activities. Be consistent in the schedule,
routines, and repetitions; a written schedule, checklists, and audiotapes
may help with memory and concentration, and a communication board
may be used.
 Assess skin. Frequently assess skin for signs of breakdown, with
emphasis on bony areas and dependent body parts.