z

Acute Ischemic
Stroke
 What is a stroke? It is a condition that develops when blood
z rich in oxygen can NOT reach brain cells (due to either a
.blockage or bleeding). This causes the brain cells to die
z
Ischemic (most common): due to a blood clot within a blood vessel or stenosis 
z
of an artery that feeds the brain tissue. This limits the blood that can reach the
:brain cells. This type of stroke can happen due to

Embolism: where a clot has left a part of the body (example the heart: this can •
happen due to a heart valve problem or atrial fibrillation). The clot develops in
.the heart and travels to the brain, which stops blood flow

Thrombosis: Clot forms within the artery wall within the neck or brain. This is •
seen in patients with hyperlipidemia or atherosclerosis

Hemorrhagic: this occurs when there is bleeding in the brain due to a break in– 
a blood vessel. Therefore, no blood will perfuse to the brain cells. In addition, this
can lead to excessive swelling from the leakage of blood in the brain. Causes of
this type of stroke includes: rupture of a brain aneurysm, uncontrolled
.hypertension, or aging blood vessels (older age)

TIA (transient ischemic attack) also called a mini-stroke. This is where signs- 
and symptoms of a stroke occurs but last only a few minutes to hours
and resolves. It is a warning signs an impending stroke may occur. If this occurs
.the patient needs to seek treatment
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Blood supply to the brain? The 

blood supply to the brain comes
for the carotid and vertebral
arteries, which then branch into
other arteries that feed the brain.
If any of these areas of the artery
become blocked or burst open it
decreases the blood supply to the
brain cells. Brain cells are very
sensitive and within 5
minutes these cells start to
become damaged, and the damage
.can become IRREVERSIBLE
 z

The right side of 

the brain is
the CREATIVE
side while
the left side is
the LOGICAL
side
z

:Right Side’s Functions 

Attention span •

Showing emotions •

Ability to solve every day problems by making decisions/plans •

Reasoning (understanding jokes…reading in between the lines) •

Making judgement calls •

Memory •

Music/art awareness •

Control the left side of the body •

If a patient has right side brain damage, what do you think the patient will 
z
?experience
Left side weakness: Hemiplegia •

Impairment in creativity: arts and music •

Confused on date, time, place •

Cannot recognize faces or the person’s name •

Loss of depth perception •

Trouble staying on topic when talking •

Can’t see things on left side: LEFT SIDE NEGLECT (unilateral neglect) •
)Ignores left side of body( •

Trouble with maintaining proper grooming •

Emotionally: not going to think things through….very impulsive •

Poor ability to make decisions and assessing spatial qualities….shapes •

Denial about limitations •

Not able to read nonverbal language or understand the hidden meaning of things •

Very short attention span •

Left Side’s Functions
: 

Speaking •

Writing • z
Reading •

Math skills •

Analyzing info •

Planning •

:?If a patient has left side brain damage, what do you think the patient will experience 

Right side Hemiplegia •

Aphasia (trouble formulating words and comprehending them) •

Aware of their limits…experiences depression, anger, frustration •

Trouble understanding written text •

Can’t write (agraphia) •

Impaired math skills •

Memory intact •

Issues with seeing on the right side •

So, as you can see when there is brain cell death in a certain area it will cause specific signs and symptoms. The amount of brain damage depends on how 
long it took for blood to return to the affected brain cells
 z

Signs and Symptoms of a Stroke 

Happens suddenly: need to act 

fast as the nurse to help save brain
cells

call rapid response so patient can •

receive appropriate treatment or
call 911 (if outside of the hospital
in the United States)

NOTE the exact time the signs •

and symptoms appears…
important for stroke treatment
z

“FAST”
Face: drooping or uneven smile
Arm: numbness, weakness, drift (raise both arms)
Speech: can’t repeat a phrase, slurred speech
Time: to call rapid response and note the time
**National Stroke Association recommends using the
mnemonic F.A.S.T. to help assess for signs and
symptoms quickly.
The patient can also have the following as well:
Bowel and bladder incontinence or retention
z .remember these terms because exams love to ask you about them 

Aphasia: unable to speak (comprehending or producing it) 

Receptive Aphasia: unable to comprehend speech (Wernicke’s area) •

Expressive Aphasia: comprehends speech but can’t respond back with •

the correct words, if at all (Broca’s area)

.Mixed Aphasia: combination of the two types of aphasia •

.Global Aphasia: complete inability to understand speech or produce it •

Dysarthria: unable to hear speech clearly due to weak muscles (hard to 

understand the patient’s speech….it may be slurred)

Apraxia: can’t perform voluntarily movements (winking/moving arm to 

.scratch an itch) even though muscles function is normal
 z
Agraphia: loss the ability to write 

Alexia: loss the ability to read… 

doesn’t understand or recognize the
words

Agnosia: doesn’t understand 

sensations or recognize known objects
or people

Dysphagia: issues swallowing (weak 

muscles)

Hemianopia: limited vision in half of 

the visual field

Hemiparesis: weakness on one side of the 

body

?Diagnosed 

CT scan •

MR •
:Medication for Ischemic Strokes 
z
!tPA (tissue plasminogen activator): for ischemia strokes ONLY not hemorrhagic 

How does it work? It dissolves the clot within the blood vessel by activating the protein that causes 
.fibrinolysis

REMEMBER: It must be given within 3 hours from the onset of stroke symptoms. It can be given 
.3 to 4.5 hours after onset IF strict criteria is met

:To receive tPA the patient should have a 

CT of head that is NEGATIVE for hemorrhage •

labs within normal limits (glucose, INR, platelets) •

BP needs to be controlled SBP <185 and DBP <110 •

glucose controlled (increases rise of hemorrhage) •

not receiving heparin or other types of anticoagulants •

Nurse’s Role: monitor for BLEEDING, neuro checks around the clock, blood pressure medication 
if needed for hypertension, vital signs, labs, glucose, preventing injury (bedrest), avoid
unnecessary venipunctures, avoid IM injections, will go to ICU to be monitored
Nursing Interventions for Stroke 

z and neuro status

:Monitor vital signs 

especially blood pressure (notify MD is hypertensive) •

airway (difficulty swallowing….at risk for aspiration HOB 30’ with suction at bedside) •

turn every 2 hours with proper alignment and watch for increased ICP (intracranial pressure) during acute stage •

headache, nausea and vomiting, increased blood pressure and decreased HR and decreased RR, decrease in •
mental status from baseline, pupils don’t respond
Assess with NIH Stroke Scale 

Score ranges from 0 to 42 •

no stroke symptoms :0 •

severe symptoms :21-42 •

assessments area are scored 11 •

:Assesses •

Level of consciousness, gaze, visual, facial palsy, motor function of extremities, sensory, best language, •
dysarthria, extinction/inattention
Check cranial nerves: pupil responses, motor function, gag reflex 

Monitor bowel and bladder function (may be incontinent or retaining) 

Passive ROM with extremities and preventing contractions 

Interventions for aphasia 

Communicationzis key (just because the patient can’t communicate doesn’t mean they have a mental deficit). They just can’t get 
.it out and it takes them time. The nurse’s role is to help bridge the gap and make it less frustrating for the patient
Receptive Aphasia: unable to comprehend speech (Wernicke’s area) •

use short phrases- 

use gestures or point while giving a command- 

be patient and not expect a fast response- 

remove distractions- 

Expressive Aphasia: comprehends speech but can’t respond back with speech (Broca’s area) •

be patient and let them speak- 

be direct and simple when asking questions…..give options- 

communication via a dry erase board- 

Stroke care is a multidisciplinary approach: need to involve family as much as possible because they will be providing care when 
patient is discharged. In addition, it is important to be always be communicating with the speech language pathologist, physical
.therapy, occupational therapy etc
Diet: evaluated by speech language pathologist 

may need thicken liquids and mechanical soft foods •

.assist with eating and monitor for pouching of food in cheek (on the affected side). This increases risk of aspiration •

Have patient tuck in chin to their chest while swallowing

. •
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Watch for neglect syndrome: (tends to happen in right side brain 
damage). The patient is at risk for injury because patient ignores the
.affected side

Remind patient to use and touch both sides of body daily (must make a •
.conscious effort to do so)

Educate the patient about the importance of turning head side-to-side •

.to prevent injuring the affected side

Hemianopsia interventions: turning head side-to-side to see all 

visual fields to prevent injury