Nursing Resources

The American Association of Neurological Nursing published an online resource on the care of ischemic stroke occurrence. This source is immensely thorough, and provides all the details of care that a nurse may need to know, in an easy-to-reference format. It's main sections include things such as procedures, interventions, education (for both patient and family), expected outcomes, evidence based practice, and innovate practice, among other things. This is a highly helpful resource when developing a nursing plan of care for ischemic stroke.
Complete Stroke Nursing Care

http://www.americannursetoday.com/wp-content/uploads/2014/07/nurse-with-old-man-in-wheelchair-624x405.jpg

Many times, stroke occurrence can't be prevented once symptoms occur--stroke generally isn't asymptomatic. However, nursing care post-discharge can heavily influence stroke reoccurrence and the success of rehabilitation. American Nurse Today presents a thorough article articulating strategies that are effective in this recovery, and many aspects of nursing care that should be considered. It promotes the ideas of individualization, self-care, and patient education as just a few topics within many.
Post-discharge Nursing 

Nutrition in Stroke Treatment

After a stroke, dietary changes must be made in order to ensure the complete restoration of health in a person. Stroke occurrence can severely hinder physical coordination of daily activities, such as feeding oneself, cooking, and grocery shopping, because of brain damage that may have occurred. According to the National Stroke Association, there may be a lack of coordination in swallowing (dysphagia) or in arm and hand movements involved in using a spoon or fork. Brain functioning may also be impaired, such as problems with memory and thinking, which could lead to forgetting to eat, as well as a loss of appetite. These problems thus lead to the need for adequate nutrient-dense foods. If caloric and nutritional needs can't be met, malnutrition can occur, which is characterized by poor appetite and weight loss.

This includes things such as:

• Fruits and vegetables: They are nutrient-dense, which is important if memory issues are present. A recovering stroke patient must eat foods that can supply their body with adequate nutrients in order to promote a full recovery. 
• Grains: Whole grains and cereals can reduce the risk of stroke, and are also nutrient dense. 
• Lean protein: Cholesterol consumption should be limited in order to reduce the risk for another stroke. Choosing low-fat meats or other protein sources, such as beans, can help facilitate a reduction in the cholesterol that can play a part in the blocking of blood in the blood vessels of the brain. 
• Limit salt: Consuming too much salt can lead to water retention. This is an issue because it causes a rise in blood pressure in the body. Being aware of the sodium content in foods you're buying is an important part in this, as well as using other flavorful spices to cook. 

http://mojotimes.com/wp-content/uploads/2015/09/healthy-diet.jpg

A healthy diet also reduces the risk of stroke occurrence in the first place, which includes low cholesterol intake, low sodium intake, and a high intake of nutrient-dense foods. 

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Stroke Nutrition

https://my.clevelandclinic.org/health/diseases_conditions/stroke/hic_The_Role_of_Nutrition_in_the_Prevention_and_Treatment_of_Stroke

Stroke Treatment

In stroke, prevention is the key to vitality of a patient. However, if signs and symptoms of stroke begin to become evident, there are several different treatment options. In ischemic stroke, which is what I've predominantly focused on in this blog, there are two main treatments: tPA treatment and mechanical thrombectomy.

tPA Treatment
A treatment of tPA, or tissue plasminogen activator, may be used to treat ischemic stroke, and is the only FDA approved treatment available. It is typically given through an IV method, and works to dissolve the blood clot that is present in order to restore or improve blood flow to the brain. The goal of this treatment is to minimize the damage that may be caused from stroke occurrence. It's important that it is administered within three hours of stroke incidence in order to increase the possibility of stroke recovery. Many patients don't go to the hospital soon enough to utilize tPA treatment, which is why early detection of symptoms is crucial.
     
     Side effects of tPA treatment: A tPA infusion can damage the basal lamina of blood vessels. This results in edema, disruption of the blood brain barrier, or hemorrhaging. This means that a patient previously taking any anti-coagulant medication or a patient at risk for hemorrhage doesn't qualify for tPA treatment. The National Institute of Neurological Disorders and Stroke found that 1 in 18 patients having tPA therapy experience brain bleeding, leading to a 45% mortality rate in these cases. These complications are more common in adults over 70 years of age, and those with a glucose level greater than 300 mg/dl. Using more than the recommended dose of tPA also has very adverse effects related to internal bleeding.

http://www.pyroenergen.com/articles13/images/tpa-intravenous-therapy.jpg

Endovascular Procedures
Another treatment method of stroke is known as mechanical thrombectomy. In this procedure, doctors attempt to remove the blood clot using a stent retriever. This occurs by threading a catheter in a groin artery back up toward the blocked artery in the brain. The stent then opens and "grabs" the clot, which doctors then remove along with the stent removal. This procedure can only be done after tPA treatment, and a patient must meet certain criteria before a mechanical thrombectomy occurs.
     Side effects: Mechanical thrombectomy can cause intercranial blood vessel wall trauma, thus making other complications more likely. With any medical procedures come risk for infection, arterial damage (due to catheterization), and anesthetic risks, especially when considering that many stroke patients are in the elderly population.

http://cirse.org/files/images/Patients/full%20sized%20images/Thrombectomy(800x534).jpg

Stroke Treatments
Side effects of tPA Infusion
More tPA effects

Signs and Symptoms

According to the Centers for Disease Control and Prevention, the main signs and symptoms of stroke include a rapid onset of numbness or weakness in the face, arm, or leg (predominantly on one side of the body), sudden confusion (including difficulty speaking or understanding speech), trouble seeing in one or both eyes, trouble walking and coordinating movements with a loss of balance, and sudden severe headache with no known cause.

There is no distinct progression of these symptoms, in that they may occur in any order, and some may be absent altogether. A stroke may affect certain individuals differently, but all these symptoms are indicative of stroke occurrence, and an individual should be aware of the variety of symptoms of a stroke that play a role in stroke identification. The important concept to remember with stroke signs and symptoms is to take fast action, in order to prevent the damage that stroke can inflict upon a person's brain.

A pneumonic that many medical professionals use when teaching those outside the medical profession to identify stroke is F.A.S.T:

http://www.strokeassociation.org/STROKEORG/WarningSigns/Stroke-Warning-Signs-and-Symptoms_UCM_308528_SubHomePage.jsp

It's likely that a patient would notice a painful headache or vision changes first, in that they affect functioning more than some of the other signs. A sign such as paresis (face drooping, muscle weakness, etc) may be noticed initially by another person sooner than the patient would notice themselves. Difficulty with speech could be apparent to either the patient or the person they may be speaking to, and difficulty coordinating movements is likely to be noticed by both parties. It's extremely important to identify stroke signs quickly, because a lack of oxygen and nutrients to the brain for more than six minutes will lead to death. Many times, symptoms have a rapid onset, and a relatively short time span, because so much damage can be inflicted on the brain in such a short amount of time.

I made this chart to demonstrate the occurrence rates of stroke symptoms in individuals who have experienced at least one stroke.

Symptom	Percentage of people experiencing symptom
Speech deficit	24%
Hemianopia (vision loss) Diplopia (double vision)	14.6% 5.5%
Paresis (weakness/partial loss of voluntary movement)	Arms: 75.5% Legs: 68.6% Face: 54.6%
Headache	25%
Gait disturbance	10.8%

http://stroke.ahajournals.org/content/33/11/2718/T2.expansion.html
http://www.cdc.gov/stroke/signs_symptoms.htm