Ischemic stroke accounts for approximately 85% of all strokes. Reperfusion therapy with intravenous Alteplase and/or endovascular thrombectomy is mainstay of acute stroke management. Approximately 30% of ischemic stroke patients will deteriorate in the first 24 hours regardless of pharmacologic and/or mechanical intervention. 15%-20%
will
require care in an intensive care unit (ICU). Severe strokes constitute a minority of cases though are associated with a majority of subsequent disability and death. The complex stroke patient presents many clinical challenges for the ICU nurse.
This presentation will review nursing clinical challenges of the complex stroke patient in the ICU.
The ICU Nurse is challenged with a variety of complex interventions caring for the ICU stroke patient. There is a significant subset of ischemic stroke patients at risk for secondary brain injury who may benefit from critical care monitoring and intervention. Nursing assessment, treatments, goals of care, and collaboration with the interdisciplinary ICU team will be addressed.
There is evidence that care in a neuroscience-specific ICU leads to improved outcomes in traumatic brain injury, intraparenchymal hemorrhage, and subarachnoid hemorrhage and reduced cost of care for neurosurgical patients. There is less direct evidence to support benefit of ICU care in ischemic stroke, but the association between care at a specialized stroke center and outcome is well established.
Recognizing nursing’s role in the care of the ICU stroke patient is key. The assessment and identification of subtle changes are imperative. Intervening with a variety of timely treatment options to eliminate complications must occur. Implementing current evidence-based practice allows for the best patient outcomes.
The ICU nurse is challenged with the early recognition and appropriate management of neurological and non-neurological complications of the stroke patient in the ICU. This can be a significant factor in reducing mortality during the acute hospitalization. Standardized care implemented by the collaboration of nursing, neurointensivist and a critical care team, can not only decrease the length of stay, though also offer a greater chance of being discharged to home.
