Stroke Nursing Care
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Direct answer
Stroke is sudden focal neurological deficit caused by interruption of blood supply to the brain — ischaemic in the large majority of cases, haemorrhagic in the rest — and is a medical emergency where "time is brain". Nursing care begins with recognising FAST (Face drooping, Arm weakness, Speech difficulty, Time to call help), securing airway and oxygenation, obtaining an urgent non-contrast CT scan, and supporting reperfusion therapy with intravenous alteplase within 4.5 hours of onset when eligible. Thereafter the nurse prevents complications — aspiration, pressure ulcers, DVT, contractures and shoulder damage — and drives early rehabilitation and family education.
What you must remember
- Immediate assessment: ABC, glucose (hypoglycaemia mimics stroke), vital signs, GCS and pupillary checks; a non-contrast CT distinguishes bleed from infarct before any thrombolysis.
- Thrombolysis with alteplase is generally limited to within 4.5 hours of symptom onset, after haemorrhage is excluded and blood pressure is controlled (commonly below 185/110 mmHg before giving the drug).
- During and after thrombolysis monitor for bleeding — frequent neurological and vital checks, avoid intramuscular injections and nasogastric tubes initially, and watch for sudden deterioration or angio-oedema.
- Screen swallowing before anything by mouth; keep the patient nil by mouth, upright, and begin dysphagia-oriented feeding only after clearance.
- Positioning: turn every two hours, support the paralysed arm (never pull it) to prevent shoulder subluxation, use a foot board or splint against foot drop, and start passive range-of-motion exercises early.
- Prevent complications: intermittent pneumatic compression for DVT prophylaxis, skin care, bladder training avoiding an indwelling catheter, bowel regulation and oral hygiene.
- Communication care: for hemianopia or neglect, approach and place objects on the unaffected side; use simple sentences and picture boards for aphasia.
- Control glucose, temperature and blood pressure as prescribed, and begin secondary prevention — antiplatelets, statins, blood pressure and diabetes control, smoking cessation.
Common confusion
The timing rules are what students scramble. Numbness alone or a transient deficit that fully resolves within hours is a TIA, which still demands urgent work-up; a stroke leaves a persistent deficit. Within stroke, the critical bedside error is giving food or tablets before a swallow screen — silent aspiration in a hemiplegic patient is a classic exam scenario. Also remember that acute blood pressure is often deliberately not lowered in ischaemic stroke unless very high, which feels counter-intuitive.
Exam-focused takeaway
Questions typically start with a FAST scenario and ask the priority action — check glucose and ABC, note the exact onset time, and arrange urgent CT. MCQs test the 4.5-hour thrombolysis window, pre-thrombolysis BP limits, dysphagia screening priority, positioning of the hemiplegic limb and DVT prophylaxis choice. Long answers expect a stroke nursing care plan plus rehabilitation role of the nurse with a multidisciplinary team, including family training for continuation at home.
Frequently asked questions
Why must a CT scan precede thrombolysis?
The scan excludes intracerebral haemorrhage, since a clot-dissolving drug would worsen a bleed. Only after confirming ischaemia, within the window, is alteplase considered.
What is the role of dysphagia screening in stroke?
Weak swallowing muscles risk aspiration pneumonia, so a bedside swallow screen precedes the first sip of water or medicine.
How is the hemiplegic shoulder protected?
The flaccid arm is supported on a pillow at all times and never pulled, preventing painful shoulder subluxation.
When does stroke rehabilitation begin?
As soon as the patient is medically stable, often within 24 to 48 hours, with passive movements, positioning and early supported mobilisation.
What should the family be taught before discharge?
Safe positioning and transfers, passive exercises, upright feeding, medication adherence, warning signs of recurrence, and continuation of therapy exercises.