# Stroke Nursing Care

> Nursing care of stroke patients for BSc and GNM — FAST recognition, thrombolysis monitoring, dysphagia screening, positioning and rehabilitation.

- Canonical URL: https://prepelephant.com/topics/allied/nursing/stroke-nursing-care
- Exam / course: Allied Health · Subject: Nursing
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Stroke Nursing Care", PrepElephant, https://prepelephant.com/topics/allied/nursing/stroke-nursing-care

## 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.