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PRACTICE STANDARD
Statement of Standard
OHSU Hospitals and Clinics have adopted these practice guidelines in order to delineate a consistent,
evidence-based approach to treating the patient who presents with signs and symptoms consistent with acute
stroke. Although these guidelines assist in guiding care, responsibility to determine appropriate care for each
individual remains with the provider themselves.
Outcomes/goals
Physician
RN
Complete admission database and initiate nursing plan of care according to the
appropriate OHSU Adult Inpatient Standards of Care:
Adult Critical Care Standard of Care
Adult Acute Care Inpatient Standard of Care
Physician
3. No intramuscular injections.
4. Head CT or MRI at 24 hours post infusion.
Blood pressure management guidelines for patients during and for the first 24hr
after having received thrombolytics:
Stroke Team
Physician or Clinical
Stroke Coordinator
and ICU RN
Neurocritical care
physician and RN
2.
3.
4.
5.
For all patients during the acute phase after ischemic stroke or TIA, and
independent of thrombolytic therapy:
Keep Cerebral Perfusion Pressure (CPP) > 70 and Mean Arterial
Pressure (MAP) 80-110.
RN, Rehabilitation
Services, and
Nutrition Services
Neurocritical care
physician and RN
Provide social and psychological support for the patient and their significant
others as needed.
Case management services to begin upon admission providing ongoing
utilization review. Works with multiple disciplines to determine patients
Identify patient and family education needs and provide appropriate information
and resources found in the stroke education packet. This should include
identification of personal modifiable risk factors, such as smoking cessation,
nutrition, exercise, and blood pressure regulation; warning signs for stroke;
activation of EMS; need for follow-up after discharge; and medications
prescribed.
Document education provided in the Patient Education section of the electronic
medical record.
Perform focused neurological assessments based on patient condition and
physician orders, every 1-2 hour while in the Neuroscience ICU and every 2-4
hours in acute care.
Changes in patient condition to be reported to the physician in a timely manner.
Bibliography:
Adams, H. P., et al. (2007). Guidelines for the Early Management of Adults with Ischemic Stroke: A
Guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical
Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic
Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working
Groups. Stroke (38), pp. 1655-1711.
Adams, R. J., et al. (2008). Update to the AHA/ASA Recommendations for the Prevention of Stroke in
Patients with Stroke and Transient Ischemic Attack. Stroke (39), pp. 1647-1652.
Bhardwaj, A., Mirski, M. A., & Ulatowski, J. A. (Eds.). (2004). Handbook of Neurocritical Care. Totowa,
New Jersey: Humana Press.
Del Zoppo, G.J., et al. (2009). Expansion of the Time Window for Treatment of Acute Ischemic Stroke
With Intravenous Tissue Plasminogen Activator: A Science Advisory from the American Heart
Association/American Stroke Association. Stroke 40, (8), pp. 2945-2948.
Pugh, S., et al. (2008). Guide to the Care of the Hospitalized Patient with Ischemic Stroke, 2nd ed. AANN
Clinical Practice Guideline Series. Publisher: AANN.
Sacco, R. L., et al. (2006). Guidelines for Prevention of Stroke in Patients with Ischemic Stroke or
Transient Ischemic Attack: A Statement for Healthcare Professionals from the American Heart
Association/American Stroke Association Council on Stroke. Stroke, 37, pp. 577-617.
Summers, D., et al. (2009). Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute
Ischemic Stroke Patient: A Scientific Statement from the American Heart Association. Stroke 40, (8), pp.
2911-2944.
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