ModuleDraftEmergencyMedicationsSwallowing

Nursing: acute ischemic stroke care basics (stroke unit workflow)

Nursing acute ischemic stroke care basics: neuro checks, vitals, escalation triggers, dysphagia screening, complications monitoring, and patient/family education checklist.

ClinicianClinicianIntermediate20 minClinical (pro)

Educational only

Clinical education only — follow your organization’s stroke protocols and orders.

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Any acute neurologic deterioration, airway compromise, uncontrolled bleeding, or suspected stroke progression is an emergency: activate local stroke alert/rapid response per protocol and document last known well time.

Key takeaways

  • Describe core nursing priorities in acute AIS
  • Differentiate dysphagia screen vs SLP assessment
  • List escalation triggers for neuro change
  • Identify nursing interventions that reduce complications

Core nursing priorities

  • Frequent neuro assessment per protocol
  • Vital signs + glucose per protocol
  • Early complication prevention
  • Family communication

Escalation triggers

  • New neuro deficit
  • Worsening NIHSS/LOC
  • Airway/breathing concerns
  • Severe headache or vomiting
  • Blood pressure extremes per local protocol

Dysphagia screen + NPO rules

  • Screen ASAP per protocol
  • Fail = NPO until evaluated
  • Oral care and aspiration precautions

Care bundles

  • DVT prophylaxis per orders
  • Skin integrity
  • Early mobilization planning
  • Medication reconciliation

Practice check

What you’ll practice

These questions are untimed. After you answer all of them, you’ll see your score and a clear next lesson or reference step.

0 of 3 answered

Question 1

1. A dysphagia SCREEN is best described as…

Question 2

2. If a patient fails a dysphagia screen, the next step is usually…

Question 3

3. Any acute change in neurological assessment should trigger provider notification/escalation per protocol.

References

  1. Tier 1
    AHA Scientific Statement: Care of the Patient With Acute Ischemic Stroke (Prehospital and Acute Phase of Care) — nursing update
  2. Tier 1
    AHA Scientific Statement: Care of the Patient With Acute Ischemic Stroke (ICU/Postinterventional Care) — nursing update
  3. Tier 1
    AHA/ASA AIS Guideline (2019 Update)