I have suspected strokes in several residents over the past year. Out of 5 suspected strokes I've seen, 4 were confirmed.
First thing I noticed in each of them was a change in mental status. Lethargic, weak, speech changes, or lack thereof. Once I noticed this, I look for a facial droop. if possible, I ask the resident to smile, puff out their cheeks, raise their eyebrows, etc. and look for symmetry. Usually, they wren't able to follow commands, but i still could notice the facial droop. I check for hand grips, push pulls, but usually the resident not following commands, is anable, so i lift the hands then drop them, checking for any resistance or if they are purley flaccid. Of course I check vitals noting a very high b/p., Also, listening to heart sounds may help because if I fib is present, a stroke would be more likely. I listen to lung sounds and check temp as having adventitious lung sounds and/or hyperthermia may decrease the possiblity of a stroke especially where the resident has any type of neuro history. If there is any neuro history, you may question yourself as to whether any slight facial droop is a change or was it already present. that has happened 3 times to me. It turned out the patient just had pneumonia and had massive mental status changes, and their droops had been normal, and their flaccidity was due to generalized weakness. thats why you really check for one side being weaker. Of course, call the doc right away with the findings and if no call back within 5 minutes and the signs are very favorable to be a stroke, just call 911. favorable signs of a stroke would be one sided weakness, pronounced facial droop. sluured speech, dysphagia.
of course you must make sure the resident doesn't have a do not transfer order. if there is a dnr, they often still want to be transfered to the hospital for acute treatment.
In every case, I collect all my data, read a quick review of their h and p, and page the doc. Usually then transfer. in the mean time, if I have available help, I begin copying hte chart. Of course family is to be notified as soon as possible after the above. document everything, the time you first noticed the chagnes, what time doc was called, what time family was called, what time paramedics called, what time paramedics arrived, what time resident transferred out, etc.