NIHSS stroke scale

[ferde1]

I am told we will be using the NIHSS stroke scale in our SICU and that we only need to do it on assessment , after 48 hours and then again at transfer. Is this standard practice?:uhoh21:

[misswoosie]

I think it would be beneficial to have stroke as a separate speciality on the all nurses forum.

I am sure that not all stroke patients in USA are cared for on ICU, and certainly here in England although we have regional neuro ICU s, they are generally for neuro trauma/surgery patients and run by neurosurgeons, so very few stroke patients make it there.Even "general" ICUs which is all most county hospitals have are very reluctant to take stoke patients, unless they had the stroke post surgery or have also had an MI!

Our stroke patients are cared for on a stroke unit which started off as a ward for elderly medical patients, so you can imagine it is a difficult transition for staff. That is why we only have the Stroke NP,Stroke physicians and research nurses doing NIHSS.

We have developed another obs chart for use on high risk stroke patients and for for post thrombolysis. It is a 24 hour chart which evaluates conscious level, speech and limb power on a quantified scale.It also has BP,pulse.O2 Sats,temp on it and has instructions on how to respond if changes meet particular criteria.

Some "stroke" units may have one 6 bedded bay (we only have 2-3 private rooms on a ward and usually they are for infectious patients of those that are dying) for hyperacute stroke patients and offer continuous monitoring, but we don't have that yet.

We also have the rehab patients on the same ward!

What I am trying to say is that stroke is high priority in most developed countries and deserves to be a speciality in its own right here.

Agree?

[Beentheredonethat]

With the advent of Primary and Comprehensive stroke centers starting to come into play and the evolution of a national standard such as Get With the Guidelines stroke is on the doorstep of being a subspecialty. It has had more time to evolve into a specialty for our physicians (USA) but has not made that transition for nursing.

I couldn't agree more with a dedicated stroke forum. It would provide fast and more efficient searching for answers and sharing of the wealth. OK that may sound like a presidential political statement so I will clarify, the wealth of knowledge.

By helping, supporting and sharing with each other we not only provide nuturing for the few who go into this field but improve the standards of care for our patients.

Lets do it!

[betty246]

has anyone yet started a stroke forum and does anyone use a seperate tool from the GCS(Glasgow Coma Scale) as you will know this is not really for assessing stroke patients does anyone know of any other tool other than the NIHSS for assessing stroke patients.

[misswoosie]

I think only the admin can start a separate forum.

For assessing neurological deficit in acute stroke the NIHSS is almost always used. Another one that used to be used pre-NINDS (at least in Europe) was the Scandanavian Stroke Scale.

For classification of type of stroke there's the Bamford or Oxford Stroke classification which is always used in the UK , but not sure about in the USA.

http://-Key role in development of hospital wide protocol and pathway for out-patient treatment of VTE

For assessment of handicap the Modified Rankin scale

Rehab Measures - Modified Rankin Handicap Scale

For assessment of disability the Barthel Index

http://www.strokecenter.org/wp-content/uploads/2011/08/barthel.pdf