blood sugar on a possible stroke patient?

MunoRN, RN · Apr 12, 2011

Hypoglycemia symptoms can appear similar if not exactly like a stroke, so an initial BG check on a patient with new CVA-like symptoms is to rule out causes of the symptoms.

The NIH scale isn't intended for hourly use, pupils would be part of a basic neuro check which if often hourly initially, which is why it isn't in the NIH scale.

misswoosie · Apr 19, 2011

Hypoglycaemia is one of the stroke "mimics" and especially in a patient with a neurological deficit due to a previous stroke can cause confusion regarding current diagnosis.Of course this is where past medical history and level of disability IMMEDIATELY PRIOR TO THE CURRENT EVENT become vital.

Hypoglycaemia should be corrected and then patients neuro deficit reassessed.

BGs only need to be done hourly if they are unstable, usually in a diabetic patient ,particularly if nil by mouth due to reduced consciousness or dysphagia.

NIHSS is a tool for measuring neurological deficit in stroke patients.

It was devised for use in clinical trials of thrombolysis in stroke back in the late 90s (I think)

In a stroke patient who has a worsening neuro deficit due to stroke progression/raised ICP it might be neccessary to do the NIH hourly.

In such patients if there is altered conscious levels with a large infarct, haemorrhage or oedema it would probably be wise to check pupils, but it's not required as a routine part of neuro stroke deficit as changes in the NIHSS should alert the nurse that things are deteriorating long before you would see pupillary changes (hopefully!)

SanskeetRN · Jan 4, 2012

Getting back into med surg area again and I have an idea why we would do a one time BS on a possible stroke patient, but I am wondering if they are not diabetic do you usually still take bs as part of the stroke scale every hour?
Also, why isn't pupil checks on the NIH check every hour?

I know this post was from a while ago but just wanted to interject that per our stroke protocol, we check glucs either q6x4 if NPO or QID for 24 hours ( this is in conjuction to ruling out hypoglycemia vs. stroke upon onset or arrival to ETC) as the other posters have stated) on all ischemic stroke patients as elevated blood sugar affects the perfussion penumbra. Anything greater than 140 usually results in giving insulin.

I also agree that pupil checks are part of a regular neuro check and in reality, you would most likely notice a patient being more lethargic or other neuro changes before pupil changes.