stroke in LTC

Check obs,check reflexes,phone doctor.

If they coherent, have them smile to see if one side of the face droops, have the patient lift their arms to see if one side is weak, and see if they can talk, and I guess before that get a set of vitals, if the patients is incoherent than I don't know what a tail tell sign would be.

Call 911

Set of vitals, neuro check (PERRLA, grasps, reflexes, orientation, consciousness), call physician.

Ask them to smile, speak, stick out their tongue, hand grasps..CALL the DOC and ask for 911 to hospital is appropriate.

It really depends, these questions are so vague. First, I would ask the patient how they are feeling (if they are able to respond)get a set of vitals then do a quick neuro check. Second, I would very quickly make sure I know what the pt's history is while checking the advance directives. Third let the doctor know and from there communicate the plan with the family and pt if coherent. It seems like a lot but all of this should be able to be done in 5-10 minutes as long as you can get ahold of the doctor.

The patient's wishes along with being able to make an informed decision is something that shouldnt be overlooked.

I have seen one first hand in LTC. I did vitals, had do Range of Motion ( noted one side weakness) and slurring speech, called 911, call Doc, called pt family, call facility RN( she always wanted to be called when sending out).

Those first few minutes can be litterally life saving or damaging.

Know the DNR status, then call 911. You can obtain vitals and assessment while ambulance is on the way.

I have not had to deal with a stroke yet as I am a new nurse. Besides, the other posters gave great advice. An elderly member of my family, just had a TIA. The symptoms she had were weakness on one side, loss of balance, and confusion. The Dr. said it was possible that she may have a stroke within a month.

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.

sometimes people wonder if a patient is dnr why transfer? what would they do for them anyway, especially if the window of quick treatment is gone. well, one thing is to determine if the stroke is hemmorrhagic or ischemic. If its a bleed vs. ischemia, many things could make it worse/better. usually with a pupil changes, its a bleed, I think, but if someone is on coumadin, and their INR has been very high, a bleed would be more likely.and you certainly wouldn't want them on aspirin or coumadin. and vice versa.