2018 Stroke Care Guidelines

The brain is a convoluted organ with many highways and byways.

It’s amazing how the brain sorts out millions of messages and allows us to communicate and move about. However, damage caused to the brain by a stroke can immensely impair a person’s ability to communicate and function effectively. For these reasons in 2017 the American Heart Association announced they were reaching beyond their boundaries of heart disease to encompass Brain Disorders, specifically that of stroke. To begin breaking down the vast and intricate details of the brain we must perceive the brain like the passengers in a flight. Are you ready!

“Passengers, we are ready for take-off. Put your seats in their upright position and turn off your electronic devices. Our destination is Stroke City where the weather is stormy.”

Passengers in the back of the plane can see everything in the cabin of the plane. Therefore, the Occipital Lobe is responsible for vision.

On the other hand, passengers in the front of the plane cannot see what is happening in the cabin. Thus, the only thing to do if you’re sitting in the front is to put your nose in a book and read. Hence, the Frontal Lobe is responsible for intellect.

Passengers in the middle of the plane have someone on their right and someone on their left. In addition, they have an annoying kid in the back kicking their chair. Not only that but, the person in the front reclines their chair and thus the person in the middle feels “squished.” The person in the middle feels everything happening around them. Therefore, the Parietal lobe is responsible for feeling.

Moreover, passengers sitting by the window seat next to the wings of the plane can hear all the turbulence. The Temporal Lobe is located next to your ears. Similar to how the ears of the passenger are next to the wings. And so, the Temporal Lobe is responsible for hearing.

There is an isle that connects the right side of the plane from the left side.

In the same way, the Corpus Callosum joins the right hemisphere of the brain from the left hemisphere.

Next, the caring flight attendant’s name is Medulla Oblongata. Indeed, she has an odd name, but she serves the various passengers with the information they need to reach their destination. The role of Medulla Oblongata is to send messages from the right side of the brain to the left side of the brain.

Next, think of the cerebellum as Sarah the Ballerina. Sarah the Ballerina needs balance and posture to be successful. Therefore, the Cerebellum is responsible for balance and posture.

The cerebral cortex is divided into the frontal, parietal, occipital, and temporal lobes.

In addition, the brain stem contains the medulla oblongata and right above is the cerebellum. As mentioned above, each lobe is associated with a different function. Damage to any of these lobes or structures caused by a stroke can lead to long-term impairment of senses, intellect, motor skills and memory. Even worse, brain damage caused by an ischemic or hemorrhagic stroke can lead to death.

Furthermore, the Circle of Willis is the vascular structure “tucked between the lobes.” The Circle of Willis directs blood supply to the lobes of the brain.

Those occlusions that occur in the forefront of the Circle of Willis are Anterior Strokes and those occlusions that occur in the posterior area of the Circle of Willis are Posterior Strokes. Furthermore, an occlusion within Circle of Willis can be detected with a Non-contrast CT scan. If the occlusion is small, tPA is used to dissolve the clot. On the other hand, if the clot is large, a Thrombolectomy is performed. Strokes that occur in certain areas of the Circle of Willis are treated very differently from one another. It is important to know which stroke is better treated with tPA and which one is better treated with PCI.

Remember in 2017 we had a total eclipse of the moon?

Some parts of the Earth were dark and some parts of the Earth were gray. The part of the planet that darkens is called the umbra. On the other hand, the part of the earth that semi-darkens (the grey areas) is called the penumbra. The umbra of the brain is most affected from of a stroke and is unable to regenerate function. Likewise, the penumbra of the brain is less affected from a stroke and is able to regenerate function, this is called Neuro-plasticity.

When the brain suffers a stroke, fibrin fragments occur and someone has to clean up the mess! That’s the job of the phagocytes and like Pac-Men they run around “gobbling up” these fragments. Apoptosis occurs when phagocytes consume fibrin fragments.

Now that you have learned a little bit about brain anatomy lets briefly discuss stroke assessments and diagnostics.

Cities have traffic and traffic causes “clogged up highways and byways.” Think of Cincinnati and Los Angeles as those cities with obstructed highways. Ischemic strokes have occlusions, therefore, the Cincinnati and Los Angeles stroke scores can determine the probability of Ischemic Stokes. Most importantly, Nurses who work in the Emergency Department, Intensive Care Unit, as well as Trauma Departments should be adept regarding the ins and outs of stroke care. These include, initial and continual assessments, treatment and medication reconstitution, prevention, post stoke care and post stroke assessments. Moreover, it is essential for the nurse to know how to perform all the correct initial assessments such as; the Cincinnati and Los Angeles Pre-Hospital Stroke Scale, NIHSS, Spetzler- Martin, WFNS, HAS-BLED, Hunt and Hess, Glascow, and the Chads I and II score.

Additionally, a TIA is the forerunner of a stroke. The ABCD stroke score can determine the risk of a patient with a TIA that can develop a stroke. ABCD is the forerunner of the alphabet and the TIA is the forerunner of a stroke.

Most nurses would “freak out” if their patient had a blood pressure of 220/120 and would rush to medicate the patient with an anti-hypertensive drug.

In fact, some clinicians would use Permissive Hypertension when managing a patient’s blood pressure. Think of this as watering your garden with a garden hose without a nozzle head. The water will not go very far. If you put a nozzle head on your garden hose the water with its added pressure would allow you to get the water to a further distance. Using greater pressures for an obstructed brain would perfuse the brain that needs more blood perfusion.

The Non-contrast CT scan is our “go-to” diagnostic tool of choice. But there is another diagnostic tool that can detect smaller and deeper occlusions. That is the MRI. The MRI is more expensive and takes longer to predict an occlusion. It is in today’s Stroke Facilities and is a significant diagnostic tool for stoke.

In all honesty, there is so much more to the brain and stroke care that a simple blog can describe.

What is more, self-care needs have proven to be a major issue with stroke patients. A skillful nurse can help guide and support patients through education. Education can empower patients to change their attitude on their remaining abilities and current habits. Understanding the new stroke care guidelines can help the nurse achieve better outcomes. However, current research has demonstrated weak points in the quality of care given to stroke patients. Nurses Educational Opportunities aims to improve our nurse’s practice in providing effective care to stroke patients. Lastly, Nurses Educational Opportunities presents this Stroke Care course with visuals to make the concepts memorable as well as understandable. We look forward to seeing you in our upcoming stroke course.