Outcome Evaluation
• Stroke outcomes are measured based on the neurologic status and functioning of the patient after the acute event. The NIHSS is a measure of daily functioning and is used to assess patient status following a stroke.
• Early rehabilitation can reduce functional impairment after a stroke. Recent stroke rehabilitation guidelines have been endorsed by the American Heart Association and the American Stroke Association. These guidelines recommend that patients receive care in a multidisciplinary setting or stroke unit, receive early assessment using the NIHSS, and recommend that rehabilitation is started as soon as possible after the stroke. Other recommendations include screening for dysphagia and aggressive secondary stroke prevention treatments.51
Table 11-6 Monitoring the Stroke Patient
|
Pwsmdtrli] |
Monitoring íitqutncy |
tummenti | |
|
Ixchcmic Stroke | |||
|
AlLtplüíí |
BP, itmrotogk (uní Liua Dieting |
tvery IS minutLi S 1 ívsji, uvwy O.J lyxif V e hftjr^íverí 1 hour v. 1? fBtB-i; then every ihlft | |
|
AV. |
Sk^lirtfl |
Djíy | |
|
QcptdDgfp) |
Sk?edinti |
Dtrty | |
|
A Wrfi dipyiidan*ile |
Heartvln*. hlw^ling |
tsáf | |
|
WicfiUlrt |
Bkrding. INR. HtVIkl |
INR tioily M J tfjyi: vjockly umil -^c.itjli then iivnmhly | |
|
Hemorrhagic Suoke | |||
|
HP, iviiroltgii furxTioa íP |
iwry 1 hckjri in K u |
MlTi'iiKf,™** tffitnieflti DO IITAVI HF to leas than 180 mm Hg syslolk: | |
|
Nimortipine fiw^H |
BP, nflutctogk: Tunccioa fluid jtAiS |
Every ? hours in ICU |
AÍA, aspirin if, blood pet-surei EHextendad-releas^; l ib; hemogtabirvHcl, hematacrl; ICH *Hracran'i1 pressure ICU, kdEnslve care unit IMK-InltfrLi: j)inl iJ- .■■!■. ilm'fl RitiCC £AH fubMClWid '"rnurrhiiir;"
AÍA, aspirin if, blood pet-surei EHextendad-releas^; l ib; hemogtabirvHcl, hematacrl; ICH *Hracran'i1 pressure ICU, kdEnslve care unit IMK-InltfrLi: j)inl iJ- .■■!■. ilm'fl RitiCC £AH fubMClWid '"rnurrhiiir;"
• Table 11-6 provides monitoring guidelines for the acute stroke patient.
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