Editing Medical-Surgical Nursing (section)

=== Stroke ===

Ischemic stroke results from thrombosis or embolism and accounts for most strokes; hemorrhagic stroke results from rupture of a vessel, often from hypertension or aneurysm. Findings include sudden unilateral weakness or numbness, facial droop, speech difficulty, vision loss, and sudden severe headache, which is more characteristic of hemorrhage. A subarachnoid hemorrhage classically presents as the worst headache of the patient's life with nuchal rigidity.

The first diagnostic priority is a noncontrast computed tomography scan to distinguish ischemic from hemorrhagic stroke, because thrombolytic therapy is life-saving in one and lethal in the other. Intravenous alteplase is given for eligible ischemic stroke patients generally within three hours and up to four and a half hours from the time the patient was last known well.

Left hemisphere stroke typically produces right-sided weakness, aphasia, and slow cautious behavior. Right hemisphere stroke typically produces left-sided weakness, unilateral neglect, impulsivity, and poor safety judgment.

Nursing application: keep the patient nothing by mouth until a swallow screen is passed, because aspiration pneumonia is a leading complication. When feeding is resumed, position upright at ninety degrees, use thickened liquids if prescribed, place food in the unaffected side of the mouth, and check for pocketing. Approach a patient with neglect from the unaffected side initially for safety, then teach scanning toward the neglected side.