Download The Stroke Checklist

KBTH ACUTE STROKE CHECKLIST
PATIENT NAME:
Please indicate specific information where it is requested and date and sign actions when they have been initiated
INITIAL ASSESSMENT
Action
Advice
Date and sign
Temperature
If temperature 38 degrees or more urgent report to doctor
Pulse
If <45 or >130 per minute urgent report to doctor
Blood pressure
If < 90 or >220 mmHg urgent report to doctor
Respiratory rate
If <10 or >25 breaths per minute start oxygen 4L/min and urgent
report to doctor
If patient choking/gasping urgent report to doctor
RBS
If less than 4 give IV glucose urgently
Glasgow Coma Scale
E
/4
M /6
V
/5 Total
/15
MEDICAL – ACUTE MANAGEMENT
History and examination
Identify risk factors, site and extent of the stroke
Remember to examine for hemianopia and neglect
Consider sources of embolism
Investigations
Treatment of infarcts
Hydration
Glucose control
Pyrexia
Blood pressure management
Atrial Fibrillation
MEDICAL – COMPLICATIONS
Aspiration pneumonia
DVT and Pulmonary embolism
Seizures
Change in conscious level
Rising ICP
DISCHARGE PLAN
Medical
FBC, Urine R/E, BUE, +Cr, Fasting glucose, Fasting cholesterol, CT
Scan, CXR, ECG
Start aspirin 300mg stat as soon as infarct identified via (oral/NG) if
no contraindications. Reduce dose to 75mg daily after 1 week, and
consider further anti-platelet medication. Give PPI cover
Aiming for euvolaemia (2.5-3L per day on average)
Use normal saline or dextrose saline
Avoid dextrose 5% or 10% unless hypoglycaemic.
Keep RBS 4 – 10
May need insulin sliding scale to control or supplement oral
medications (avoid oral metformin if diabetic)
If >37.5 manage with regular paracetamol to control pyrexia
Consider source (?chest ?urine ?malaria ?other) and treat
Often rises as direct result of stroke and may partially settle with no
action. If < 220/120 then monitor. If BP remains high treatment can
be started at 48 hours. Continue pre-stroke medication if indicated.
DO NOT USE SL NIFEDIPINE . Sudden reduction in BP can lead to
extension of stroke. Gradual reduction of no more than 20% over
24 hours
Consider rhythm control and anticoagulation
Look for signs of this regularly (rising RR, tachycardia, chest signs).
Treat with IV co-amoxiclav and IV metronidazole for first 48 hours
then review
Prophylactic heparin if infarct detected on CT scan
Terminate. Regular anticonvulsant if more than one
Urgently consider possibilities such as
hypoglycaemia/metabolic/drug causes that can be reversed
Nurse at 30 degrees head up, IV mannitol
Ensure secondary prevention measures in place:
-
Anti-platelet ,statin, BP control, blood sugar control, lifestyle
modification
Ensure follow-up plan is written
Signs of depression
Yes
No
Plan?
KBTH ACUTE STROKE CHECKLIST
PATIENT NAME:
PAY SPECIAL ATTENTION TO THE HEMIPLEGIC SIDE DURING ALL ACTIVITIES
Physiotherapy and Nursing Care
Swallow Assessment
Performed by……………………………………………..
Date……………….
To be done within 2
Passed
days of admission to
Failed
medical ward, by
(Please circle)
trained nurse
Plan: (please document)…………………………………
Positioning/Manual
Handling Assessment
To be done within 2
days of admission to
medical ward
Communication
Assessment
To be done within 2
days of admission to
medical ward
Performed by………………………………………………….
Mobile
Assistance required to mobilise
To remain in bed - needs positioning chart
(Please circle)
Plan: (please document plan eg arjo)……………….
Date…………………
Performed by……………………………………………………..
Communication normal
Slurred speech/dysarthria
Aphasia
(Please circle)
Plan: (please document aids needed)
Date………………..
Performed by…………………………………………………..
Continent
Incontinent: (offer timed toileting)
Catheter: (if in retention – treat cause; remove catheter if possible)
(please circle)
Plan: (Please document)……………………………………..
Date…………………
Performed by……………………………………………………….
Please document what information has been given to the
family/patient prior to discharge
Date………………….
Continence Assessment
Patient and Family
Education
To be done prior to
discharge
Verbal
Leaflet
(Please circle)
IMPORTANT
ALL OF THE ABOVE SHOULD BE REASSESSED AS NECESSARY