Download Stroke Nursing Conference PP - Photolaterna

Best Practice Nursing Care Across
the Acute Stroke Continuum
Module 1
Prevention of
Stroke
VER 1.2 SEPT 2009
1
Prevention of Stroke
Welcome!

This session includes presentations and
activities to enhance your learning

The focus is on working with colleagues to
discover best ways of using the tools in your
institutions

So, sit back (or stand up) and have fun!!!
5/25/2017
2
Prevention of Stroke
Expectations?
So, what do you want to get
out of this module?
5/25/2017
3
Prevention of Stroke
Objectives







Identify the goal of stroke prevention across the stroke
care continuum
Identify the impact and cost of stroke in Canada
Identify signs and symptoms of stroke
Identify risk factors for stroke
Review Best Practice Recommendations related to
prevention of stroke, public awareness and patient
education
Discuss how you can implement these at your institution
Create a stroke care action plan for prevention of stroke,
public awareness and patient education
5/25/2017
4
Prevention of Stroke
Agenda









Introduction
Stroke 101 (optional)
Impact & Cost of Stroke in Canada
Signs, Symptoms & Risk Factors
Break
Canadian Stroke Strategy
Public Awareness & Patient Education BPRs
Recommendations for Prevention of Stroke BPRs
Putting It All Together
5/25/2017
15 min
15 min
20 min
25 min
15 min
15 min
30 min
30 min
30 min
5
Prevention of Stroke
Continuum of Stroke Care
Prevention of stroke
Public awareness & patient
education
Hyperacute stroke
management
Acute inpatient stroke
care
Stroke rehabilitation
& community reintegration
Prevention of Stroke
Continuum of Stroke Care
Should be
addressed at all
stages across the
stroke care
continuum
Prevention of stroke
Public awareness & patient
education
Hyperacute stroke
management
Acute inpatient stroke
care
Stroke rehabilitation
& community reintegration
Prevention of Stroke
Why Is This Important?
 Healthy lifestyle can reduce incidence of
initial and subsequent stroke by 30%
 Public awareness of stroke symptoms and
seeking urgent medical attention to take
advantage of new therapies such as
reperfusion
Early
detection
means
better
outcomes!
 Education facilitates better understanding
and supports coping and self-management
•
Simple distribution of pamphlets is not sufficient
5/25/2017
8
Prevention of Stroke
Stroke 101
INSERT SLIDE SET
Intended only for
audiences with no
previous
knowledge of
stroke.
5/25/2017
9
Prevention of Stroke
Impact & Cost of Stroke
in Canada
20 min
5/25/2017
10
Prevention of Stroke
Stroke Risk Round Up
1. A volunteer begins by reading out her Question card.
Everyone should have received a Question and Answer card
from the Facilitator.
2. The person who thinks she has the correct Answer
card must wave it and read the answer aloud.
3. If correct, it will be her turn to read out the question
on her Question card.
4. If not correct, everyone must agree on the correct
answer, then ask the person with the correct Answer
card to read out her question.
5. Play will continue in this manner until all questions
have been read along with their correct answers.
WHOLE
6. .
GROUP ACTIVITY
5/25/2017
11
Prevention of Stroke
Stroke Subtypes
Lacunar
20%
SAH
10%
Hemorrhagic
20%
Thromboembolic
10%
Cardioembolic
20%
Ischemic
80%
ICH
10%
Other 5%
REVIEW
Unknown
25%
Adapted from Foulkes MA, et al. Stroke 1988;19:547-554
5/25/2017
12
Prevention of Stroke
Outcome of Ischemic Stroke
Dead
15%
Full
Recovery
25%
Major
Disability
15%
Moderate
Disability
15%
Minor
Disability
30%
Adapted from Stegmayr B, et al. Stroke 1997;28:1367-1374
REVIEW
5/25/2017
13
Prevention of Stroke
Epidemiology of Stroke
A Canadian Perspective
 50,000
new stroke patients/year in Canada†
 200,000–300,000
 4th
stroke survivors†
leading cause of death in Canada
 The
 28%
leading cause of adult disability
of stroke patients are under age 65*
 Estimated
cost of stroke 3.6 billion annually
†Statistics
REVIEW
Canada
*Kiely DK, et al. Stroke 1993;24:1366-1371
5/25/2017
14
Prevention of Stroke
Impact of Stroke in Canada
~ 50,000
strokes/year
Someone has a stroke
every 10 minutes
300,000 Canadians
living with stroke
16,000 Canadians
die from Stroke
each year
20% chance of
second stroke
within 2 years
For every symptomatic
stroke there are 9 ‘silent’
strokes resulting in
cognitive impairment
REVIEW
Price Tag:
$3.6 Billion annually
Prevention of Stroke
Signs, Symptoms
&
Risk Factors
25 min
5/25/2017
16
Prevention of Stroke
Stroke Jeopardy
1.
We’ll split into two teams to compete in a game
of Stroke Jeopardy
2.
Each team will get the chance to answer key
questions about the signs, symptoms and risk
factors for stroke.
3.
So let’s see which team is the Stroke Jeopardy
Champion
PRESS TO START JEOPARDY
5/25/2017
17
Prevention of Stroke
Warning Signs of Stroke
Sudden onset of:

Weakness or numbness

Speech disturbances

Unexplained dizziness

Visual changes

Sudden severe headache of
unknown cause
REVIEW
KEY POINT
Time of the
onset of stroke
symptoms is
critical for
consideration of
acute
thrombolytic
therapy.
5/25/2017
18
Prevention of Stroke
Left & Right Hemisphere
Common Presentations
Left Hemisphere







Expressive aphasia
Receptive aphasia
Global aphasia
Right sided
weakness/sensory loss
Intellectual impairmentalexia, agraphia, acalulia
Slow and cautious behavior
Defects in right visual fieldhomonymous hemianopsia
REVIEW
Right Hemisphere
 Spatial-perceptual
 Left
deficits
sided
weakness/sensory loss
 Neglect of the affected side
 Distractible
 Impulsive behavior
 Poor judgment
 Loss of flow of speech
 Defects in left visual fieldhomonymous hemianopsia
Prevention of Stroke
Transient Ischemic Attacks: TIA
Anterior Circulation

Opthalmic Artery

◦ Amaurosis Fugax
◦ Foggy vision
◦ Shade effect
Middle Cerebral Artery
◦ Hemiparesis
◦ Sensory loss

Anterior Cerebral
Artery
◦ Hemiparesis
REVIEW
5/25/2017
21
Prevention of Stroke
Transient Ischemic Attacks: TIA
Posterior Circulation

Posterior Cerebral
Artery
◦
◦
◦
◦
◦
◦
Dysarthria
Dysphagia
Diplopia
Bilateral Blindness
Motor/Sensory weakness
Quadriparesis
REVIEW
5/25/2017

Cerebellar Arteries
◦ Ataxia
◦ Vertigo
◦ Dizziness
22
Prevention of Stroke
Types of Stroke

Thrombotic strokes:
◦ Blood clot forms in a large (majority) or small artery
blocking blood flow to the brain

Embolic strokes:
◦ Blood clot forms in another part of body and travels to
brain blocking a blood vessel

Hemorrhagic strokes:
◦ Occurs when a blood vessel ruptures within the brain
(intracerebral) or on brain surface with bleeding into
subarachnoid space
REVIEW
5/25/2017
23
5/25/2017
Prevention of Stroke
Carotid & Vertebrobasilar
Syndromes
Carotid






Sensory/motor deficit
Aphasia
Cortical sensory loss
Apraxia, neglect
Visual field deficit
Retinal ischemia
Vertebrobasilar









REVIEW
5/25/2017
Diplopia
Vertigo
Coma at onset
Crossed sensory loss
Bilateral motor signs
Isolated field defect
Pure motor and sensory
deficit
Dysarthria
Dysphagia
25
Prevention of Stroke
Lacunar Syndromes
Type of Syndrome
Patient Presentation
Pure motor hemiparesis
Results from an infarct in the internal
capsule or pons
Contralateral hemiparesis of face, arm
and leg, dysarthria
Pure motor hemiparesis with motor
aphasia
Results from an infarct of the internal
capsule and adjoining corona radiat
Hemiparesis of face, arm and leg with
inability to speak
Ataxic hemiparesis
Results from an infarct in the pons
Paresis of the contralateral leg and side of
the face, ataxia of the contralateral leg and
arm
REVIEW
5/25/2017
26
Prevention of Stroke
Lacunar Syndromes
Type of Syndrome
Patient Presentation
Dysarthria and clumsy hand syndrome
Results from an infarct in the pons or
internal capsule
Dysarthria, dysphagia,contralateral facial
and tongue weakness, paresis and
clumsiness of the contralateral arm and
hand
Pure sensory stroke
Results from an infarct in the thalamus
Contralateral sensory loss to all
modalities that usually affect the:
Face, upper and lower extremities
REVIEW
5/25/2017
27
Prevention of Stroke
Dominant Left Hemisphere Stroke






Aphasia
Right field defect
Left gaze preference
Right upper motor
neuron facial
weakness
Right hemiparesis
Right hemisensory loss
REVIEW
5/25/2017
28
Prevention of Stroke
Non-Dominant Right Hemisphere Stroke






Left neglect, inattention
Left field defect
Right gaze preference
Left upper motor neuron
facial weakness
Left hemiparesis
Left hemisensory loss,
sensory extinction
REVIEW
5/25/2017
29
Prevention of Stroke
Risk Factors
MODIFIABLE
- Hypertension
- Diabetes
- High cholesterol
- Cigarette smoking
- Atrial Fibrillation
- Cardiac disease
- Hypercoagulative states
- Obesity
- Excessive Alcohol Intake
- Physical Activity
- Stress
- Hormone replacement therapy
REVIEW
NON-MODIFIABLE
- Age
- Gender
- Race
- Prior stroke/TIA
- Heredity
30
Prevention of Stroke
Risk Factors: Hypertension


#1 risk factor for primary and recurrent
strokes
Accounts for about ~60% of attributable risk
for cerebrovascular disease
– MRFIT trial (multiple risk factor intervention trial): 350,000 men from
1973-1978:
• 733 stroke deaths
• 8-fold increased risk across systolic BP deciles and 4-fold risk for
DBP
• Men over 65 with isolated HTN had over 2x risk for ischemic
stroke and women just < 2x.
REVIEW
31
Prevention of Stroke
Risk Factors: Hypertension

A meta-analysis (Lewington, 2002) showed
each 2 mmHg reduction in systolic blood
pressure is associated with a:
◦ 7% reduction in mortality from ischemic
heart disease
◦ 10% reduction in mortality from stroke
REVIEW
5/25/2017
32
Prevention of Stroke
CHEP Blood Pressure Recommendations


Patients who have had a stroke: <140/90
mmHg
Prevention of first stroke or recurrent stroke:
 Patients with chronic kidney disease: <130/80
mmHg
 Patients with diabetes: <130/80 mmHg


Prevention of stroke in the general
population: <140/90 mmHg
Visit: www.hypertension.ca
REVIEW
5/25/2017
33
Prevention of Stroke
Diabetes





Major risk factor for ischemic stroke
Potent risk factor in younger
patients
Risk of stroke increased 1.5 to 3
times
Doubles the risk of stroke
recurrence
Outcomes after stroke significantly
worse
REVIEW
5/25/2017
34
Prevention of Stroke
Risk Factors: Age

Age is a significant risk factor
for stroke
◦ About 75% of strokes occur in
individuals ≥ 65 yrs
◦ With each decade after age 65,
risk of stroke doubles
5/25/2017
REVIEW
35
Prevention of Stroke
Risk Factors: Concomitant Factors

People with a history of heart
disease or TIAs :
◦ High cholesterol levels, obesity and
physical inactivity increase risk of heart
disease and therefore of stroke
◦ CAD, CHF, LVH, valvular heart disease,
AF, cardiac thrombosis
◦ AF increases with age and is more
prevalent in males
◦ ~ 15% of AIS caused by AF
◦ Patients with TIA’s: 10.5% will have a
stroke within 3 months and of these,5%
will have a major stroke within 48 hours
5/25/2017
REVIEW
36
Prevention of Stroke
Risk Factors: Race

African Americans have 2x risk
of death and disability from
stroke
◦ May be from higher incidence of smoking,
hypertension, sickle cell anemia and other
stroke-related risk factors
5/25/2017
REVIEW
37
Prevention of Stroke
Risk Factors: Family History

Patients with large vessel strokes 3x more
likely to have a first-degree relative who
suffered from early stroke or heart attack
• Slightly greater risk for the small vessel stroke patients
• Risk greater if a parent, grandparent, sister or brother has
had a stroke
• Paternal history of stroke increases the risk by 2.4 times;
maternal history increases risk by 1.4 times
REVIEW
5/25/2017
Jerrard-Dunne, P., & Goldstein, L .(2003). Stroke Risk Often Runs in the Family: genetic
predisposition linked to 2 types of stroke. Stroke
38
Prevention of Stroke
Stroke in Women

Incidence of ischemic stroke, hemorrhagic
stroke, and total stroke examined over 16
years in the Nurses’ Health Study
◦ ↑BMI (>27) had significantly increased risk of ischemic
stroke
◦ From age 18 to 76 a weight gain of 11-19.9 kg was
associated with a RR of 1.69 and a RR of 2.52 for a gain
of ≥20kg.
◦ BMI should be maintained between 18.5 and 24.9
◦ Waist circumference should be maintained < 88cm
REVIEW
5/25/2017
Adams, PH. (2004). Handbook of Cerebrovascular Diseases
39
Prevention of Stroke
Let’s take a break…
15 min
5/25/2017
40
Prevention of Stroke
Canadian Stroke Strategy
15 min
5/25/2017
41
Prevention of Stroke
Canadian Stroke Strategy

Joint initiative of the Canadian Stroke Network
and the Heart and Stroke Foundation of
Canada since 2005
◦ Goal :
 to help support an integrated approach to stroke
prevention, treatment and rehabilitation in every
province and territory by 2010.
Prevention of Stroke
Canadian Stroke Strategy

Provides a framework to facilitate widespread
adoption of evidence-based best practices
across the continuum of stroke care focusing
on two levels of change:
◦ At the national level
◦ At the provincial/territorial level
The Canadian Stroke System Model
• Decrease burden of stroke
• Improve quality and efficiency of care
• Establish Canada as an international leader
Provincial/Territorial/Regional Implementation of Best Practice
Prevention
Prevention
Clinics
Treatment
Protocols, Stroke Teams
Rehabilitation
Personal Care
Plans
Reengagement
Coordinated Support
National Platforms to Support Provincial/Territorial/Regional Strategies
Public Awareness
Best Practices and Standards
Professional Development
Information/Evaluation
Coordinated Research
5/25/2017
44
Canadian Stroke Strategy Best
Practices & Standards Platform

Goal:
◦ To review and recommend best practices
in stroke care appropriate to the latest and
highest level of evidence, including key
system drivers and appropriate Canadian
context
5/25/2017
46
Prevention of Stroke
Best Practice Recommendations
Dissemination

National release of CSS Best Practice Stroke
Recommendations in September 2006 and
December 2008

CMAJ publication:
◦ Lindsay et al.(2008). Toward a more effective approach to
stroke: Canadian Best Practice Recommendations for Stroke
Care.

Websites www.canadianstrokestrategy.ca
www.cmaj.ca

Broad dissemination across provinces, at national
and international meetings
5/25/2017
47




Synthesis of best practice recommendations
for stroke care across the continuum
Address critical topic areas
Commitment to keep current and update
every two years
Current update:
◦ With four new recommendations
◦ Elaboration of existing ones
◦ www.cmaj.ca December 2, 2008
Prevention of Stroke
CSS Best Practice Recommendations 2008
1. Public Awareness and Patient Education (2)
2. Stroke Prevention (7)
3. Hyperacute Stroke Care (7)
4. Acute Inpatient Stroke Management (2)
5. Stroke Rehab & Community Reintegration (5)
6. Selected Topics in Stroke Management (4)
5/25/2017
49
Prevention of Stroke
Recommendations for
Public Awareness
& Patient Education
20 min
5/25/2017
50
Prevention of Stroke
1: Public Awareness and Patient Education
1.1: Public awareness and responsiveness
◦ Public should be able to recognize signs and
symptoms of stroke
◦ Education should emphasize stroke is a medical
emergency
◦ Education should include that stroke can affect
persons of any age
OVERVIEW
5/25/2017
51
Prevention of Stroke
1: Public Awareness and Patient Education
1.2: Patient and family education
◦ Integrated and coordinated education should be
provided across the continuum of stroke care
◦ For all patients with stroke or at risk of stroke,
and their families and caregivers
OVERVIEW
5/25/2017
52


Basic information for patients and their
families
Includes
◦
◦
◦
◦
◦
◦

Signs and symptoms
Emergency response
Stroke care in hospital
Rehabilitation
Prevention
Education
Visit: www.canadianstrokestrategy and click
on A Patient’s Guide to Canadian Best
Practice Recommendations for Stroke Care
Prevention of Stroke
Patient and Family Education

Content should be specific to;
◦ The phase of care
◦ Patient/caregiver readiness
◦ Patient/caregiver needs

Education should be timely, interactive, up to date
and provided in a variety of formats, languages
including aphasia friendly

Processes should be established by clinical teams
for education including designating team members
for provision and documentation of education
REVIEW
5/25/2017
54
Prevention of Stroke
Patient and Family Education

Education content should include:
◦
◦
◦
◦
◦
◦
◦
◦
◦
◦
The nature of the stroke and its manifestations
Signs and symptoms of stroke
Impairments and their impact on the person
Caregiver training to manage
Risk factors
Post-stroke depression
Cognitive impairment
Discharge planning and decision making
Community resources
Home adaptations
REVIEW
5/25/2017
55
Prevention of Stroke
Recommendations for
Prevention of Stroke
25 min
5/25/2017
58
Prevention of Stroke
2: Prevention of Stroke
2.1: Lifestyle and risk factor management
◦ Persons at risk of stroke and persons who have had
a stroke should be assessed for vascular disease
factors and lifestyle management issues (diet,
sodium intake, exercise, weight, smoking and alcohol
intake)
◦ They should receive information and counselling
about possible strategies to modify their lifestyle and
risk factors
OVERVIEW
5/25/2017
59
Prevention of Stroke
2: Prevention of Stroke
2.2: Blood pressure management
◦ Hypertension is the single most important modifiable
risk factor for stroke
◦ Blood pressure should be monitored in all persons
at risk for stroke
OVERVIEW
5/25/2017
60
Prevention of Stroke
2: Prevention of Stroke
2.3: Lipid management
◦ Lipid levels should be monitored for all persons
at risk for stroke
OVERVIEW
5/25/2017
61
Prevention of Stroke
2: Prevention of Stroke
2.4: Diabetes management
◦ All individuals in the general population should
be evaluated annually for type 2 diabetes on
the basis of demographic and clinical criteria
OVERVIEW
5/25/2017
62
Prevention of Stroke
2: Prevention of Stroke
2.5: Antiplatelet therapy
◦ All patients with ischemic stroke or TIA should
be prescribed antiplatelet therapy for secondary
prevention of recurrent stroke unless there is an
indication for anticoagulation
OVERVIEW
5/25/2017
63
Prevention of Stroke
2: Prevention of Stroke
2.6: Antithrombotic therapy in atrial fibrillation
◦ Patients with stroke and atrial fibrillation should be
treated with warfarin at a target international
normalized ratio of 2.5, range 2.0 to 3.0
OVERVIEW
5/25/2017
64
Prevention of Stroke
2: Prevention of Stroke
2.7: Carotid intervention
◦ Patients with TIA or nondisabling stroke and
ipsilateral 70%-90% internal carotid artery
stenosis should be offered carotid
endarterectomy within 2 weeks of TIA or stroke
unless contraindicated
OVERVIEW
5/25/2017
65
Prevention of Stroke
Goals of Stroke Prevention Clinics
(where these are available)

Screening, monitoring and assessing of high risk
population

Providing education about risk factors, lifestyle
management issues (exercise, smoking, diet,
weight, alcohol, stress management)

Counseling about possible strategies to modify
lifestyle and risk factors
REVIEW
5/25/2017
66
Prevention of Stroke
Role of Nurses in Stroke Prevention

Screening and monitoring of high risk population

Assessment and education about risk factors,
lifestyle management issues (exercise, smoking,
diet, salt intake, weight, alcohol, stress
management)

Counseling about possible strategies to modify
lifestyle and risk factors
REVIEW
5/25/2017
67
Prevention of Stroke
Recommendations Briefing
1.
Form two groups at your table and have
each select and prepare a “briefing” on one
Imagine you have
of the sections in Prevention of stroke or
asked to brief
Public Awareness and Patient Education been
your colleagues
2.
Use the worksheet in your PW to help
structure your briefing and focus on the
following topics:



3.
Rationale for recommendation
System implications of it
Performance measures
back home on one
of the key sections
in “Prevention of
stroke or Public
Awareness and
Patient Education”
When done, each group will present its
briefing to the other and discuss
TABLE
ACTIVITY
5/25/2017
68
Prevention of Stroke
Recommendations Briefing
Now switch sections with the other group at
your table and prepare to answer the
Imagine you have
following:
1.
◦
How will this recommendation improve stroke
care at your institution?
◦
What role can you play in implementing it?
◦
What barriers or enablers do you see?
2.
When done, brief the other on these
issues and discuss
3.
Then, we’ll debrief the whole group to
arrive at some best practices
TABLE
ACTIVITY
been asked to brief
your colleagues
back home on one
of the key sections
in “Prevention of
stroke or Public
Awareness and
Patient
Education”.
5/25/2017
69
Prevention of Stroke
Check Up Quiz
QUIZ
5/25/2017
73
Prevention of Stroke
Check Up
To help support an
integrated approach to
What
the goal
stroke is
prevention,
oftreatment
the Canadian
and
rehabilitation
in every
Stroke Strategy
?
province and territory
by 2010.
5/25/2017
74
Prevention of Stroke
Check Up
How often are the
Best Practice
Every two years
Recommendations
to be updated?
5/25/2017
75
Prevention of Stroke
Check Up
Education should
Medical
emphasize that
emergency
stroke is a…?
5/25/2017
76
Prevention of Stroke
Check Up
On what website can you
see www.cmaj.ca
the Best Practice
Guidelines?
5/25/2017
77
Prevention of Stroke
Check Up
What is the single
most important
Hypertension
modifiable risk
factor for stroke?
5/25/2017
78
Prevention of Stroke
Check Up
What should all patients
with ischemic stroke or
TIA be prescribed for
secondary
prevention
Antiplatelet
therapy of
recurrent stroke unless
there is an indication for
anticoagulation?
5/25/2017
79
Prevention of Stroke
Check Up
To what target
international normalized
ratio should patients
2.5, range 2.0 to 3.0
with stroke and atrial
fibrillation be treated
with warfarin?
5/25/2017
80
Prevention of Stroke
Check Up
Within how many weeks of
TIA or stroke should patients
with TIA or nondisabling
stroke and ipsilateral 70%Within
weeks
90%
internaltwo
carotid
artery
stenosis be offered carotid
endarterectomy unless
contraindicated?
5/25/2017
81
Prevention of Stroke
Check Up
1. The phase of care
Education
content should
2. Patient/caregiver
be specific
with respect to
readiness
three factors?
3. what
Patient/caregiver
needs
5/25/2017
82
Prevention of Stroke
Putting It All Together
30 min
5/25/2017
83
Prevention of Stroke
Case Study
1.
Review the case study
2.
With your team, answer the questions on
the worksheet at the end of the study
3.
We’ll review when done to share some
best practices and get ready to create a
Stroke Care Action Plan
TABLE
ACTIVITY
5/25/2017
84
Prevention of Stroke
Case Study




Mr. C is a 72 year old right handed man who was well
this morning when he got up at 9:15am. He was
eating breakfast at 9:30am when his wife noticed that
he couldn’t hold his toast with his right hand and his
speech was slurred.
She wanted to call 911 but he insisted on going to lie
down first.
At 1100, he was no better and finally agreed to let his
wife call 911.
He was seen in the ER at 1130am
Prevention of Stroke
Case Study




Mr. C has a past medical history of coronary artery disease,
myocardial infarction, pacemaker, atrial fibrillation and
hyperlipidemia
His current medications are: digoxin, nitroglycerin, sotalol,
terazosin,aspirin and altace.
He has no known allergies
On examination in ER, the following were found:
 BP 182/72,P-86, R-16
 No carotid or supraclavicular bruits. Heart sounds regular with no murmurs.
No peripheral edema. His 12 lead ECK showed a ventricular paced rhythm
 Neurologically he is alert, unable to verbalize but follows simple commands.
Unable to formally assess mental status due to aphasia.
 Aphasia appears expressive but he is able to get some words out but they
are dysarthric
 Right visual field deficit and visual neglect
 Motor exam: dense right upper limb weakness and moderate right lower
limb weakness
 NIHSS score: 15
 CNS score: 4.5
Prevention of Stroke
Case Study Questions

What are Mr. C’s risk factors for stroke?

What would be the priority teachings for
Mr. and Mrs. C at this point?
Prevention of Stroke
Creating a Stroke Care Action Plan
1.
With the case study we just reviewed in mind,
create a stroke care action plan

What can you do in your institution to initiate
changing Stroke Care practices with respect to
prevention of stroke and/or public awareness
and patient education

Identify 1-2 key learnings from today that you
could take back to help kick start your change
initiatives
Use the Stroke Care Action Plan worksheet in
INDIVIDUAL
your PW to record your plan
ACTIVITY
2.
5/25/2017
88
Best Practice Nursing Care Across
the Acute Stroke Continuum
Thank you for
your participation!
89