Take-home points for new staff and unique-versus-generic aspects of stroke care on the stroke unit
| Most Important Teaching Points (Take-Home Points) for New Team Members | Unique Characteristics of the Stroke Unit Environment (Not Ideal Tasks for New Team Members) | Generic Aspects of the Stroke Unit Environment Similar to Other Medical Areas (Appropriate Initial Tasks for New Team Members) |
|---|---|---|
| Recognizing an acute stroke, recurrent stroke, and abrupt neurologic deterioration of recent ischemic or hemorrhagic stroke | Monitoring a patient in the unit after receiving IV alteplase (involves watching for angioedema, bleeding, frequent neurologic vital sign monitoring, close blood pressure control, and so forth) | Obtaining/interpreting scheduled vital signs (temperature, blood pressure, heart rate, respiratory rate, oxygen saturation) and point-of-care blood glucose in patients |
| Managing infusions of alteplase for stroke or of heparin (eg, for intraluminal thrombosis, venous sinus thrombosis) | Being part of the acute stroke thrombolysis team (being comfortable with the “code stroke” and mixing alteplase) | Foley catheter insertion, urinary dipstick testing, and identification of potential urinary tract infection |
| Grossly identifying patients who are potentially aspirating versus those safe to swallow | Managing a patient at risk of malignant middle cerebral artery or cerebellar stroke (involves closely watching for neurologic deterioration and liaising with stroke/neurosurgery team for potential decompressive craniectomy) | Managing the patient’s routine medications and reconciling them with those taken preadmission |
| NG insertion, feeding, and NG medication administration | Managing a patient with a major intracranial hemorrhage (involves watching for emerging symptoms of hydrocephalus or major hematoma expansion that may warrant neurosurgical intervention or ICU transfer) | Caring for a patient in the subacute-to-chronic poststroke period with/without medical issues like urinary tract infection, cellulitis, or pressure ulcers |
| Performing a NIHSS bedside examination | Receiving a patient after thrombectomy (involves monitoring the groin puncture site or managing hematoma) | Evaluation and initial management of a patient with chest pain or shortness of breath (eg, poststroke myocardial infarction, aspiration pneumonia) |
| Pager or phone numbers and schedule of stroke fellows and neurologists on call | Receiving a patient after carotid endarterectomy (involves watching for reperfusion complications, lower cranial neuropathies interfering with swallowing) | Evaluation and initial management of a patient with deep vein thrombosis |
| Understanding basic stroke mechanisms for early secondary prevention | Defining a stroke mechanism through a sophisticated understanding of neurovascular anatomy, localization, and cerebrovascular syndromes | Working with patient and pharmacy to ensure proper dosing and administration of early secondary stroke prevention (eg, antithrombotics, statin therapy, blood pressure regimen, smoking cessation) |
Note:—NG indicates nasogastric tube.