Preparation for 2022 Comprehensive
Stroke Certification Visit - Sample
questions
How do you get notified that a stroke patient is coming to the ICU? - ✔✔The charge nurse
Who are the physician members of the stroke te
...
Preparation for 2022 Comprehensive
Stroke Certification Visit - Sample
questions
How do you get notified that a stroke patient is coming to the ICU? - ✔✔The charge nurse
Who are the physician members of the stroke team? - ✔✔Neuro Interventionalist Jumaa, Zaidi,
Burgess, Kung, residents and fellow, they see the stroke patients. Neurosurgical team Reinard,
Healy, McCormick, Gable and Schroeder we call them directly.
What are the priorities when caring for a patient who is newly diagnosed stroke patient? -
✔✔Blood pressure management, neuro assessments, NIHSS, observe and notify change in neuro
exam
Do you have CT scanning capability 24/7? YES Do you have MRI capability 24/7? - ✔✔Yes
Do stroke patients have any priority when ordered a CT scan of the brain? - ✔✔If they are a
stroke alert.
What other orders can you anticipate for the acute stroke patient? - ✔✔Use stroke admission
orders; echo, lipids and fingerstick blood sugar
Do you perform dysphagia screening in the ICU? - ✔✔Yes bedside swallow by nursing prior to
any PO intake. If the patient fails then speech sees the patient
What is the time frame for IV TPA administration? - ✔✔3 hours we do treat with tPA if they
meet the 4.5 hour criteria
What treatment is provided/available for patients beyond the IV TPA window? - ✔✔We perform
embolectomies if the patient meets criteria per neuro interventionalist
Who mixes IV TPA? - ✔✔The pharmacist
What are the priorities in the ICU when caring for patient who has received IV TPA? - ✔✔Vital
signs including blood pressure management and neuro assessments, NIHSS, notifying of MD
changes in the neuro assessment, bleeding, angioedema
How can you ensure vital signs and NIHSS are in compliance with frequency when
administering TPA? - ✔✔Use the stroke order set, tPA order set and the audit tool
What type of neurologic exam is performed on the stroke patient? - ✔✔NIHSS and complete
neuro assessment
What are the symptoms of angioedema? How would you assist in treatment? - ✔✔This is a rare
but serious reaction to TPA, symptoms include tongue lip swelling , difficult swallowing.
Treatment includes stop the tPA, airway management.
What would you do if your patient suddenly complains of a severe headache, nausea, vomiting
and a change in the neuro exam. - ✔✔Complete NIHSS contact MD immediately
What would you do if your tPA patient suddenly complains of a severe headache, nausea and
vomiting. - ✔✔Stop tPa, notify MD, perform a complete neuro assessment and NIHSS, prepare
for CT scan
What are the care priorities when you receive a SAH patient from the ED or outside hospital -
✔✔Complete neuro assessment, NIHSS, manage blood pressure, monitor vital signs, consider
angiogram
Do you know what a Hunt and Hess score is? - ✔✔It is a score that indicates severity of a non
traumatic subarachnoid hemorrhage scale 1-6 it is a core measure completed by the provider
within 6 hours of arrival or prior to procedure
What is the 1st type of management of aneurysmal SAH? - ✔✔coiling of the aneurysm if cannot
be coiled then surgical clip
How quickly do the patients typically get their aneurysms treated if ruptured? - ✔✔The neuro
interventionalist will take a patient to do a cerebral angio with in the first 24-48 hours and will
proceed with coil at that time if possible
What are your care priorities in the care of the SAH patient? - ✔✔Monitor the patient's neuro
status, monitor the Blood pressure, and watch for neurological changes that indicate vasospasms.
When is nimotop started for a SAH? - ✔✔Within the first 24 hours
Do you care for patients who have ICP monitoring and EVD's? - ✔✔yes
Do you know the types of infections that are tracked and reported for your unit? - ✔✔CAUTI,
CLABSI, VAP and EVD associated infections
Where can you find an answer to a stroke question? - ✔✔Business unit, then policy and
resources, then the interdepartmental section to #14 Stroke pathways, clinical guidelines and the
book on the unit
When is stroke education initiated? - ✔✔on admission
When is a rehabilitation consult initiated? - ✔✔PT,OT ST and PMR is part of the Stroke
Admission order set, SAH order set and the ICH order set.
What actions would you take if a non stroke patient you were assigned to care for developed
sudden onset of weakness, aphasia, or visual field cut? - ✔✔Call stroke alert 1-HELP (1-4357)
What initial training did you receive in preparation of caring for a ischemic stroke, ICH, and
SAH patient? - ✔✔In High Acuity class, Apex hemispheres, health stream and the Neuro
education book
How did you complete training in the NIHSS? - ✔✔Complete it every 1 years in health stream
or Apex Hemispheres
How many stroke hours are required each year for continual education? - ✔✔8 hours for RN, 2
hrs non clinical
What opportunities are available to complete this? - ✔✔Conferences, health stream, journal club,
unit based education, weekly case conferences, monthly neuro lectures
What quality measures are being collected/reported on stroke patients? - ✔✔Both the primary
and the comprehensive core measures, , tPA times, monitoring infections of invasive cranial
monitoring.
What types of patients are typically cared for on this unit? - ✔✔Stroke ,ICH, SAH patients and
other patient types that need ICU care
Do you have critical care available 24/7? - ✔✔yes
What is the role of Critical care in the care of the stroke patients? - ✔✔Critical care is either
admitting or consulted on all neuro interventional patients.
Are you aware of any stroke research at your hospital - ✔✔1. Yes 1. CREST 2; vascular study
whether to treat asymptomatic carotid stenosis medical status
2. Relationship between high degree ICA stenosis and blood flow shear rate
3. The effect of carotid artery near occlusion or contralateral carotid velocity meausrements
4. Teview of outcomes of patients undergoing CEA with acute stroke
5. CHARM (IV glyburide for large hemispheric infarction) ASTRAL ( IV glyburide for brain
contusion) -
6. STRATIS Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic
Stroke Registry
7. Impact Collateral Blood Flow Assessment Following SPG Stimulation in Acute Stroke
8. Zoll ReCCLAIM 2- (cooling to 33C in tandem with thrombectomy
9. TIMELESS TENECTEPLASE @ 4.5 to 24 hrs after LKW Toledo Hospital, Monroe and
Bixby
10. RESTORE - Phase 2a, Randomized, Double-Blind, Placebo-Controlled 21-Day Treatment
Study to Evaluate the Effect of HT-3951 on Upper Extremity Motor Function Following
Ischemic Stroke
You may also be asked about the following - so be prepared to discuss the care of complex
stroke patients as it relates to the following: - ✔✔Neurologic and CV assessment Nursing
assessment and Management of ventriculostomy devices Treatment of intracranial pressure
Nursing care of hemorrhagic stroke patients ( ICH and SAH) Nursing care of patient received IV
tpa and IA Care of the IA tPA and tPA patient is the same. IA patient we add groin checks also
Management of malignant ischemic stroke with craniectomy Use of therapeutic normothermia
orders We have an order set for normothermia. Use of IV vasopressor, antihypertensive and
positive inotropic agents Methods for invasive and noninvasive ventilator management
Do you respond to in-house stroke alerts? - ✔✔If yes, what is your role. A stroke nurse responds
to all stroke alerts my The role is to assist in the NIHSS, making sure the time metrics are met to
CT. If tPA to assist in the administration.
Do you have palliative care available?
In what types of patients is it utilized? - ✔✔Yes.
Assist with patients with poor prognosis or patients who have chronic conditions for the end of
life
Is hospice /end of life care available? - ✔✔Yes
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