code stroke ecc rn (2)

Please read the following scenarios and complete the post test.

A Code Stroke will be initiated when a patient develops a sudden onset of one or more of the following symptoms with the last known "baseline/normal" time less than 4.5 hours: Numbness or weakness of the face, arm or leg, especially on one side of the body. Sudden onset of blurred or decreased vision in one or both eyes. Difficulty speaking or understanding simple statements. Loss of balance or coordination.

*** It is the primary RNs responsibility to notify the MD of

a potential code stroke ***

The ECC MD assesses a suspected stroke patient within 10 minutes of arrival to the ECC.

All lab work is drawn and sent with the awaiting lab technician prior to the CT.

EKG (don’t hold the patient in triage to perform….obtain in pt room so the ECC MD can begin assessment).

FSBG

Door to CT time: A STAT CT of the Head without contrast must be performed within 25 minutes.

All patients receiving tPA will have an actual weight prior to dosing. (use stretcher with scales)

Door to needle time: tPA is administered within 60 minutes of patient’s arrival to the ECC.

Approximately 800,000 people suffer from a stroke/TIA in the US annually.

Stroke is the 4th leading cause of death in the US.

A CT of the Head without contrast is performed to rule out a hemorrhage or tumor.

An acute ischemic stroke may not be visible on a head CT for 24 hours.

What do you do if a patient presents with acute neurological changes outside the 4.5 hour window? The ECC MD can STAT consult a neurologist to

evaluate the patient. Other interventions may be warranted (i.e. vascular procedures, EEG, etc.)

CMC-NorthEast currently has 4 inpatient Neurologists and 2 Nurse Practitioners.

A neurologist is on call 24/7/365.

Document the following times: Patient arrival to ECC Time last seen at baseline ECC MD in room Code Stroke called Neurologist in room Dysphagia screening tPA start time (if applicable)

FAQs

What if the patient is a difficult stick? Do we hold the CT until the lab work is completed? NO. Send the patient to CT and call the IV team

to be available once patient returns from CT.

What if a neurologist hasn’t arrived within 10 minutes of a code stroke call? Have the operator re-page the code stroke again.

Mrs. Jones, 49 years old, presents to the ECC with dizziness and difficulty walking that started 45 minutes ago while she was preparing breakfast. She is triaged and sent to the waiting room. Two hours later she receives a room. Another hour passes before the MD assesses her. After assessing the patient, a code stroke is activated.

What went wrong with this scenario?A.Mrs. Jones waited too long to present to the

ECC.B. Mrs. Jones waited in the waiting room for 2

hours.C. One hour passed before Mrs. Jones is

assessed by the MD.D.B and CE. A and CF. All of the above

Mr. Smith, a 79 year old, is brought via EMS from a skilled nursing facility with drooling, decreased responsiveness, and leaning towards the left side. The nurses at the facility report he started acting less responsive last night.

True or False: This warrants immediate notification to the physician of a possible code stroke.

Mr. Doe is a 27 year old male that presents with acute confusion and “staring into space”. His girlfriend states they had just left a movie about 30 minutes ago and he started acting “strange” on the way home.

True or False: This warrants immediate notification to the physician of a possible code stroke.

Ms. Whitley teaches at a local elementary school. While lecturing, she began speaking “gibberish” per the students. When she arrives at the hospital 50 minutes later she continues to speak incomprehensible words.

True or False: This warrants immediate notification to the physician of a possible code stroke.

True or False Questions

True or False: It is ok to use the patient’s stated weight for tPA dosing.

True or False: The ECC MD must assess a suspected code stroke patient within 10 minutes.

True or False: Lab work can be obtained after the head CT if the patient is a difficult stick.