Stroke Treatment and Nursing Care

Evidence-based nursing care and continuous assessment are essential to reduce adverse outcomes after stroke.

First: Ongoing Clinical Assessment

·        Assess neurological impairment using tools such as the Glasgow Coma Scale, together with evaluation of motor and sensory deficits.

·        Assess the airway, breathing, circulation, and vital signs.

·        Monitor the fluid-balance chart to maintain appropriate fluid balance, especially during the first 24 hours, with particular caution in patients with cardiac disease or renal impairment.

·        Monitor cardiac function using electrocardiography (ECG) to detect atrial fibrillation or other cardiac arrhythmias. 

·        Maintain continuous cardiac monitoring for at least 24 hours during the acute phase.

Second: Respiratory Support and Circulatory Perfusion

·        Position the patient correctly to maintain a patent airway and prevent complications such as pressure injuries or thrombosis.

·        Use pillows or splints to support body alignment and prevent joint deformity. 

·        In selected cases, a fully supine position may improve cerebral perfusion without increasing the risk of pneumonia.

·        Maintain optimal oxygenation by monitoring oxygen saturation (SpO₂).

·        Prevent respiratory complications such as aspiration pneumonia.

Third: Medication Management

·        Administer medications as prescribed by the physician, including:

-   Antithrombotic medications.

-  Antiarrhythmic medications.

-   Antihypertensive medications.

-   Analgesics, medications for muscle spasticity, or neuropathic pain medications as required.

Fourth: Prevention of Complications

·        Prevent pressure injuries by repositioning the patient every two hours and using pressure-relieving mattresses.

·        Reduce skin friction and pressure by using appropriate positioning cushions.

·        Use compression stockings and anticoagulants, as prescribed, to prevent deep-vein thrombosis. 

·        Apply infection-prevention and control protocols.

·        Prevent falls by raising the bed rails as appropriate and providing a safe environment.

·        Apply oral-hygiene protocols to reduce the risk of ventilator-associated or aspiration pneumonia.

Fifth: Nutrition and Dysphagia Management

·        Monitor regularly for signs of dysphagia.

·        Collaborate with the dietitian to develop an appropriate nutritional plan.

·        In severe dysphagia, enteral feeding through a nasogastric tube should be initiated within 72 hours after the stroke, according to the care plan. 

Sixth: Motor and Functional Rehabilitation

·        Assist with physiotherapy to restore motor function and balance.

·        Gradually support the patient in performing activities of daily living, such as:

o   Personal hygiene.

o   Eating.

o   Dressing.

Seventh: Relief of Pain and Discomfort

·        Implement a nursing care plan to relieve stroke-related symptoms, including:

o   Headache.

o   Muscle spasms or spasticity.

o   Neuropathic pain.

Eighth: Psychological and Social Support

·        Provide emotional support to the patient and family.

·        Monitor and assess for signs of depression or anxiety.

·        Provide counseling or refer the patient for psychological care when necessary.

Ninth: Promoting Independence and Safety

·        Improve the patient’s ability to move and walk safely, with or without assistive devices.

·        Encourage active participation in rehabilitation to achieve the highest possible level of independence.