General Stroke Care

The Stroke Pathway

After a clinician performs fibrinolytic and/or endovascular therapy, the patient receives general stroke care, including commencement of the “stroke pathway.” The stroke pathway involves transferring the patient to a stroke unit for observation. Trained healthcare personnel closely monitor neurological status and vital signs, paying attention to blood pressure. 

The stroke unit should support the patient’s airway, breathing, and circulation, while monitoring and maintaining a normal blood pressure.¹

If a patient’s condition worsens in the stroke unit, a CT scan of the brain must be repeated. Cerebral edema or intracerebral hemorrhage may be present, worsening the patient’s symptoms.

Monitoring blood pressure is essential after a stroke.

Related Video – How Do You Treat a Stroke?

Blood Glucose Monitoring

Clinicians closely monitor blood glucose levels in acute ischemic stroke patients. Studies show an association between hypoglycemia and acute ischemic stroke. However, there is no evidence the active control of blood glucose improves outcomes.²

Conversely, hyperglycemia treatment may improve survival rates in acute stroke patients. It is recommended that clinicians administer insulin subcutaneously to patients with elevated blood glucose levels 185 mg/dL and above.

Clinicians monitor blood glucose levels for patients at risk of hypoglycemia, improving survival rates.

Clinicians also monitor fibrinolytic therapy complications and the stroke itself. Seizures may occur after stroke, so anticonvulsants should be on standby.³ Providers also monitor patients for increased intracerebral pressure. When blood pressure is controlled, the risk of intracerebral bleeding is abated.

Read: Systems of Care: In-Hospital Cardiac Arrest

Hypertension Management

The table below displays the general guidelines for hypertension management in acute ischemic stroke patients considered for rTPA therapy. Clinicians must control the patient’s blood pressure to prevent the risk of intracerebral hemorrhage, a potential side effect of fibrinolytic therapy. Clinicians should aim for a systolic blood pressure less than 185 mmHg and a diastolic pressure less than 110 mmHg.

Related Video – Hypertensive Meds for Stroke

Acute ischemic stroke patients with sustained hypertension are not eligible for rTPA therapy. Its administration is time sensitive, and the time it takes to lower the blood pressure elapses the limit. Studies haven’t shown data supporting hypertension control, so the treatment for malignant hypertension is the aggressive control of hypertension and exclusion of fibrinolytic therapy.

Management of hypertension in acute ischemic stroke patients.

Summary

Providers administer general stroke care after fibrinolytic or endovascular therapy. Trained stroke unit personnel closely monitor neurological status and vital signs, paying close attention to breathing, circulation, blood pressure, and blood glucose levels. If a patient’s condition worsens, another CT scan should be administered. The clinician’s most important task is blood pressure maintenance.