Managing a Stroke as a CNA
I’d like to go over a very common ailment that we see in elder care facilities and as home health aides. One of the more common emergencies I saw CNAs deal with in the field was strokes.
Stroke patients can create a rather scary emergency scenario. Many times, the emergency can be confusing and frustrating. Thus, I think it would be best if we talked a bit about what exactly a stroke is, and how we can help our patients during this emergency.
A stroke is caused by a part of the patient’s brain being deprived of oxygen. This can happen in a few different ways.
Types of Strokes
Ischemic Strokes
An ischemic stroke is essentially a blockage in the arteries leading to the brain. This kind of stroke is very similar to what occurs in a patient that is having a heart attack. However, in this case, it doesn’t cause ischemia to the heart, but instead, to the brain. A blood clot (or embolus), can dislodge and move through the blood. This blood clot can affect many different areas; however, if it blocks the cerebral arteries, it can cause a stroke.
Hemorrhagic Strokes
The second kind of stroke that can occur is called a hemorrhagic stroke. These strokes are caused from burst blood vessels within the brain. What essentially happens is an artery bursts within the patient’s brain, which can also be called an aneurysm. The blood flows out of the vasculature and into space between the brain and the skull. The brain is kept at a certain pressure, which is called the ICP (or intracranial pressure). This pressure is increased drastically as more blood flows into this space. The brain is slowly pushed to one side as the pressure increases. The pushing of the brain to one side can cause damage, and lack of blood flow and oxygenation to the brain’s tissues.
Transient Ischemic Strokes
The third type of stroke that can be seen is called a TIA (or Transient Ischemic Attack). This is similar to an ischemic stroke; however, in the case of a TIA, the embolus or blood clot blocks the artery for a time, and then passes through. Subsequently, the patient presents as possibly having a stroke, but then the signs go away and the patient returns to normal. This type of stroke will often reoccur as an ischemic stroke in approximately 70% of patients. Therefore, it is important that patients who present as having a stroke are still taken to a hospital.
Recognizing a Stroke
There are a few different things that we as CNAs should look for when checking to see if our patient may have had a stroke. Signs and symptoms of a stroke can vary, and if you ever have any concerns about whether a patient has had a stroke, it is best to call 911.
Altered Mental Status: If a patient is altered, there is a chance he or she may have had a stroke. There are many reasons a patient could become altered, and it is definitely not always a stroke. But, if a patient becomes altered, it is important that you consider that it might very well be a stroke. Talk to the patient, ask them if they know where they are, their name, and the day of the week. You probably know the patient better than most people, so if they seem different from what you are used to, then it is time to get them help.
Unilateral Weakness: This is a fancy term for one-sided weakness. Oftentimes, strokes will cause a weakness in one side of the body. We can see facial droop on one side of the face, or we will see the inability of the patient to use one side of his or her body. A great way to assess for this is to have the patient give you a great big smile, asking them to show you their teeth. This will often show the patients facial droop, if there is any.
Assessing for unilateral weakness can be done by asking the patient to squeeze your fingers on both hands at the same time. You can easily tell if one side is stronger than the other by doing this. One other effective method is to hold the patients hands up with palms up in front of them. Often, this will show a weak side, as the patient’s arm will drift down back to his or her side if the arm lacks the strength to keep itself up; and this may indicate a stroke.
Dilated Pupil: If you see unequal pupil size on your patient, it may be indicative of a stroke. In hemorrhagic strokes, the increased intracranial pressure can cause one-sided pupil dilation.
Aphasia: Oftentimes, people that have had strokes may not be able to speak properly. They are either unable to speak the words, or the words they speak will not make any sense.
Incontinence: Patients who have had a stroke will often be incontinent, and this can be a helpful clue in determining if your patient has had a stroke.
Vital Signs: Oftentimes, patients that have had strokes will have high blood pressure reading. This is not always the case; however, in most stroke cases that I have seen the patient’s blood pressure will be at a systolic BP of 170+. A lot of times, we will see an increased pulse rate, which can be due to the heart responding to the decreased oxygenation of the brain, or it can be simply due to the fear and anxiety that is involved with having a stroke. It can be common to see a change in the patient’s respiratory rate; this can be attributed to the same reasons the heart rate increased (such as fear, anxiety and an increased need for oxygen).
Treatment Plan
OK, so we think our patient has had a stroke…. what should we do?
Call 911! There isn’t a great deal that we can do to help a patient with a stroke, but the best thing we can do is get them to a hospital quickly. There are very effective treatments for patients who have had strokes, but they need to be done fast.
Ischemic strokes can be helped with antithrombolytics. This medication can break up the clot that is causing the damage and allow for oxygenation of the damaged area. This must be done within 2 hours of the patient’s stroke onset, so time is of the essence!
Hemorrhagic strokes can also be treated. Doctors will try to control the bleeding and control the intracranial pressure of the patient, so time is also of the essence for these patients.
Assist the patient with his or her oxygen, if this is already prescribed. Putting the patient on a nasal canula and giving them 100% oxygen can be very helpful for this patient’s current condition. Always remember to follow your protocols as a CNA and of your facility. Remember this patient’s emergency is all about lack of oxygen to certain tissues, so increasing oxygen supply in the blood can help. Once again, do not give unprescribed oxygen to a patient unless you have consent from a doctor or your RN.
Protect your patient’s airway. Oftentimes, patients who have had strokes are going to be drooling, and sometimes they have difficulty swallowing. You can make sure that the patient’s airway is not compromised by removing excessive saliva by either utilizing suctioning, or helping clear the excess saliva with a clean and sterile cloth or dressing.
If possible, grab a quick set of vital signs to hand off to the paramedics that arrive to treat the patient.
IMPORTANT: Write down the exact time that the patient’s emergency began. Give this your best shot, but it’s extremely important information for the attending paramedic and the ER doctor that will be treating this patient. This is possibly the most important information you can give to the medical professionals.
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