Chapter 62: Stroke Nursing Care

The chapter establishes stroke as the fifth leading cause of mortality in the United States and the primary cause of severe long-term disability, with incidence rates increasing with age but affecting individuals across all age groups. Risk factor assessment distinguishes between nonmodifiable elements such as age, gender, ethnicity, and genetic predisposition, and modifiable factors including hypertension, cardiac arrhythmias particularly atrial fibrillation, diabetes mellitus, tobacco use, obesity, and sedentary lifestyle patterns. The pathophysiology section examines cerebral circulation dynamics, autoregulation mechanisms, and collateral blood flow patterns, differentiating between ischemic strokes caused by thrombotic or embolic occlusion and hemorrhagic strokes resulting from intracerebral or subarachnoid bleeding. Clinical manifestations vary significantly based on the affected cerebral hemisphere, with left-brain damage typically producing language deficits and cautious behavioral patterns, while right-brain injuries often result in impulsivity, spatial neglect, and compromised judgment. Diagnostic protocols emphasize rapid neuroimaging through computed tomography or magnetic resonance imaging to differentiate stroke subtypes, supported by angiographic studies and cardiac evaluations. Treatment approaches include emergency fibrinolytic therapy using tissue plasminogen activator within critical time windows for ischemic events, mechanical thrombectomy procedures, and comprehensive hemorrhage management strategies. Nursing interventions span acute stabilization focusing on respiratory support and neurological monitoring using standardized assessment tools, through rehabilitation phases emphasizing mobility restoration, communication enhancement, and prevention of secondary complications such as aspiration pneumonia, pressure injuries, and thromboembolic events.