Stroke Management: Interventions for Nursing Professionals

This article discusses stroke management interventions for nursing professionals, including antithrombotic drugs, antihypertensive drugs, oxygen therapy, and neuroprotection. It also highlights the side effects of these interventions and their mechanism of action.

Running head: STROKE MANAGEMENT
STROKE MANAGEMENT
Name of the student:
Name of the university:
Author note:

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Introduction:
Stroke is the third leading cause of death in the nation of Australia. In the year 2015,
about 10,869 stroke fatalities in the nation had been reported and this accounted for about 6.8%
of the 159,052 deaths. In medical terms, stroke can be defined as the cerebrovascular accidents
that affect the blood flow of the brain. Two types of strokes might occur in the individuals (Mega
& Simon, 2015). One of them is the hemorrhaging stroke that results in bleeding in the brain and
another one is the infarction that is caused by the blood clot or a fatty plaque in the blood vessels
(that are supplying to the brain). These moments of occurrence of stroke are crucial emergency
moments when the professionals need to quickly diagnose the patients and provide interventions.
Gradual loss of time in initiating treatment of the patients results in an increased chance of risks
of mortality. This assignment will thereby show how the nursing professionals need to be aware
of the different stroke management interventions so that they can apply each of the interventions
successfully. This would help the patients to come out of threatening situations and live a better
quality of life.
Antithrombotic drugs:
Under normal situation, blood mainly flows through the different blood vessels like
arteries and veins smoothly and efficiently. However, if a clot occurs or a thrombus is formed, it
results in the blocking of the smooth flow of the blood. This occurrence results in a situation
called thrombosis. This is a serious condition and can even lead to deaths. Different types of
disorders can develop from the clotting of the blood like the heart attack, stroke and many others.
The patient who had admitted to the ward had gone through similar situations that had made him
suffer from stroke (Rothwell et al., 2016). Therefore, in such situation, the medical science had

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provided important drugs called the anti-thrombotic drugs that help in the prevention as well as
the treatment of the thrombosis. These drugs are of two types:
Anticoagulant drugs are one form of antithrombotic drugs. These drugs are mainly seen
to produce a highly variable anticoagulant effect in the patients. The nursing professionals
always need to measure the effects of the drugs by different types of special blood tests and their
doses are adjusted according to the outcomes. Studies suggest that heparin is seen to act
immediately and is mainly given intravenously. Again, warfarin is another such drug that is
mainly swallowed in the tablet form but the effect of the anti-coagulants is delayed for days
(Posquini et al., 2014). Therefore, when such patients would arrive in the hospitals with
accidents of strokes, the nursing professionals should first start heparin infusion and would then
initiate warfarin before discharging them after five to seven days. Some of these types of drugs
are the heparin, warfarin, rivaroxaban, dabigatran, apixaban and others.
Blood platelets remain inactive until the specific damages to the different blood vessels
as well as blood coagulation make them explode into sticky irregular cells. These cells are seen
to clump together helping in the formation of thrombus. Antiplatelet drugs interfere with the
procedure of the binding of the platelets and prevent them from starting the blood clotting
procedures (González-Pérez et al., 2017). Studies suggest that Antiplatelet drugs help in
decreasing the aggregation of the platelets and help by inhibition of the thrombus formation.
They are effective in the arterial circulation where anticoagulants have little effects. Some of the
common Antiplatelet drugs are the clopidogrel, ticagrelor, prasugrel, dipyridamole or aspirin and
many others.

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The nursing professional who would be treating the patient should be well aware of the
side effects that remain associated with the drugs. Effective precaution can be taken accordingly
while providing anticoagulant or Antiplatelet drugs. These drugs might result in the increased
number of side effects like increased bruising as well as red and pink colored urine. The stools
will become bloody or might also look like coffee grounds. These drugs will result in more
bleeding than the normal mainly during the menstrual periods. It might also result in purple toes
and might cause pain as well as a change in temperature. Blackish areas in the fingers, toes,
hands and feet are also seen to occur in the patients who are taking the medication. The nurse
should, therefore, provide a wear to the patient for the identification bracelet. She should also
instruct the patient to avoid the sports as well as other activities that might cause injury making it
difficult for their bodies to stop bleeding or clotting normally.
Antihypertensive drugs:
Antihypertensive drugs are the drugs that are used in the treatment of high blood
pressure. Hypertension is a significant diagnosis and is seen to be linked substantially with an
increased risk of heart attack as well as stroke. The patient in the case study might have high
blood pressure that has become one of the contributors to the stroke occurrence in him. Different
classes of antihypertensive drug classes are present which have a great contribution to the
management of the disorders (ENOS Trial Investigators, 2015). Studies have shown that
uncontrolled high blood pressure can lead to stroke by the damaging as well as the weakening of
the blood vessels of the brain. These aspects cause them to become narrow leading them to either
rupturing or leaking. High blood pressure is also seen to form clots in the arteries that lead to the
brain. These block the blood flow and results in the occurrence of stroke.

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The first type of drugs is called the ACE inhibitors that are the ramipril, lisinopril as well as
perindopril. These drugs are mainly seen to work by inhibition of the enzyme called the
angiotensinogen protecting enzyme or the ACE. This enzyme is mainly present on the surface of
the pulmonary as well as the renal epithelia. The drugs cause blockage to the enzyme, thereby
preventing aldosterone release from the adrenal cortex. These drugs cause the elimination of
sodium along with water from the kidneys (Tully et al., 2016). These two effects are seen to
occur cumulatively for reduction of the blood volume as well as blood pressure. The nurses
should be careful about the occurrence of the side effects like the persistent dry cough,
hyperkalemia and other effects like fatigue, dizziness, headache and nausea.
Diuretics are another class of drugs which help in the promotion of the dieresis or the
loss of water along with the elimination of the sodium and in some cases potassium. Some of the
diuretic drugs are the loop diuretics, thiazide as well as thiazide-like diuretics and even
potassium-sparing diuretics (Ettehad et al., 2016). The nurses should be aware of the side effects
when providing this intervention to the patients. It raises the chances of hypovolemia,
hypokalemia, metabolic alkalosis and many others.
Another class of drug that is extensively used is the beta-blockers. They are only given
as drugs for hypertension but also for the treatment of ischemic heart disorders, supra-ventricular
tachycardia, atrial fibrillation as well as heart failures. These drugs might include the metoprolol,
bisoprolol, labetalol as well as nebivolol. In the case of hypertension issues, these dugs mainly
act by the reduction of the renin secretion of the kidney, which is an effect that is usually
mediated by the beta-1 receptor. Beta 1 receptor is present in heart and beta 2 receptors are
present in the blood vessels and the airways. Some of the side effects that the professionals

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should be aware of are the occurrence of fatigue, cold extremities, vivid dreams, headache as
well as nausea (Manning et al., 2015).
Some of the other classes of drugs that are also included under the hypertensive drugs are
the angiotensin-II receptor agonists, calcium channel blockers, alpha-blockers, alpha 2 blockers,
renin inhibitors as well as vasodilators. The nursing professionals need to be well aware of the
mechanism by which they act. Then only they can administer the correct medication depending
upon the condition and requirement of the patient (Xu et al., 2016). They should be also knowing
about the side effects of the medications so that they can help the patient to overcome the
negative impacts accordingly.
Oxygen therapy:
Researchers are of the opinion that healthcare professionals can utilize the oxygen
therapy for improvement of the overall movements after the stroke and ineffective management
of the other stroke side effects. Oxygen therapy is formally known as the Hyperbaric Oxygen
therapy (HBOT). It exposes the patients to pure oxygen and this helps in increasing the amount
of oxygen in the brain. In order to understand the working procedure of the oxygen therapy, the
mechanism of neuro-plasticity is to be discussed. During the neuro-plasticity, the surrounding
parts of the brain are seen to take over the responsibility of the damaged parts of the brain. This
is mainly done by the building of the new connections between the cells of the brain. In order to
initiate rewiring of the process, professionals need to stimulate the brain through the repetitive
procedures (Girardis et al., 2016). This repetitive procedure is an essential ingredient into the
effective rehabs. Studies say that the brain is responsible for the consumption of the 20% of the
oxygen of the brain. However, that becomes only sufficient for operating a small percentage of

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the brain cells at any given point of time. When the brain of individuals becomes bus in the
rebuilding of the connections through the process of neuroplasticity, it requires taking up of more
oxygen. Oxygen therapy in such a situation helps the brain by providing the extra oxygen that
mainly acts in this situation as the "brain food". It helps in speeding up the process of the neuro-
plasticity. Studies have suggested that although repetitive practices are the main primary drivers
of the neuro-plasticity, this HBOT can play a significant role by speeding up the procedures
rapidly (Efrati et al., 2015). Therefore, in the case of the stroke patients, oxygen therapy is
mainly seen to improve movement of the patient after the stroke for those survivors suffering
from the post-stroke paralysis.
Many of the studies have reported that patients have experienced positive outcomes like
that of the reversal of paralysis, increased sensation, and renewed use of language. The nursing
professionals can provide patients suffering from a stroke with HBOT at any stage of the
recovery. Oxygen therapy has the potential for helping stroke survivors at any stage of the post-
stroke. The nursing professionals should be aware of the risks that remain associated with the
oxygen therapies. Researchers suggest that the main risks come from treatment equipment
(Fisher & Saver, 2015). Moreover, compressed pure oxygen is a fire hazard and therefore any
form of malpractices can lead to an explosion and even death. Nurses should only use this
therapy for the students who are hypoxic about less than 95% should be given supplemental
Nurses should only use this therapy for the students who are hypoxic about less than 95% should
be given supplemental oxygen. The routine use of supplemental oxygen is not recommended in
acute stroke patients who are not hypoxic.

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Neuroprotection:
Neuro-protection can be defined as the protection of the neurons and is a strategy that can
be adopted by the healthcare professionals for potentially protecting the brain in a number of
different cerebral conditions. Researchers are of the opinion that this strategy of the intervention
can be applicable for Parkinson’s diseases, traumatic brain injury as well as ischemic strokes.
Some of the main targets where the neuro-protection is seen to act are called the inflammation,
oxidative stresses, blood-brain barrier disruption, excitotoxicity, apoptosis as well as autophagy
(Lopez et al., 2015).
The neuro-protection mainly shows two stages of action. The first step is the prevention
of the early ischemic injury and prevention of the reperfusion injury. In the first stage,
neuroprotective agents are seen to limit the acute injuries to the different neurons in ischemic
penumbra. The neurons in the penumbra have very fewer chances in the suffering of the
irreversible injuries at any early points in comparison to neurons that are in the infarct core.
Studies suggest that many of these agents can modulate the neuronal receptors (Chassogan et al.,
2015). They help in reducing the release of the excitatory neurotransmitters that can contribute to
the early neuronal injuries.
The second step is called the prevention of the reperfusion injury. These neuroprotective
agents are seen to prevent potentially detrimental events that remain associated with the return of
the blood flow. Researchers state that although the return of the blood flow in the brain is
generally associated with the improved outcomes, reperfusions can lead to additional brain
injuries. The blood that is returning is seen to contain the leukocytes and this might occlude
smaller vessels that cause the release of the toxic products. Neuro-protection agents are seen to

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work primarily during the reperfusion. This may have a longer window for the therapeutic effect
than the drug. This is mainly seen to work earlier in the ischemic cascade.
Some of the classes of the agents that help in the first step of prevention of the early
ischemic injury are the free radical scavengers, modulators of the N-methyl-D-aspartate
receptors, modulation of the non-NMDA receptors and other like the high dose albumin,
hypothermia and others. For the second steps, the significant agents are the anti-adhesion
antibodies, membrane stabilization with that of Citicoline, neuronal healing and others (Majid,
2014). Some of the drugs that the nursing professionals can utilize are antihypertensive drugs,
lipid-lowering drugs, hypoglycemic drugs and many others.
In simple words, neuro-protection is seen to refer to the concert of the application of the
therapy that directly affects the brain tissues. It also salvages or delays the infarction of the still
viable ischemic penumbra.
Glycemic therapy:
Growing bodies of evidence suggest that disordered physiological variables are often
seen to follow acute ischemic strokes like that of hyperglycemia and these affect the outcomes
adversely. Studies have indeed seen that poststroke hyperglycemia is common to about 505 of
the patients who have suffered from the stroke and this might be rather prolonged regardless of
the diabetes status. Hyperglycemia has a number of severe impacts on the patients like different
clinical and morphological stroke outcomes (Darsalia et al, 2016). Therefore, hyperglycemia is
one of the targets for different types of acute stroke therapies. However, there had been studies
where the researches have shown concern about the application of insulin as it might result in a
situation of hypoglycemia in the patient. This can induce further cerebral damages. Therefore,

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the nursing professionals have to be aware of such harmful outcomes and should take up
initiatives by which they can ensure effective intervention for controlling the high blood glucose
level without creating any negative aspects.
The nursing professionals need to be very careful and avoid rapid shifts in the fluid,
electrolyte abnormalities as well as hypoglycemia as all these can prove to be detrimental to the
health of the patient. Patients with critical brain disorder should be continuously monitored for
glucose levels as hyperglycemia and even hypoglycemia can prove to be detrimental. Careful
utilization of the insulin protocols is advised by many studies (Lin et al., 2017). However, strict
maintenance of the normoglycemia cannot be recommended in this population of patients
because it increases the risk for hypoglycemia. Many researchers are of the opinion that success
can be obtained when nurses gain the ability to check glucose continuously for adapting to the
insulin therapy on time and for this, the CGMS device can be very helpful as it has good
accuracy and short lag time. It would help in the minimization of the risks of both stroke induced
hyperglycemia and iatrogenic hypoglycaemia. Glucose-potassium-insulin (GKI)-based regimes
can be suggested as it helps in infusing the solution of the predetermined concentrations of
glucose, insulin and potassium with peripheral glucose monitoring (Groenveled et al., 2016).
This helps in guiding the rate of infusion. Another approach that should be also considered is the
‘sliding scale’ insulin administration. Here, the infusion uses the rapidly acting insulin
preparation. Different proponents of the GKI show that it is important to approach and
physiological' and less prone to dangerous extremes of blood sugar.

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Pyrexia management:
Patients who have acute stroke would develop fever and are seen likely to die within the
first 10 days after the stroke in comparison to those individuals who have a lower temperature.
Data from various studies have shown that the body temperature higher than 37.5-degree
centigrade is significantly associated with poor outcomes (Tsujimeoto et al., 2016). Researchers
have stated that high body temperature is associated with the transformation of the ischemic
penumbra into the infarction and the apoptosis procedure thereby worsening the situation. In
most cases, fever mainly occurs in stroke patients due to infection. However, in other cases,
fever might represent a secondary condition like that of the aspiration, pneumonia, urinary tract
infection or other causes of sepsis. Others are seen to include infective endocarditis and might be
stroke it causing central fever. Massive tissue necrosis, as well as hemorrhage in the brain, can
also result in high body temperature. Therefore, the treatment of stroke patients is extremely
important where the management of fever is also very important.
The nursing professionals first need to include treatment of the body temperatures that are
higher than the 37.5-degree centigrade. They should search for the possible infection and should
start the tailored antibiotic treatment. Monitoring the body temperature and then searching for the
concurrent infection is very important. Administration of paracetamol is also very important.
antipyretic agents should be provided if the temperature is above 38 degree Celsius. The
Australian Quality in Acute Stroke Care (QASC) protocol recommends “prompt treatment of a
temperature 37.5 ºC or greater in the first 72 hours” (Cocchi et al., 2014). The nursing
professionals should record the baseline temperature on admission to the stroke unit and for the
first 72 hours following admissions. When the temperature is below 37.5 degree, blankets and
heaters should be removed as well. The patient might not be able to swallow and hence, in that

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case, the nasogastric tube should be used for administering paracetamol. Professionals should
monitor and record the temperature. If it tends to increase greater than 38 degrees, medical teams
should be informed, consideration of sepsis screens like a chest x-ray, blood tests for
inflammatory markers, blood cultures as per infection control and others should be done
(Grossestreuer et al., 2018).
Conclusion:
From the above discussion, it becomes clear that a stroke is a form of cerebrovascular
accident that has the capability of threatening the lives of the individuals resulting in death.
Therefore, nursing professionals need to follow the formulated clinical guidelines for stroke
management (2017) so that the interventions that they apply can bring out positive impacts on
the patient. Different management therapies that should be inculcated are the antithrombotic,
antihypertensive, oxygen therapies, neuroprotection. They should also provide Glycemic therapy
as well as pyrexia management. Every healthcare professionals need to understand how each of
the therapies work and the rationale behind using such therapies. Therefore, the nurses need to
develop evidence-based clinical knowledge and skills so that they can manage the symptoms of
the stroke patient effectively and ensure in development of the health of the patient.

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