An Update on Transient Ischemic Attacks

Janice Hinkle

Disclosures

J Neurosci Nurs. 2005;37(5):243-248. 

In This Article

Nursing Interventions

The patient who has experienced TIA is at risk for altered cerebral tissue perfusion. Important nursing interventions include performing baseline and subsequent serial assessments of neurological status for any further signs and symptoms of altered cerebral tissue perfusion that may indicate a recurrence of TIA or a developing stroke. The nurse must also educate the patient and family about the laboratory and diagnostic tests being performed during the initial evaluation (Hickey, 2003; Hinkle, 1997).

Most patients with TIA and their families also have a knowledge deficit related to risk factors for TIA and stroke. A nationwide survey of 11,400 adults reported that 8.2% of those surveyed were able to identify the definition of TIA and only 8.6% were able to recognize at least one common symptom (Johnston et al., 2003). In another study of 215 hospitalized women, all respondents named stress as the number one risk factor for stroke (Kattapong et al., 1998).

Patient and family education should proceed according to a baseline assessment of knowledge deficit related to risk factors and secondary prevention. The degree of readiness to change must also be assessed (Miller & Spilker, 2003). Assessment needs to be directed first toward the recognition of nonmodifiable risk factors including advancing age, male gender, Hispanic or African American race, and heredity (Albers & Easton, 2001; Albers et al., 1999). Individuals in these groups need to be more vigilant about controlling modifiable risk factors.

Recommendations for prevention of modifiable TIA risks include

  • Hypertension should be treated aggressively to maintain systolic blood pressure (BP) below 140 mm Hg and diastolic BP below 90 mm Hg (Albers et al., 1999; Wolf et al., 1999).

  • Diabetes mellitus, if present, must be controlled (Albers et al., 1999; Wolf et al., 1999).

  • Cigarette smoking must be eliminated (Feinberg et al., 1994; Wolf et al.).

  • Coronary artery disease, cardiac arrhythmias, congestive heart failure, and valvular heart disease should be treated (Feinberg et al., 1994).

  • Excessive alcohol use or any illicit drug use should be eliminated (Wolf et al., 1999).

  • Use of oral contraceptive should be discontinued, or at minimum a low-estrogen version should be used (Feinberg et al., 1994).

  • Cholesterol levels need to be monitored and hyperlipidemia should be treated for reduction of coronary artery disease (Wolf et al., 1999).

  • Physical inactivity must be corrected and the benefits of an exercise program as well as a healthy diet leading to weight loss in overweight individuals should be explained (Albers et al., 1999; Wolf et al., 1999).

  • Hormone replacement therapy in postmenopausal women is not recommended for prevention of stroke (Brass, 2004).

All educational interventions need to be appropriate for individual educational levels and learning styles (Hickey, 2003; Moore, 2001). Educational materials in a variety of media are available to meet the needs of patients and families. Printed materials about specific medications are available from most hospital pharmacies, many in both English and Spanish. Videotapes or DVDs on medications and procedures are also available for visual learners. Patients who are computer savvy may prefer to read information that is available online from organizations such as the American Stroke Association (ASA) and National Stroke Association.

Each patient and family should receive printed materials outlining the warning signs of stroke. These are available from the ASA in both English and Spanish (ASA, 2000). Printed patient teaching materials regarding stroke risks, modifiable risk factors, and carotid endarterectomy are also available through the ASA's Get with the Guidelines Program (www.americanheart.org).

In their capacity as healthcare professionals, advocates, educators, and role models, neuroscience nurses can best educate and advocate for patients and families by staying informed about current research findings related to TIAs. Table 3 provides sources of information about ongoing clinical trials that can assist in answering questions about options, especially prevention, for patients who have had TIA.

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