Acute Ischemic Stroke Review

Janice L. Hinkle, PhD RN CNRN; Mary McKenna Guanci, MS RN CNRN


J Neurosci Nurs. 2007;39(5):285-293, 310. 

In This Article

Abstract and Introduction


More than 700,000 people have a stroke each year in the United States. A diagnosis of stroke formerly elicited a nihilistic approach, but this has substantially changed in the last decade. Currently, time is brain, and it is important for all disciplines to work together to initiate acute stroke protocols in the emergency department and identify patients within the therapeutic time window for thrombolytic and neuroprotective therapies. Evolving protocols, management, and nursing care all have important implications during the acute phase of ischemic stroke. Patient and family education on risk reduction must also be addressed by the entire healthcare team.


Stroke is the third leading cause of mortality in the United States. Of the approximately 700,000 strokes occurring each year, about 550,000 are first strokes. About 400,000 strokes are ischemic (Thom et al., 2006). Stroke is the leading cause of adult disability with more than 4 million stroke survivors in the United States alone. Approximately 90% of stroke survivors are left with some residual deficit.

In 1994 the Stroke Council of the American Heart Association (AHA) published the first guidelines for the management of acute ischemic stroke (Adams et al., 1994). In 1996, the U.S. Food and Drug Administration (FDA) approved intravenous (IV) tissue plasminogen activator (tPA) as the first medication to treat acute ischemic stroke. The AHA subsequently published a supplement to the 1994 guidelines that addressed tPA (Adams et al., 1996). The advent of new therapies for acute ischemic stroke has brought about higher expectations for improved recovery and good outcome (Demchuk & Buchan, 2000). The AHA published guidelines for the early management of ischemic stroke in 2003 (Adams et al., 2003) and updated them in 2005 (Adams, Adams, del Zoppo, & Goldstein, 2005) and in 2007 (Adams et al., 2007).

This article reviews the pathophysiology of acute ischemic stroke and related patient care, identifies the laboratory and diagnostic tests the neuroscience nurse can expect to see in the fast-paced evaluation of a patient following an ischemic stroke, addresses the medical and nursing management approaches with which the neuroscience nurse needs to be familiar during the acute phase of the inpatient stay for ischemic stroke, and reviews patient and family education topics that must be addressed by the healthcare team.


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