Ischemic Stroke 69
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Neurologic Disorders
Ischemic Stroke
1. Admit to:
2. Diagnosis: Ischemic stroke
3. Condition:
4. Vital signs: Vital signs and neurochecks q30minutes for 6 hours, then q60
minutes for 12 hours. Call physician if BP >185/105, <110/60; P >120, <50;
R>24, <10; T >38.5
C; or change in neurologic status.
5. Activity: Bedrest.
6. Nursing: Head-of-bed at 30 degrees, turn q2h when awake, range of motion
exercises qid. Foley catheter, eggcrate mattress. Guaiac stools, inputs and
outputs's. Oxygen at 2 L per minute by nasal cannula.
Bleeding precautions: check puncture sites for bleeding or hematomas. Apply
digital pressure or pressure dressing to active compressible bleeding sites.
7. Diet: NPO except medications for 24 hours, then dysphagia ground diet with
thickened liquids.
8. IV Fluids: 0.45% normal saline at 100 cc/h.
9. Special Medications:
Ischemic Stroke < 3 hours:
-Tissue plasminogen activator (t-PA, Alteplase) is indicated if the patient
presents within 3 hours of onset of symptoms and the stroke is non-
hemorrhagic; 0.9 mg/kg (max 90 mg) over 60 min, with 10% of the total
dose given as an initial bolus over 1 minute.
Completed Ischemic Stroke >3 hours:
-Aspirin enteric coated 325 mg PO qd OR
-Clopidogrel (Plavix) 75 mg PO qd OR
-Ticlopidine (Ticlid) 250 mg PO bid.
10. Symptomatic Medications:
-Ranitidine (Zantac) 50 mg IV q8h or 150 mg PO bid
-Omeprazole (Prilosec) 20 mg PO bid or qhs.
-Docusate sodium (Colace) 100 mg PO qhs
-Bisacodyl (Dulcolax) 10-15 mg PO qhs or 10 mg PR prn.
-Acetaminophen (Tylenol) 650 mg PO/PR q4-6h prn temp >38°C or
headache.
11. Extras: CXR, ECG, CT without contrast or MRI with gadolinium contrast;
carotid duplex scan; echocardiogram, 24-hour Holter monitor; swallowing stud-
ies. Physical therapy consult for range of motion exercises; neurology,
rehabilitation medicine consults.
12. Labs: CBC, glucose, SMA 7&12, fasting lipid profile, VDRL, ESR; drug
levels, INR/PTT, UA. Lupus anticoagulant, anticardiolipin antibody.
