Brain Attack
New Hope for Fighting Back from a Stroke
This article was first published in Health View, April 2002.
It began with an intense headache that just wouldn't relent. Then she started losing feeling on her right side. In good health for her 69 years, the woman didn't understand this rapid and troublesome assault on her body. She also didn't realize that she was having a stroke...
Pat Reeves, R.N.
"Knowing the early signs of a stroke is so important," said Pat Reeves, R.N., a Nurse Manager at Carolinas Hospital System. (See accompanying box with stroke warning signs.) Reeves' 36-bed nursing unit includes a newly-established six-bed unit dedicated to the care of stroke patients. "I don't think people have been educated enough about brain attack," said Reeves, referring to another term used to describe stroke. "We need to continue to educate the public and heighten their awareness about brain attack," she said.
Stroke ranks as the third leading cause of death in the United States. South Carolina leads the nation in incidence of stroke and the Pee Dee region has the highest incidence in the state. "We live in an area where the risk factors for stroke are so high because of culture and diet," said Reeves. The new stroke unit was created in response to the overwhelmingly high stroke rate in the nine-county area served by Carolinas Hospital System. It followed an extensive process by a team of clinical personnel to create a comprehensive plan for the treatment of patients who experience ischemic strokes.
The ischemic stroke is the most common type of stroke, and occurs when a sudden blockage forms in an artery leading to the brain or forms elsewhere in the body and travels to a brain artery. The blockage of blood flow to the brain, making immediate diagnosis and treatment critically important. "Time is the biggest factor," said Scott Allen, M.D., a radiologist at Carolinas Hospital System. "With a stroke you want to minimize the amount of brain tissue that is damaged. The earlier you can treat it, the more you can minimize the extent of the damage and the better the patient outcome will be," he said. New software soon to be utilized with the hospital's CT scan will give the hospital additional capabilities to benefit stroke patients.
An emerging technology that will likely play a major role in stroke diagnosis in the coming years, CT perfusion imaging shows where there is decreased blood flow to the brain. "It's standard procedure for every patient that comes into the Emergency Room with symptoms suggesting a stroke to have a CT scan," said Dr. Allen, explaining that the diagnostic procedure is used to look for signs of a stroke and/or hemorrhaging in the brain. Yet the radiologist quickly added that typically signs of a stroke would not be detected early on by a standard CT. "With the new software, the CT uses a very small amount of x-ray dye called contrast. The contrast will allow us to see areas of the brain that have a lack of blood flow. We can see the stroke at a time when a standard CT would show up as negative," he said.
CT perfusion imaging will dramatically decrease the amount of time in diagnosing an ischemic stroke. "We will have the results while the patient is still on the table. It's amazing," said Reeves. The quicker turnaround is of particular importance to patients who are determined to be candidates for treatment with t-PA (tissue plasminogen activator [clot busters]). The powerful clot-busting medication must be administered within three hours of the onset of symptoms. While patients who are treated with t-PA and those with hemorrhagic strokes (caused when a weakened blood vessel in the brain bursts) are admitted to the intensive care unit, patients diagnosed with ischemic strokes go directly from the emergency room to the dedicated stroke unit. Vital signs and neurological status are checked every hour for the first few hours, and every two hours after that for the next day or two. "It's very critical to watch for any changes in their condition. We want to make sure that their brain is getting oxygen," said Reeves.
A multidisciplinary team is involved in caring for each patient, including the resources of nursing; respiratory therapy; dietary; physical, speech, and occupational therapy; and case management. "You start discharge planning on the day of admission. Our hope is to get them into rehabilitation by the fifth day, if not sooner," Reeves said. A stroke can affect a patient in a variety of ways, depending on what part of the brain was affected. Patients can experience a range of impairments, including paralysis on one side of the body, memory loss, vision problems, and speech and language problems. While patients receive daily therapy on the stroke unit to address these difficulties, those that require the hospital's inpatient rehabilitation program experience a much more intensive therapy regime. Reeves noted, "The sooner you rehabilitate an area of deficit, the better the outcome." Because stroke can make such a dramatic impact on so many of patients' capabilities, it often takes an emotional toll as well, with depression and anger being common responses. "Who wouldn't be angry? Patients question why this happened to them," said Reeves. Yet, she emphasized that strong family support and skilled, caring nurses can influence even the most discouraged patient. "A good nurse can motivate a patient. Some patients you have to push, others you can motivate just by talking softly to them," she said.
Working with stroke patients on a daily basis, Reeves is concerned about the lack of knowledge that the average person has about stroke. "The major thing is to get educated on what a brain attack is, and to know that there are things you can do to prevent it," she said. It also concerns her that many people dismiss transient ischemic attacks (TIAs). During a TIA, (also called a mini-stroke) a blood clot temporarily clogs an artery, preventing blood from getting to part of the brain. TIAs usually last less than five minutes, after which the accompanying stroke symptoms subside and the patient goes back to normal.
Yet Reeves warns that the apparent return to normalcy should not lure someone into complacency. "A TIA is a major warning for the potential of a full-blown stroke so it needs to be followed up on and reported to your physician,"she said. Once more, she brings the focus back to education. "If we can teach one person and challenge them to educate another, then we may prevent someone from having a fatal brain attack."
By Diane J. Epperly, Contributing Writer.
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