Journal
AACN ADVANCED CRITICAL CARE
Volume 23, Issue 2, Pages 158-172Publisher
AMER ASSOC CRITICAL CARE NURSES
DOI: 10.1097/NCI.0b013e31824fe1b6
Keywords
acute stroke; advanced practice nurses; intra-arterial treatment; intravenous tissue plasminogen activator (tPA); head-of-bed positioning
Categories
Funding
- NET SMART-Advanced Practice Acute Neurovascular Fellowship Program
- NET SMART- Junior Acute Stroke Nursing Education Program - U.S. Health Resource Services Administration
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The evidence base supporting the management of patients with acute stroke is evolving at a rapid rate, as new methods that aim to reduce disability and death from stroke are explored. Intravenous tissue plasminogen activator remains the only treatment shown in numerous studies to reduce disability 3 months after stroke with no increase in the risk of death and a relatively minor rate of symptomatic intracerebral hemorrhage complications. Despite these findings, health care providers have been slow to adopt this evidence-based treatment, which results in many patients experiencing disability caused by stroke. Numerous controversies exist related to the management of patients with acute stroke, including the use of tissue plasminogen activator, positioning and early mobility, blood pressure lowering in acute intracerebral hemorrhage, and even the use of innovative advanced practice nurse-led stroke treatment teams, with varying amounts of evidence available to provide direction. This article explores controversies associated with both approved and evolving treatments for ischemic and hemorrhagic stroke and makes recommendations for practice on the basis of the body of existing evidence, with an aim to improve the delivery of acute stroke treatment.
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