Table 4:

Take-home points for new staff and unique-versus-generic aspects of stroke care on the stroke unit

Most Important Teaching Points (Take-Home Points) for New Team MembersUnique Characteristics of the Stroke Unit Environment (Not Ideal Tasks for New Team Members)Generic Aspects of the Stroke Unit Environment Similar to Other Medical Areas (Appropriate Initial Tasks for New Team Members)
Recognizing an acute stroke, recurrent stroke, and abrupt neurologic deterioration of recent ischemic or hemorrhagic strokeMonitoring a patient in the unit after receiving IV alteplase (involves watching for angioedema, bleeding, frequent neurologic vital sign monitoring, close blood pressure control, and so forth)Obtaining/interpreting scheduled vital signs (temperature, blood pressure, heart rate, respiratory rate, oxygen saturation) and point-of-care blood glucose in patients
Managing infusions of alteplase for stroke or of heparin (eg, for intraluminal thrombosis, venous sinus thrombosis)Being part of the acute stroke thrombolysis team (being comfortable with the “code stroke” and mixing alteplase)Foley catheter insertion, urinary dipstick testing, and identification of potential urinary tract infection
Grossly identifying patients who are potentially aspirating versus those safe to swallowManaging a patient at risk of malignant middle cerebral artery or cerebellar stroke (involves closely watching for neurologic deterioration and liaising with stroke/neurosurgery team for potential decompressive craniectomy)Managing the patient’s routine medications and reconciling them with those taken preadmission
NG insertion, feeding, and NG medication administrationManaging a patient with a major intracranial hemorrhage (involves watching for emerging symptoms of hydrocephalus or major hematoma expansion that may warrant neurosurgical intervention or ICU transfer)Caring for a patient in the subacute-to-chronic poststroke period with/without medical issues like urinary tract infection, cellulitis, or pressure ulcers
Performing a NIHSS bedside examinationReceiving a patient after thrombectomy (involves monitoring the groin puncture site or managing hematoma)Evaluation and initial management of a patient with chest pain or shortness of breath (eg, poststroke myocardial infarction, aspiration pneumonia)
Pager or phone numbers and schedule of stroke fellows and neurologists on callReceiving a patient after carotid endarterectomy (involves watching for reperfusion complications, lower cranial neuropathies interfering with swallowing)Evaluation and initial management of a patient with deep vein thrombosis
Understanding basic stroke mechanisms for early secondary preventionDefining a stroke mechanism through a sophisticated understanding of neurovascular anatomy, localization, and cerebrovascular syndromesWorking with patient and pharmacy to ensure proper dosing and administration of early secondary stroke prevention (eg, antithrombotics, statin therapy, blood pressure regimen, smoking cessation)
  • Note:—NG indicates nasogastric tube.