Stroke: The Brain Factory Under Attack
Stroke is a true factory emergency. When blood flow to a region of the brain is cut off, that region loses glucose and oxygen simultaneously. Within four to six minutes without ATP, brain cells begin to die permanently. The LPN's role in stroke is time-critical: recognize cues, report immediately, and support the response. The window for thrombolytic treatment (tPA) is narrow — every minute matters.
Ischemic (87% of strokes): A clot blocks an artery supplying the brain factory. No glucose, no oxygen → ATP failure → cell death. Treatment: tPA (tissue plasminogen activator) if within time window — dissolves the clot.
Hemorrhagic (13%): A vessel ruptures. Blood floods the brain factory — mechanical pressure + loss of downstream supply. tPA is contraindicated — it would worsen bleeding. Treatment is surgical.
Balance — sudden loss of balance or coordination
Eyes — sudden vision change or double vision
Face — facial drooping (ask to smile; note asymmetry)
Arms — arm weakness (ask to raise both; note drift)
Speech — slurred, confused, or no speech
Time — note exact time cues began. Report IMMEDIATELY.
| LPN Action | Rationale |
|---|---|
| Note and report EXACT time symptoms began | tPA must be given within 3–4.5 hours of last known well time |
| Do NOT give anything by mouth | Swallowing ability is impaired — aspiration risk |
| Collect and report neurological cues every 15 minutes | Rapid change indicates expansion of infarct or hemorrhage |
| Position: HOB 0–30° (per order) | Optimizes cerebral perfusion pressure |
| Do NOT give antihypertensive unless specifically ordered | Elevated BP may be compensatory — lowering it can worsen infarct |
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