Stroke: Time-Critical Care

By VeriScorePrep Team · 5 min

Stroke care is a race against time. Ischemic strokes may be eligible for thrombolysis within a narrow window — typically up to 4.5 hours from last known well — and mechanical thrombectomy for selected large-vessel occlusions. Every minute of delay means more neurons lost.

Recognition

Use BE-FAST: Balance loss, Eye changes (vision loss, double vision), Face drooping, Arm weakness, Speech difficulty, Time to call. Sudden onset is characteristic.

Immediate nursing actions

• Note the exact last known well time — it determines eligibility for interventions.
• Protect airway, support breathing; oxygen only if hypoxic.
• NPO until swallow screen completed (many stroke patients aspirate silently).
• Establish IV access, draw labs (avoid dextrose-containing fluids; hypoglycemia can mimic stroke).
• Keep blood pressure within permissive range — do not lower acutely unless directed; hypertension may be a compensatory mechanism for cerebral perfusion.
• CT without contrast to rule out hemorrhage.

Positioning and care

Head of bed typically 15–30 degrees (per facility policy) to reduce intracranial pressure. Monitor neuro signs frequently — a decline in Glasgow Coma Score is a red flag.