This story was originally published in the Chicago Tribune brand publishing special section Nursing In Action.
When a stroke hits, time is precious.
There is a narrow window of time for lifesaving measures, usually only a few hours. Until recent years, stroke victims had little in the way of immediate treatment when they came through the hospital doors.
Today, the country has more than 1000 certified stroke centers where patients are offered the latest in help and hope.
Nurses are at the forefront of this revolutionary stroke care.Advanced practice nurse Dr. Sarah Livesay, DNP, RN, ACNP-BC, ACNS-BC, associate professor at Rush University College of Nursing and a clinician, is one of those nurses. She spends part of her busy days making sure patients get the latest and best care in the neurosciences intensive care unit (neuro ICU) at Rush University Medical Center while instructing other nurses there. She also teaches at the Rush College of Nursing and serves as a reviewer for The Joint Commission, the body that certifies hospitals as specialized stroke centers.
Livesay has been fascinated with stroke care since she saw her first neuro patient 17 years ago as a new nurse. The treatment and care of people who have had brain injuries, seizures and strokes has evolved a lot since then, she says.“I love the neuroscience field because there is so much happening right now. We are literally discovering new treatments every day,” Livesay says. “What was standard even two years ago has changed. Doctors and nurses are able to be more effective than in the past.”
For example, Livesay recently took care of a young woman who had a stroke while pregnant. “She received tPA (a blood clot busting drug), and she and her baby were safe,” Livesay reports.“Then I was on service and admitted an older woman in her 70s, whose daughter had called 911 because she thought her mother was having a stroke. The daughter was the woman we had treated before!” Fortunately, the mother also was given tPA in time. “Now she will be able to enjoy her grandchild,” she happily adds.
As a reviewer of hospital stroke programs for The Joint Commission, Livesay and others hope to increase access to the lifesaving treatments certified stroke centers provide. Certification is earned: A center must have up-to-date equipment, offer approved treatments and have staff properly trained for an emergency.
The world of post-stroke care in the neuro ICU is a minute-to-minute exercise in subtle observation. To properly understand these complex patients, training is crucial. Oftentimes there are multiple medical issues to weigh. “The acute issue may be the stroke, but they may also have kidney or heart or lung disease or maybe all three. It makes their care much more complex,” Livesay says.
Because strokes occur in blood vessels hidden in the brain or leading to it, the problem is hidden and nurses must interpret subtle changes quickly.
“Even after patients are treated, their condition can change quickly at any moment, and some of the changes are not very obvious,” says Valerie Musolf, BSN, RN, CCRN, CNRN, a clinical nurse educator and a student of Livesay’s in the Doctor of Nursing Practice program at Rush.
“A good neuro ICU nurse will be able to pick up on tiny little things and relate them to what vessels might be affected and what is going on. To work on our unit you have to be very well versed in stroke management,” Musolf says.
There are different types of strokes with different root causes that require different treatments. For example, bigger blood clots are often manually removed by interventional radiology in a procedure called a thrombectomy, which is a mechanical way of breaking up the clot using a catheter. Smaller clots may be treated with the intravenous drug tPA.
Stroke patients need a lot of education afterward, because once someone has a stroke there is greater risk of another. But the good news is that most strokes are preventable.
The No. 1 risk factor is high blood pressure. Other risk factors include diabetes, smoking, drinking, atherosclerosis (artery disease) and atrial fibrillation (irregular heartbeat), according to the National Stroke Association. So diagnosing and controlling those conditions is the best thing you can do to lower your risk of stroke.
“Part of being a stroke center is we have to educate every patient before they are discharged,” Musolf says. This is likely what saved the life of Livesay’s patient’s mother, because her daughter was able to recognize the symptoms.“(The stroke) was unfortunate for the family but it was huge that they recognized the signs,” Livesay says.