Management of Acute Stroke in Older Patients

Management of Acute Stroke in Older Patients is organized by AchieveCE. This Course has been approved for a maximum of 2.0 Contact Hours.

Target Audience:
• Nursing
• Registered Nurse (RN)
• Advanced Practice Registered Nurse (APRN)
• Certified Nursing Assistant (CNA)
• Licensed Practical Nurse (LPN)

Activity overview:
Stroke may be a leading cause of death in the world, but the studies for it have largely been performed on younger people. This is unfortunate because strokes are less likely to affect the age groups of study participants, making the evidence presented less useful than when performed on the most vulnerable populations. If healthcare providers are going to manage the risks of stroke, they need to first understand the many symptoms of a stroke, how they manifest as people age, and which treatments are best for each individual. For example, comorbidities should be considered before deciding whether to treat someone with thromboembolism after a stroke. The good news is that developed countries have already made huge strides in managing acute stroke (the most common type of stroke). In fact, the mortality rate has been reduced by nearly 50% over the course of less than two and a half decades. Not only have there been more studies conducted to prove the efficacy of managing certain complications, but there are also more practicing physicians dedicating themselves to better stroke care. Still, as the population both grows in number and in overall lifespan, healthcare practitioners are also seeing a higher rate of stroke, especially in those aged 80 and over. This fact needs to prompt healthcare practitioners to learn more about stroke and to call for studies that incorporate everyone, and not just those who are fit and healthy.

Many of the treatments and methods for stroke victims are relatively new to the healthcare industry, leaving professionals with a less than complete body of research. To prevent brain damage, it’s clear that arteries need to be unblocked, brain bleeds to be staunched, and clots need to be extracted. Due to the severity of a stroke, the most effective treatments post-stroke are those done within 9 hours after the event occurs. Today, providers are more likely to use multidisciplinary stroke wards to treat the common ailment, rather than a general ward that has limited knowledge of the complexity of a stroke. Most significantly, stroke-unit care can be the saving grace for older victims of stroke who would prefer not to move into a nursing home. These units simply have better trained people who can manage common complications before they turn into near-fatal disasters. Hyperacute treatments like thrombectomy and decompressive hemicraniectomy have proven to be effective for the managing of strokes. Management techniques like dysphagia screening and fluid monitoring can also successfully address the after-effects in the stroke victim. However, there’s still a lot to learn about the complications and recovery of stroke victims. There also may need to be some changes when it comes to how palliative care is administered. With the tendency to promote life beyond all else, this emphasis may stand in the way of the quality of life for the patient. This should be reconsidered in order to honor the patient’s wishes, whether they can speak for themselves or not.

Learning Objectives
By the end of this acute stroke management course, you should be able to do the following:
• Discuss the history of stroke treatments and how they’ve impacted the worldwide mortality rate
• Define the general purpose of acute stroke care and how it works to prevent a wide range of complications
• Define the general purpose of hyperacute stroke care and how it works to prevent brain damage in victims
• Talk about the role of DNR orders and how stroke victims are most likely to express their wishes over time
• Assess the nature of modern stroke studies and how their methodology affects patient outcome
• Analyze why researchers and patients have different priorities, and how this conflict can influence the quality of life for a patient
• Recall the most effective treatments for stroke, and why age should or shouldn’t influence administered treatment
• Discuss why studies often exclude those over 80 and how this impacts the collective body of knowledge of strokes
• Assess how timing affects the stroke victim and why healthcare practitioners need to think about stroke care long before they see a patient presenting with symptoms
• Review how formal screening for things like incontinence, retention, and dysphagia helps patients after they’ve suffered a stroke

Course Outline
Section 1: Introduction
Section 2: Hyperacute Stroke Treatments
Section 3: Acute Stroke Care
Section 4: Special Considerations
Section 5: Conclusions