Page 526 - Encyclopedia of Nursing Research

STROKe n 493

that has dislodged and traveled to the brain, There are a number of treatments for
or a lack of blood flow to the brain due to cir- stroke. Carotid endarterectomy is the most
culatory failure (American heart Association common surgical procedure, and antico- S
[AhA], 2004). A hemorrhagic stroke results agulants and antiplatelet agents are the
from the rupture of a blood vessel either in most common medications used to pre-
the space between the brain and the skull vent stroke (AhA, 2004). Tissue-type plas-
(subarachnoid hemorrhage) or deep within minogen activator (tpA) is a drug that must
the brain tissue (intracerebral hemorrhage; be given intravenously to patients with
AhA, 2004). A transient ischemic attack is ischemic stroke within 3 hours of the first
a brief neurological dysfunction resulting warning sign to prevent disability from
from focal cerebral ischemia; however, it is stroke. Unfortunately, few stroke survi-
not associated with any permanent cere- vors are able to make it to a physician who
bral infarction (easton et al., 2009). Transient can administer tissue-type plasminogen
ischemic attacks are considered warning activator within the 3-hour time window.
signs of stroke. Specific warning signs of This dilemma has prompted the develop-
stroke include (a) sudden numbness or weak- ment of primary stroke centers, which the
ness of the face, arm, or leg; (b) sudden con- Joint Commission on the Accreditation
fusion, trouble speaking, or understanding; of healthcare Organizations began cer-
(c) sudden trouble seeing in one or both eyes; tifying in 2003 (lichtman et al., 2009).
(d) sudden trouble walking, dizziness, loss Certification by Joint Commission on the
of balance, or coordination; or (e) a sudden Accreditation of healthcare Organizations
severe headache (lloyd-Jones et al., 2010). is given to those centers that are compliant
Common disabilities from stroke include with national stroke standards, follow the
hemiparesis (50%), inability to walk with- primary Stroke Center recommendations
out assistance (30%), activities of daily living and recent clinical practice guidelines, and
dependency (26%), aphasia (19%), depressive are active with performance measurement
symptoms (35%), and institutionalization in a and improvement activities (lichtman et al.,
nursing home (26%) (lloyd-Jones et al., 2010). 2009). Recommendations for primary stroke
Stroke is the third leading cause of centers include an integrated emergency
death in the United States, behind heart response system, acute stroke team, inpatient
disease and cancer, and about a quarter of stroke unit, and written care protocols. The
first-time stroke survivors die within 1 year acute stroke team must include a physician
of having a stroke (lloyd-Jones et al., 2010). and a nurse who are available 24 hours a day
Approximately 610,000 people each year for rapid evaluation of patients experienc-
experience a stroke for the first time, and ing the warning signs of stroke (Alberts
another 185,000 suffer a recurrent stroke et al., 2000). get With the guidelines-Stroke
(lloyd-Jones et al., 2010). Stroke is also a (gWTg-Stroke), an improvement program
leading cause of serious, long-term disability that aligns patient care with the latest up-to-
in the United States (lloyd-Jones et al., 2010). date stroke guidelines, has been extremely
Between 50% and 70% of stroke survivors beneficial in the care and treatment of acute
will recover their independence; however, stroke. gWTg-Stroke has generated a lot of
15% to 30% become permanently disabled interest in research and in hospitals nation-
(lloyd-Jones et al., 2010). In 2010, stroke was wide. In a study of 790 U.S. academic and
estimated to cost $73.7 billion, with a mean community hospitals using gWTg-Stroke,
lifetime cost for ischemic stroke estimated at Schwamm et al. (2009) reported substantial
$140,048 per person including inpatient care, and sustained improvement in adherence to
rehabilitation, and follow-up care (lloyd- all acute stroke care and secondary preven-
Jones et al., 2010). tion performance measures.