PHTY2030 - Week 2 Exam Study
Guide
Acute Stroke Assessment - ANSWER NIHSS: The National Institute of Health Stroke
Scale
mRS: Modified Rankin Scale
NIHSS: The National Institute of Health Stroke Scale - ANSWER 15 item scale :
consciousness, eye movement, visual fields, strength, ataxia, dyarthria, language,
sensation
0 = no stroke symptoms
1-4 = minor stroke 21
5-15 = moderate stroke
16-20 = moderate to severe stroke
21-42 = severe stroke
mRS: Modified Rankin Scale - ANSWER 0 = No symptoms at all
1 = No significant disability despite symptoms; able to carry out all usual duties and
activities
2 = Slight disability; unable to carry out all previous activities, but able to look after own
affairs without assistance
3 = Moderate disability requiring some help, but able to walk without assistance
4 = Moderate severe disability; unable to walk without assistance and unable to attend
to own bodily needs without assistance
5 = Severe disability; bedridden, incontinent, and requiring constant nursing care and
attention
6 = Death
Standard Management Pathway for Stroke - ANSWER ABC & hourly neurological obs
Oxygenation
Nurse at 45' head elevation
NBM → removed only after assessment of stroke
, IV canula
Urgent head MRI/CT & chest Xray
IDC/continence plan
Compression stockings
Anticoagulation → depends on type of stroke, makes plasma thinner
Monitor fever, glucose and BP → needs to be closely controlled
Multidisciplinary assessment
Discuss the management strategies within the first 48 post stroke
(THINK FAST) - ANSWER F = face - dropping?
A = arms - lift?
S = speech - slurring?
T = time - call 000
Screening questions for hyperacute patients - ANSWER is the patient living
independently (driving, banking, shopping)
stroke symptom onset less than 24 hours
stroke symptoms 4 or greater on the NIHSS score or isolated hemianopia or aphasia.
If yes to all : the Ambulance or ED contact the JHH stroke team.
Acute Medical Management (Principles) - ANSWER Provide optimal environment for
recovery
Avoid secondary insults eg hypoxia, hypotension
Treat raised ICP
Prevent complications: eg aspiration, falls
Brain Imaging for stroke - ANSWER NCCT exclude haemorrhage look for areas of
hypodensity and swelling
MRI diffusion-perfusion mismatch
Multimodal CT
(most people usually get a CT scan rather than an MRI)
Brain imaging is crucial to hyper-acute stroke management
Guide
Acute Stroke Assessment - ANSWER NIHSS: The National Institute of Health Stroke
Scale
mRS: Modified Rankin Scale
NIHSS: The National Institute of Health Stroke Scale - ANSWER 15 item scale :
consciousness, eye movement, visual fields, strength, ataxia, dyarthria, language,
sensation
0 = no stroke symptoms
1-4 = minor stroke 21
5-15 = moderate stroke
16-20 = moderate to severe stroke
21-42 = severe stroke
mRS: Modified Rankin Scale - ANSWER 0 = No symptoms at all
1 = No significant disability despite symptoms; able to carry out all usual duties and
activities
2 = Slight disability; unable to carry out all previous activities, but able to look after own
affairs without assistance
3 = Moderate disability requiring some help, but able to walk without assistance
4 = Moderate severe disability; unable to walk without assistance and unable to attend
to own bodily needs without assistance
5 = Severe disability; bedridden, incontinent, and requiring constant nursing care and
attention
6 = Death
Standard Management Pathway for Stroke - ANSWER ABC & hourly neurological obs
Oxygenation
Nurse at 45' head elevation
NBM → removed only after assessment of stroke
, IV canula
Urgent head MRI/CT & chest Xray
IDC/continence plan
Compression stockings
Anticoagulation → depends on type of stroke, makes plasma thinner
Monitor fever, glucose and BP → needs to be closely controlled
Multidisciplinary assessment
Discuss the management strategies within the first 48 post stroke
(THINK FAST) - ANSWER F = face - dropping?
A = arms - lift?
S = speech - slurring?
T = time - call 000
Screening questions for hyperacute patients - ANSWER is the patient living
independently (driving, banking, shopping)
stroke symptom onset less than 24 hours
stroke symptoms 4 or greater on the NIHSS score or isolated hemianopia or aphasia.
If yes to all : the Ambulance or ED contact the JHH stroke team.
Acute Medical Management (Principles) - ANSWER Provide optimal environment for
recovery
Avoid secondary insults eg hypoxia, hypotension
Treat raised ICP
Prevent complications: eg aspiration, falls
Brain Imaging for stroke - ANSWER NCCT exclude haemorrhage look for areas of
hypodensity and swelling
MRI diffusion-perfusion mismatch
Multimodal CT
(most people usually get a CT scan rather than an MRI)
Brain imaging is crucial to hyper-acute stroke management
