Comprehensive Neuro and Stroke Assessment & Management 2025-2026 latest updated version with expert solutions

Level of Consciousness (LOC)

A measure of a person's alertness and cognitive power.

Alertness

Arousal state and response to stimuli.

Cognitive power

Process stimuli and produce response.

Full consciousness

Awake and alert, orients x3.

Confusion

Impaired decision making.

Disorientation

Confusion regarding person, place, and time.

Lethargy

Sluggishness, drowsiness, limited spontaneous movement.

Obtundation

Arousable with stimulation.

Stupor

Remains in deep sleep, responsive only to vigorous repeated stimulation.

Coma

No motor or verbal response to painful stimuli.

Persistent vegetative state

Permanently lost function of cerebral cortex.

Glasgow Coma Scale

Scoring from 3 to 15 based on eye opening, verbal, and motor responses.

CVA

Cerebral vascular accident; sudden decrease in blood flow to an area of the brain.

Ischemic stroke

Blood flow interrupted, accounting for 87% of strokes.

Hemorrhagic stroke

Blood spill into spaces, accounting for 13% of strokes.

Transient Ischemic Attack

Sudden onset, causes neurologic deficits for less than 24 hours.

Large Vessel Stroke

Occlusion of a large cerebral vessel by a thrombus.

Small Vessel Stroke

Occlusion of a smaller cerebral vessel by a thrombus.

Cardiogenic Emboli Stroke

Blood clot enters circulation from atrial fibrillation or myocardial infarction.

Intracerebral Hemorrhage

Bleeding into the brain tissue, often occurs in older adults with hypertension.

Subarachnoid Hemorrhage

Bleeding in the space surrounding the brain, life-threatening medical emergency.

Risk Factors for Stroke

Hypertension, cigarette smoking, heart disease, diabetes, TIAs.

BE FAST

A mnemonic to spot a stroke: Balance, Eyes.

Contralateral deficit

Loss or impairment found on the opposite side of damage.

Right Brain Injury

Paralyzed left side, special perceptual deficits, quick impulsive behavioral style.

Left Brain Injury

Paralyzed right side, speech-language deficits, slow cautious behavioral style.

F.A.S.T.

A method to assess stroke symptoms: Face, Arm, Speech, Time.

Face

Ask patient to smile - is their face symmetrical?

Arm

Ask patient to raise their arms out with palms out for 10 seconds.

Speech

Ask to repeat the phrase, 'you can't teach an old dog new tricks.'

Time

Determine time of symptoms onset, last known well time.

Symptoms of Stroke

Manifestations vary according to the area of the brain affected.

Sensory Perceptual Deficits

Impaired ability to integrate, interpret, and attend to sensory data.

Hemianopia

Loss of half of the visual field in one or both eyes.

Agnosia

Inability to recognize one or more familiar objects.

Apraxia

Difficult or impossible to perform certain movements or tasks.

Neglect Syndrome

Disorder of attention that impairs awareness of one side of the body or surroundings.

Cognitive Changes

Change in consciousness ranging from confusion to coma.

Emotional Liability

Laughing or crying inappropriately.

Aphasia

Inability to use or understand language.

Expressive Aphasia

Can understand what is said but has difficulty getting words out.

Receptive Aphasia

Can't understand words; speech is fluent but may be inappropriate.

Global Aphasia

Dysfunction in both understanding and expression.

Dysarthria

Difficulty in speaking clearly due to issues with the muscles used for speech.

Hemiplegia

Paralysis on half of the body (right or left).

Hemiparesis

Weakness on half the body (right or left).

Flaccidity

Absence of muscle tone.

Spasticity

Increased muscle tone, usually with some degree of weakness.

NIH Stroke Scale

A tool for assessing stroke severity.

CT Scan

Used to distinguish between hemorrhagic stroke and ischemic stroke.

Fibrinolytic Therapy

Used in ischemic strokes to prevent further thrombosis and increase cerebral blood flow.

TPA

Tissue-type plasminogen activator; causes fibrinolysis of the clot.

Anticoagulants

Prevent growth of clot and prevention of new clots.

Mechanical Thrombectomy

A procedure to retrieve clot in patients with large vessel obstruction.

Carotid Endarterectomy

Surgical procedure that removes plaque from the carotid arteries.

Rehabilitation

Includes physical therapy, occupational therapy, and speech therapy.

Aspiration prevention

Eat upright, soft food- liquid honey thick

Assessment for aspiration

Assess for coughing, have suction available

Food placement for aspiration risk

Food on unaffected side of mouth

Peripheral vascular disease

Inadequate blood flow in arteries of lower extremities

Peripheral artery disease

Vessels carry blood away from the heart

Acute vascular condition

Thrombus

Chronic vascular condition

Atherosclerosis

Peripheral venous disease

Disrupted venous return of blood from the extremities

Vessels in venous disease

Vessels carry blood toward the heart

Types of venous thromboembolism

VTE- venous thromboembolism

Venous insufficiency

Inadequate venous return leading to complications

Varicose veins

Enlarged veins due to valve failure

Peripheral Arterial Disease (PAD)

Most common cause- arteriosclerosis

Atherosclerosis

A type of arteriosclerosis

Arteriosclerosis in abdominal aorta

Leads to aneurysms

Obstruction manifestation

Seen when occluded by 60% or more

Primary symptom of PAD

Pain

Intermittent claudication

Cramping, aching and weakness occurring with activity

Rest pain

Occurs during inactivity, worse when legs are elevated

Skin changes in PAD

Legs pale when elevated, dark red (rubor) when dependent

Complications of PAD

May lead to gangrene, amputation, AAA rupture, infection and sepsis

Diagnostics for PAD

Often diagnosed by history and examination

Segmental pressure measurements

Compares pressures between upper and lower extremities

Doppler ultrasound

Evaluates blood flow using sound waves

Medications for PAD

Meds for peripheral atherosclerosis less effective than with coronary heart disease

Antiplatelets

ASA and clopidogrel (plavix): Reduce risk of arterial thrombosis

Cilostazol (pletal)

Platelet inhibitor with vasodilator properties: Improves circulation

Pentoxifylline (trental)

↓ blood viscosity and ↑ RBC flexibility; ↑ blood flow to extremities

Revascularization indications

Progressive, severe or disabling symptoms- interfere with ADLs

Non-surgical revascularization

Percutaneous transluminal angioplasty (PTA), Stent Placement, Balloon angioplasty

Surgical revascularization

Endarterectomy, Bypass graft (fem pop)

Nursing care for PAD

Assessment- health history and thorough physical assessment

Promoting effective perfusion

Use foot cradle, avoid heating pads, don't cross legs

Skin integrity promotion

Frequent skin assessment q8h, keep clean/dry, heel protectors/egg crate

Activity tolerance promotion

Gradual increase in duration, frequent position changes, active range of motion