Comprehensive care of adults with acute ischemic stroke.

Stroke continues to represent the leading cause of long term disability despite positive achievements in the last few years. An estimated 50 million stroke survivors world wide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors will require some assistance or are fully dependent on caregivers for activities of daily living. The interdisciplinary team approach, with the nurse playing the central role, is important across the continuum of care. Families must cope with the impact of stoke on their daily lives once the acute phase of stroke care is over. Studies have shown personal and environmental factors influence outcomes after stroke. Patient and family education during the acute phase of stroke care is vitally important. There is also a need to educate nursing and other members of the interdisciplinary team about the potential for recovery in the later or more chronic phases of stroke care. The goal of hospitals seeking and obtaining certification as a Primary Stroke Center is to provide the best possible outcomes for patients suffering a stroke. An organized evidence-based approach to each aspect of stroke care contributes to the quality of the outcomes and requires an infrastructure that the organized center can provide. Stroke is a complex disease process that requires the skills of an interdisciplinary team. Prevention of medical complications and neurologic deterioration is key in managing patients with acute ischemic stroke. The use of clinical pathways and physician standing orders helps to guide the team in managing the care of stroke patients in the acute phase of care. Traditionally the role of educating patients and families about the modifiable and treatable risk factors, and the nonmodifiable risk factors for stroke has been a nursing responsibility. Because patient education is a performance standard for primary stroke centers, nurses must be well informed regarding evidence-based practices associated with effective lifestyle modification strategies for a diverse population.