CULLMAN REGIONAL MEDICAL CENTER
Stroke/TIA Clinical Pathway
Patient Identification / Time & initial all entries:Date: / Date: / Date: / Date:
Stroke / 1. Upon admission check to see if t-PA received within past 24hrs.
Yes-date & time or No or NA due to 3 hour window
2. If t-PA given:
· No ASA, Coumadin, Heparin or Lovenox for 24 hours
· All venipuncture sites held x 5 minutes
· No shaving
· Sign posted above bed with above info
Yes to all, Reviewed with patient and family, document in education record
3. Fasting Lipid Profile obtained and results on chart Yes
4. If t-PA not given: Antithrombotic Medication given within 48 hours
of hospitalization Yes
5. HOB FLAT, suction at bedside, bed in low position, bedrails up
Yes / NA with reason
Treatments / 1. NIH Stroke flow sheet completed Yes
2. Oxygen Per Protocol Yes – indicate rate or Not Ordered
3. Cardiac Monitor Reading – Rate/Pattern or NA – no longer ordered
4. Patient in A-fib receiving anticoagulation therapy Yes – indicate type
5. Swallowing Screen prior to PO intake Yes – indicate restrictions if any
Activity/DVTP / 1. Complete NIH Stroke Scale Flow Sheet every 2hrs x 48 hrs, then
every shift Yes
2. If patient is on bed rest or if ambulation requires assistance the
following are provided for DVTP:
· Physician ordered Lovenox/Heparin
· Physician ordered TED hose – fitted and applied
· Sequential Compressive Devices applied if nothing else ordered and patient meets above criteria
3. Physical Therapy consult for deficit assessment and possible rehab on discharge
Education / 1. Stroke Education Packet given to patient/family - Yes
2. Documentation of packet given in education record – Yes
3. Smoking cessation options discussed - Yes
Discharge
Planning / 1. Rehab options considered: PT consult order obtained. See PT flow sheet.
2. Orders for Antithromboitcs on discharge
3. Orders for Lipid Lowering Agent on discharge if Lipid > 100
Nurse’s Signature ______
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