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07.09 Ischemic (CVA) Stroke Labs

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Overview

  1. Ischemic stroke
    1. Labs to consider for disease process
    2. Lab purposes
    3. Special Considerations

Nursing Points

General

  1. Ischemic stroke
    1. Labs to consider for disease process
      1. Comprehensive/Basic metabolic panel
      2. Capillary Blood Glucose (CBG)
      3. Lipids
      4. Complete blood count
      5. Coagulation studies
    2. Lab purposes
      1. Comprehensive/Basic metabolic panel
        1. Organ function
        2. Electrolytes
          1. Sodium
            1. Low sodium causes cerebral edema
      2. Capillary Blood Glucose
        1. Bedside testing
          1. Quick testing
          2. Hypoglycemia mimics stroke
          3. Rule out at bedside
      3. Lipids
        1. Determines risk for arteriosclerosis
        2. Increased risk of ischemic stroke
      4. Complete Blood Count
        1. Anemia
        2. Infection
        3. Platelets
          1. Anticoagulation therapy based on platelet counts
            1. tPA
      5. Coagulation studies
        1. Monitoring therapy of other anticoagulants
    3. Special considerations
      1. CMP/BMP
        1. Green top
      2. CBG
        1. Bedside blood sugar  testing
      3. Lipid panel
        1. Green top
      4. CBC
        1. Lavender top
      5. Coagulation studies
        1. Blue top

Nursing Concepts

  1. Intracranial Regulation
  2. Perfusion
  3. Lab Values

Reference Links

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Video Transcript

All right in this lesson we’re going to take a look at the labs associated with ischemic stroke

Similar to that some of the other lessons, what we’ve done is we’ve gotten together a framework of the potential labs that you may end up seeing for your patients with particular illnesses, diseases, or injuries. This is not an all-inclusive list, but I want you to understand that our goal here is to give you some sort of idea of the labs that you may potentially run into so that you know why we do them.

What we’re dealing with patients with ischemic strokes, it’s a really common admission. The goal here is to number one, access them quickly which is why we do some of the labs that we do. We need to differentiate between an ischemic stroke and a hemorrhagic stroke because the treatments are vastly different. Once we figure out what’s going on with our patient then we can develop an a plan of care focused on what’s going on with them.

The first test you’ll probably see is some form of imaging. This is most commonly a CT scan and sometimes MRIs. But we’ll go into that a little bit. Other tests that you’re going to see our comprehensive or a basic metabolic panel and also cbgs, or capillary blood glucoses. It’s not uncommon to get lipid panels on these guys and also to do complete blood counts and coagulation studies

The reasons why we do these are very very important. Aside from all the imaging associated with it these are the labs that you’re most likely going to run into.

With the comprehensive or basic metabolic panel, we’re looking at organ function. We want to get an idea of what’s going on inside of our patient. The other thing that we pay attention to particular really early electrolytes mostly sodium. Low sodium causes cerebral edema, so we want to make sure that our sodium levels are good.

Your the thing you’re going to do is probably a capillary blood glucose or bedside glucose testing. The reason you do it for a couple of reasons. First it’s quick, and it gives you pretty immediate results. Secondly, hypoglycemia mimics stroke. The treatment for low blood sugar is so much easier than treating a patient is having an ischemic stroke. So identifying that it’s not actually low blood sugar and then it actually is a stroke helps us to take the correct steps.

The other thing that we’re going to take a look at is CBC. The reason we take a look at CBC is because we want to keep an eye on those platelets. Platelets play a role in how we use TPA to break up those clots. There’s a great lesson on ischemic strokes I encourage you to check it out and it goes more into depth about treatment options, but this is why you need to pay attention to it. The other reason we want to check the CBC out as to check for any sources of infection or potential anemia.

When we do a lipid panel is what we’re looking for a risk for plaques. High levels of lipid deposits in a blood like cholesterol and LDL can contribute to risk for ischemic stroke.

And lastly we want to pay attention to those coagulation studies. If we’re going to put our patient on any sort of anticoagulants in the future, we need to know where we start from the beginning.

So what do you need to know about whenever you’re submitting your Labs? First off know that your metabolic panel and your electrolytes are going to go in a green top tube. Your CBC is going to go in the lavender top tube, and your coags are going to go into your blue top tube. Also your lipids go into your green top tube as well.

Well you do have a glucose that comes back with your metabolic panel, you’re also going to be using your bedside glucometer to check your cbgs on your patient.
For patients that have an ischemic stroke, are nursing Concepts focus on lab values, intracranial regulation and perfusion.
So let’s recap.

Imaging is one of the first steps that you’re going to see for a patient that suspicious of an ischemic stroke. You need to see if there’s an active lead or if there’s ischemia. We need to figure out what’s going on so that we make the correct steps to treat it.

You’re going to check out my metabolic panel is to look at organ function and electrolytes particularly sodium.

You’re going to be doing CGBs of the bedside, mainly because they quickly realized hypoglycemia which mimics and ischemic stroke.

Your patients will also probably getting lipid panels to identify risks of plaques and arteriosclerosis.

Finally your patient will probably be getting some coagulation studies just to check for monitoring problems and you need to do you.

And that’s all I sent for patients that had ischemic stroke and the labs that you may see for them. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!

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  • Question 1 of 2

The nurse is caring for a client who has been admitted for a stroke. Vital signs and neurological exams have been stable. The client has a follow-up CT scan of the head for tomorrow, orders to see PT/OT, a diet order, and sequential compression devices to be placed. The client has also requested a glass of water. What is the nurse’s priority at this time?

  • Question 2 of 2

The nurse is working in the emergency department with a client who presented with stroke-like symptoms. A non-contrast head CT was performed and was negative for hemorrhagic stroke. The provider wants tissue plasminogen-activase administered, and has placed the following orders. Which of the following orders must be completed first?

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