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ICU Nursing Care of the Stroke Patient

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      Mary P. Amatangelo, DNP, RN, ACNP-BC, CCRN, CNRN, SCRN, FAHA, Editor
      Almost 25 years ago, in June 1996, the Food and Drug Administration (FDA) approved intravenous (IV) Alteplase as the only acute drug therapy for ischemic stroke. It remains the mainstay drug to date and revolutionized Neurology, Stroke, and Neurocritcal Care. In 2013, the success of several mechanical thrombectomy studies proved the efficacy of endovascular thrombectomy for large vessel occlusions (LVO), both alone and in combination with IV Alteplase. The expanded time window opened this treatment option to a greater number of patients, who are now surviving with fewer deficits.
      The heterogeneity of the underlying disease process of stroke requires an interdisciplinary care team in concert to manage the complex stroke patient along the continuum. The constant in the process of stroke care is the bedside nurse. Fifteen percent to 20% of acute stroke patients will require management in an intensive care unit (ICU). The number of general ICUs far outweigh those that are neuroscience specific. Therefore, it is imperative for nurses working in the general ICU to be knowledgeable about caring for the stroke patient.
      The aim of this issue is to review the major topics and controversies in caring for the complex stroke patient. Neuroscience nursing experts from across the country have been asked to contribute their expertise regarding key stroke issues. The goal of this issue was to provide a wide range of topics purposely selected to cover the continuum of care from localization, diagnostics, rehabilitation, and the ethical issues surrounding end-of-life care. It is our hope that this will contribute to improved stroke care and patient outcomes.