Nursing Diagnosis of CVA Patient: Comprehensive Guide for Stroke Care

A cerebrovascular accident (CVA), commonly known as a stroke, is a critical medical condition characterized by the interruption of blood supply to the brain. This deprivation of oxygen and nutrients leads to rapid brain cell damage, potentially resulting in significant neurological deficits. Understanding the nursing diagnosis for CVA patients is crucial for effective care and improved patient outcomes.

Types of Stroke: Ischemic and Hemorrhagic

Strokes are broadly classified into two primary categories: ischemic and hemorrhagic, each with distinct underlying mechanisms and treatment approaches.

Ischemic Stroke: This type of stroke, accounting for the majority of cases, occurs due to a blockage in the arteries supplying blood to the brain. This obstruction can be caused by:

• Thrombosis: Formation of a blood clot within a cerebral artery.
• Embolism: Migration of a clot or plaque from another part of the body (often the heart or carotid arteries) to a cerebral artery.
• Systemic hypoperfusion: Reduced blood flow to the brain due to conditions like shock or severe hypotension.

The lack of blood flow in ischemic stroke deprives brain tissue of oxygen and glucose, leading to cellular injury and infarction within minutes.

Hemorrhagic Stroke: Hemorrhagic strokes result from the rupture of a blood vessel in the brain, causing bleeding into the brain tissue or surrounding spaces. The primary causes include:

• Intracerebral hemorrhage: Bleeding directly into the brain parenchyma, often due to hypertension, cerebral amyloid angiopathy, or arteriovenous malformations (AVMs).
• Subarachnoid hemorrhage: Bleeding into the subarachnoid space, typically caused by the rupture of a cerebral aneurysm or trauma.

The escaped blood in hemorrhagic stroke increases intracranial pressure, compresses brain tissue, and exposes brain cells to toxic blood components, leading to neuronal damage and dysfunction.

Transient Ischemic Attacks (TIAs), often referred to as “mini-strokes,” are temporary episodes of neurological dysfunction caused by brief interruptions in cerebral blood flow. TIA symptoms are similar to those of a stroke but resolve spontaneously, usually within minutes to hours, without causing permanent brain damage. However, TIAs are significant warning signs of an increased risk of future stroke and necessitate prompt medical evaluation and risk factor management.

The Nursing Process in CVA Patient Care

The nursing process is fundamental to providing holistic and individualized care for patients who have experienced a stroke. Stroke severity and resulting disabilities vary widely depending on factors such as the stroke’s location, size, and the time elapsed before treatment initiation. Nurses play a pivotal role throughout the continuum of stroke care, from acute management in intensive care settings to rehabilitation and long-term support.

Nurses specializing in stroke care often hold NIH Stroke Scale (NIHSS) certification, demonstrating expertise in neurological assessment and stroke-specific interventions. The rapidly changing and often subtle nature of stroke symptoms demands critical thinking, vigilant monitoring, and swift nursing actions to prevent neurological deterioration and optimize patient outcomes.

Patients with severe strokes may experience profound disabilities, requiring comprehensive assistance with all aspects of daily living, including feeding, bathing, and mobility. The long-term consequences of stroke can be emotionally and physically challenging for both patients and their families, potentially leading to depression and reduced quality of life. Nurses provide compassionate care focused on patient safety, dignity, and addressing the complex physical and psychosocial needs of stroke survivors.

Nursing Assessment for CVA Patients

The initial nursing assessment is a cornerstone of stroke care, involving the systematic collection of subjective and objective data to understand the patient’s condition and guide subsequent interventions.

Review of Health History: Subjective Data Collection

1. Eliciting General Stroke Symptoms: Prompt recognition of stroke symptoms is critical for timely intervention. Nurses should inquire about the sudden onset of any of the following:

• Motor Weakness or Paralysis (Hemiparesis/Hemiplegia): Weakness or paralysis affecting the face, arm, and leg on one side of the body is a hallmark stroke symptom.
• Sensory Deficits: Numbness, tingling (paresthesia), or loss of sensation in the extremities.
• Swallowing Difficulty (Dysphagia): Difficulty swallowing can lead to aspiration and nutritional compromise.
• Visual Disturbances: Sudden vision loss in one or both eyes, double vision (diplopia), or visual field deficits (hemianopia).
• Speech Impairments:
  • Expressive Aphasia (Broca’s Aphasia): Difficulty producing speech, although comprehension may be relatively preserved.
  • Receptive Aphasia (Wernicke’s Aphasia): Difficulty understanding spoken language, leading to nonsensical speech.
  • Dysarthria: Difficulty articulating words due to muscle weakness affecting speech.
• Balance and Coordination Problems (Ataxia): Unsteady gait, dizziness, or loss of coordination.
• Changes in Mental Status : Confusion, disorientation, lethargy, or decreased level of consciousness.

2. Determining Symptom Onset: The precise time of symptom onset or “last known well” is vital information. This time window is crucial for determining eligibility for thrombolytic therapy (tPA) and other time-sensitive interventions.

3. Identifying Stroke Risk Factors: Assessing for stroke risk factors helps in understanding the patient’s predisposition and guiding long-term prevention strategies:

• Age: Risk increases significantly with age, particularly after 55 years.
• Ethnicity: African Americans and Hispanics have a higher stroke incidence compared to Caucasians.
• Gender: Men have a slightly higher stroke risk overall, although stroke is more common in women after menopause.
• Prior Stroke or TIA: A history of stroke or TIA significantly elevates future stroke risk.

4. Reviewing Medical History: Pre-existing medical conditions are major contributors to stroke risk. Nurses should gather information about:

• Hypertension: Uncontrolled high blood pressure is the leading risk factor for both ischemic and hemorrhagic stroke.
• Obesity: Obesity is associated with increased risk of hypertension, diabetes, and hyperlipidemia, all stroke risk factors.
• Hypercholesterolemia: High cholesterol levels contribute to atherosclerosis, increasing ischemic stroke risk.
• Diabetes Mellitus: Diabetes damages blood vessels and increases the risk of blood clots.
• Obstructive Sleep Apnea: Sleep apnea is linked to hypertension, atrial fibrillation, and other cardiovascular risk factors.
• Heart Disease: Conditions like coronary artery disease, heart failure, and valvular heart disease increase stroke risk, particularly cardioembolic stroke.
• Atrial Fibrillation: Atrial fibrillation is a major risk factor for cardioembolic stroke due to clot formation in the atria.
• COVID-19 Infection: COVID-19 has been associated with an increased risk of stroke, possibly due to hypercoagulability and endothelial dysfunction.

5. Family History of Stroke: A family history of stroke, especially in first-degree relatives and at a young age (before 65), increases an individual’s stroke risk. Genetic conditions like CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) can predispose to stroke.

6. Medication History: Certain medications can influence stroke risk:

• Estrogen-containing birth control pills or hormone replacement therapy: These can increase the risk of blood clots and ischemic stroke, particularly in women who smoke or have other risk factors.
• Non-adherence to antihypertensive medications: Poorly controlled hypertension significantly raises stroke risk.
• Aspirin or other anticoagulants (e.g., enoxaparin, heparin, warfarin): Use of these medications may indicate pre-existing conditions (e.g., atrial fibrillation, history of clots) that increase stroke risk.

7. Substance Use: Illicit drug use, particularly stimulants like amphetamines, cocaine, and heroin, is associated with increased stroke risk, including hemorrhagic stroke.

8. Lifestyle Factors: Modifiable lifestyle factors significantly impact stroke risk:

• Unhealthy Diet: Diets high in cholesterol, saturated fats, and trans fats contribute to atherosclerosis and increase stroke risk.
• Physical Inactivity: Lack of regular exercise increases the risk of obesity, hypertension, and diabetes, all stroke risk factors.
• Excessive Alcohol Consumption: Heavy alcohol use is linked to hypertension, atrial fibrillation, and hemorrhagic stroke.
• Smoking: Smoking damages blood vessels, promotes atherosclerosis, and increases blood clot formation, dramatically raising stroke risk.

Physical Assessment: Objective Data Collection

1. Recognizing F.A.S.T. Signs: The acronym F.A.S.T. is a widely used tool for rapid stroke recognition:

• F – Face: Assess for facial drooping or asymmetry when the patient smiles or attempts to show teeth.
• A – Arms: Check for arm weakness by asking the patient to raise both arms and observe for downward drift in one arm.
• S – Speech: Evaluate speech for slurring, difficulty finding words, or inability to speak.
• T – Time: Note the time of symptom onset and emphasize the urgency of seeking immediate medical attention.

2. Assessing ABCs (Airway, Breathing, Circulation): Initial assessment must prioritize airway patency, breathing effectiveness, and circulatory stability. Stroke patients are at risk for aspiration, airway obstruction, and respiratory compromise due to neurological deficits and increased intracranial pressure.

3. Performing a Stroke-Specific Neurological Examination: A comprehensive neurological assessment is essential using a standardized tool like the National Institutes of Health Stroke Scale (NIHSS). The NIHSS objectively quantifies neurological deficits across various domains:

• Level of Consciousness (LOC): Alertness, orientation, and responsiveness to stimuli.
• Eye Movements (Gaze): Horizontal and vertical eye movements, presence of gaze deviation.
• Visual Fields: Assessment of visual field deficits, such as hemianopia.
• Facial Palsy: Muscle weakness or paralysis affecting facial expression.
• Motor Function (Arms and Legs): Strength and movement in upper and lower extremities bilaterally.
• Limb Ataxia: Coordination and balance testing, assessing for cerebellar dysfunction.
• Sensory Function: Light touch and pain sensation in different body regions.
• Language (Aphasia): Assessment of speech production, comprehension, naming, and repetition.
• Speech Articulation (Dysarthria): Clarity and intelligibility of speech.
• Neglect/Inattention: Awareness of stimuli in both visual fields and body sides.

4. Monitoring Vital Signs: Hypertension is commonly observed in acute stroke. However, it’s crucial to avoid rapid blood pressure reduction, especially in ischemic stroke, as it can compromise cerebral perfusion. Blood pressure management in stroke is complex and guided by stroke type and treatment strategy.

Diagnostic Procedures for CVA

1. Blood Glucose Measurement: Immediate fingerstick glucose testing is essential to rule out hypoglycemia, as its symptoms can mimic stroke.

2. Brain Imaging: Neuroimaging is paramount in stroke diagnosis and management:

• Non-contrast Head CT: The initial imaging modality of choice in acute stroke. CT rapidly differentiates between ischemic and hemorrhagic stroke, guiding immediate treatment decisions.
• CT Angiography (CTA) and CT Perfusion (CTP): CTA visualizes cerebral blood vessels to identify large vessel occlusions amenable to thrombectomy. CTP assesses cerebral blood flow and tissue viability, helping to determine the extent of ischemic penumbra (potentially salvageable tissue).
• Magnetic Resonance Imaging (MRI): MRI provides more detailed anatomical and physiological information than CT, particularly for detecting small ischemic lesions and assessing tissue damage. Diffusion-weighted imaging (DWI) is highly sensitive for early ischemic changes.
• Carotid Duplex Ultrasound: Evaluates carotid artery stenosis (narrowing), a common cause of ischemic stroke.
• Digital Subtraction Angiography (DSA): An invasive angiography technique providing detailed visualization of cerebral vasculature, typically reserved for complex cases or interventions.

3. Laboratory Blood Tests: Blood tests help identify underlying causes and contributing factors to stroke:

• Complete Blood Count (CBC): Evaluates for polycythemia (increased red blood cell count) or thrombocytopenia (low platelet count), which can contribute to stroke risk.
• Cardiac Biomarkers (Troponin, CK-MB): Assess for cardiac injury, as stroke can be associated with underlying cardiac conditions like myocardial infarction or cardioembolism.
• Toxicology Screen: Rule out drug intoxication as a cause of stroke-like symptoms, particularly in younger patients.
• Fasting Lipid Profile: Identifies hyperlipidemia, a major risk factor for atherosclerosis and ischemic stroke.
• Coagulation Studies (PT, INR, aPTT): Baseline coagulation tests are essential before administering antiplatelet or anticoagulant medications.

4. Pregnancy Test: Urine pregnancy tests are performed for women of childbearing age before fibrinolytic therapy, as the safety of tPA in pregnancy is not fully established.

5. Electrocardiogram (ECG): ECG helps detect cardiac arrhythmias, particularly atrial fibrillation, a common source of cardioembolic stroke. Identifying and managing atrial fibrillation is crucial for secondary stroke prevention.

Nursing Interventions for CVA Patients

Nursing interventions are critical in minimizing brain damage, preventing complications, and facilitating stroke recovery.

Restoring Brain Perfusion: Acute Stroke Management

1. Rapid Initial Evaluation and Diagnostic Imaging: Within minutes of arrival in the emergency department, patients with suspected stroke should undergo a neurological assessment and STAT non-contrast head CT. Timely imaging is essential to differentiate ischemic from hemorrhagic stroke and guide treatment decisions.

2. Re-establishing Cerebral Blood Flow: For ischemic stroke, alteplase (tPA) is the primary thrombolytic medication to dissolve blood clots and restore blood flow. Alteplase is contraindicated in hemorrhagic stroke due to the risk of exacerbating bleeding. Administer IV alteplase promptly within the guideline-recommended time window (typically within 3-4.5 hours of symptom onset, depending on specific criteria).

3. Continuous Neurological Monitoring: Frequent neurological assessments are crucial to detect changes in the patient’s condition and promptly intervene. Monitor:

• Pupil Size and Reactivity: Changes can indicate increased intracranial pressure or neurological deterioration.
• Speech, Memory, and Cognition: Assess for worsening aphasia, confusion, or decreased cognitive function.
• Mood Changes: Stroke can affect mood and emotional regulation.
• Bilateral Strength and Coordination: Monitor for worsening weakness or new neurological deficits.

4. Medication Administration: Manage secondary complications and risk factors:

• Antihypertensive Medications: Maintain blood pressure within target ranges. Permissive hypertension is often allowed in the acute phase of ischemic stroke (unless thrombolysis is planned) to maintain cerebral perfusion. Lower blood pressure is often targeted in hemorrhagic stroke.
• Antiseizure Medications: Seizure prophylaxis may be considered, particularly in hemorrhagic stroke or cortical strokes. Treat seizures promptly if they occur.
• Stool Softeners/Laxatives: Prevent constipation and straining during bowel movements, which can increase intracranial pressure.

5. Blood Pressure Management: Maintain blood pressure within ordered parameters, which vary based on stroke type and treatment strategy.

• Ischemic Stroke: In patients receiving alteplase, maintain BP < 180/105 mmHg for the first 24 hours. In patients not receiving thrombolysis, moderate hypertension may be tolerated in the acute phase to support cerebral perfusion, with gradual reduction later.
• Hemorrhagic Stroke: Aggressive blood pressure control is often indicated, with a target systolic BP of around 140 mmHg in many cases.

6. Mechanical Thrombectomy: For large vessel occlusions in ischemic stroke, mechanical thrombectomy is a highly effective intervention. This involves using a catheter to physically remove the clot from the cerebral artery. Ensure informed consent is obtained before the procedure.

7. Endovascular Procedures: For patients with carotid artery stenosis, carotid endarterectomy (surgical removal of plaque) or carotid angioplasty with stenting may be performed to improve cerebral blood flow and reduce stroke risk.

Stroke Recovery and Prevention: Rehabilitation and Long-Term Management

1. Stroke Rehabilitation Referral: Early and comprehensive rehabilitation is essential to maximize functional recovery. Refer patients to:

• Speech Therapy: For aphasia, dysarthria, and swallowing difficulties.
• Physical Therapy: To improve motor function, balance, gait, and mobility.
• Occupational Therapy: To enhance independence in activities of daily living (ADLs), fine motor skills, and cognitive-perceptual function.
• Cognitive Therapy: For cognitive deficits, memory problems, and executive function impairments.

2. Speech Deficit Management Education: Educate patients and families on strategies to improve communication:

• Communication Partner Training: Train family members and caregivers on effective communication techniques for individuals with aphasia.
• Speech Practice: Encourage consistent speech practice using flashcards, books, computer programs, and apps.
• Alternative Communication Methods: Utilize communication boards, writing, gestures, and assistive communication devices as needed.

3. Medication Education: Educate patients on prescribed medications for secondary stroke prevention:

• Anticoagulants (e.g., Apixaban, Dabigatran, Rivaroxaban, Warfarin): For patients with atrial fibrillation to prevent cardioembolic stroke.
• Antiplatelet Agents (e.g., Aspirin, Clopidogrel): To prevent platelet aggregation and reduce ischemic stroke risk.
• Antihypertensive Medications (e.g., Diuretics, Beta-blockers, Calcium Channel Blockers, ACE Inhibitors): To manage hypertension and reduce stroke recurrence.

4. Safety Strategies: Address physical deficits to prevent falls and injuries:

• Fall Prevention Measures: Ensure bed rails are up, bed alarms are active, and call lights are within reach.
• Assistive Devices: Provide appropriate assistive devices for walking and ADLs (walkers, canes, grab bars, reachers).

5. Support Group Encouragement: Refer patients and caregivers to stroke support groups for emotional support, peer interaction, and shared experiences.

6. Lifestyle Modification Education: Educate patients on modifiable risk factors and lifestyle changes to reduce secondary stroke risk:

• Heart-Healthy Diet: Emphasize limiting processed foods, saturated and trans fats, and sodium. Promote a diet rich in fruits, vegetables, and whole grains.
• Regular Exercise: Encourage daily physical activity to maintain a healthy weight, control blood pressure and cholesterol, and improve cardiovascular health.
• Smoking Cessation: Provide resources and support for quitting smoking.
• Moderate Alcohol Consumption: Advise limiting alcohol intake.
• Weight Management: Support patients in achieving and maintaining a healthy weight.

7. Adherence to Treatment Regimens: Emphasize the importance of medication adherence, follow-up appointments, and management of comorbidities (hypertension, diabetes, hyperlipidemia) to prevent future strokes.

Nursing Care Plans for CVA Patients: Addressing Common Nursing Diagnoses

Nursing care plans provide a structured framework for organizing nursing care and prioritizing interventions based on identified nursing diagnoses. Common nursing diagnoses for CVA patients include:

Impaired Verbal Communication

Stroke often affects communication abilities due to neurological damage.

Nursing Diagnosis: Impaired Verbal Communication

Related Factors:

• Prolonged cerebral occlusion
• Dysarthria
• Aphasia

As Evidenced By:

• Slurred speech
• Nonverbal communication
• Difficulty forming words
• Difficulty expressing thoughts
• Delayed comprehension
• Extremity weakness impacting writing/typing

Expected Outcomes:

• Patient will establish effective communication methods.
• Patient will participate in speech therapy.
• Patient will utilize communication aids as needed.

Assessments:

1. Type of Aphasia: Determine if it is global, Wernicke’s, or Broca’s aphasia to tailor communication strategies.
2. Communication Methods: Observe patient’s attempts to communicate (gestures, sounds, etc.) and involve family in understanding their cues.

Interventions:

1. Simple Communication: Use short, direct sentences, speak clearly, and face the patient. Ask yes/no questions.
2. Alternative Methods: Utilize writing, drawing, flashcards, or communication boards.
3. Speech Therapy: Encourage and facilitate speech therapy sessions.
4. Family Involvement: Engage family in communication strategies and therapy sessions.

Ineffective Cerebral Tissue Perfusion

Stroke directly impairs blood flow to the brain, risking tissue damage.

Nursing Diagnosis: Ineffective Tissue Perfusion

Related Factors:

• Interrupted cerebral blood flow
• Thrombus/embolism
• Arterial occlusion
• Cerebral edema
• Hemorrhage

As Evidenced By:

• Altered mental status
• Blurred vision
• Slurred speech
• Extremity weakness

Expected Outcomes:

• Patient will recognize stroke symptoms and seek help promptly.
• Patient will demonstrate improved cerebral perfusion (stable vital signs).
• Patient will show improvement in stroke deficits by discharge.

Assessments:

1. Baseline Presentation: Determine “last known well” time to assess for changes and thrombolysis eligibility.
2. Neurological Assessments: Perform frequent stroke scale assessments (NIHSS) to monitor neurological status.
3. Brain Imaging: Review CT/MRI results to confirm stroke type and guide treatment.

Interventions:

1. Blood Pressure Management: Maintain BP within ordered parameters to optimize cerebral perfusion.
2. Thrombolytics: Administer tPA for ischemic stroke within the appropriate time frame, if indicated.
3. Stroke Risk Factor Education: Educate on modifiable risk factors (hypertension, diabetes, smoking, etc.) for secondary prevention.
4. FAST Education: Instruct patient and family on recognizing F.A.S.T. stroke symptoms and the need for immediate action.

Risk For Injury

Neurological deficits post-stroke increase the risk of falls and other injuries.

Nursing Diagnosis: Risk For Injury

Related Factors:

• Impaired judgment
• Spatial-perceptual deficits
• Weakness
• Poor coordination/balance
• Impaired sensory awareness
• Dysphagia
• Communication difficulties
• Hemiplegia
• Short attention span
• Impulsivity

Expected Outcomes:

• Patient will remain free from falls and injuries.
• Patient will maintain skin integrity.
• Caregivers will create a safe environment for the patient.

Assessments:

1. Deficit Assessment: Determine specific neurological deficits (right vs. left brain stroke) and their impact on safety.
2. Sensory Awareness: Assess for sensory deficits that increase injury risk.
3. Neglect/Visual Disturbances: Identify neglect or hemianopia that can compromise safety.

Interventions:

1. Safety Alarms: Use bed and chair alarms, especially for impulsive patients.
2. Eating Assistance: Assist with meals, provide dysphagia-appropriate diet, and monitor for aspiration.
3. Environment Scanning: Teach patients with neglect or visual deficits to scan their environment.
4. Skin Care: Frequent turning, skin assessment, and pressure relief for paralyzed/immobile patients.

Self-Care Deficit

Stroke-related impairments often affect the ability to perform self-care activities.

Nursing Diagnosis: Self-Care Deficit

Related Factors:

• Neurobehavioral manifestations
• Weakness
• Musculoskeletal impairment
• Cognitive dysfunction
• Decreased motivation
• Impaired mobility
• Unilateral neglect

As Evidenced By:

• Inability to perform hygiene independently
• Difficulty dressing/undressing
• Impaired feeding skills
• Toileting difficulties

Expected Outcomes:

• Patient will maintain skin integrity and hygiene.
• Patient will utilize assistive devices for self-care.
• Patient will express satisfaction with self-care assistance.
• Patient will achieve optimal independence in ADLs.

Assessments:

1. Functional Ability: Assess physical, sensory, cognitive, and emotional limitations affecting self-care.
2. Patient Preferences: Consider patient preferences and cultural factors in hygiene and self-care.
3. Risk Assessments: Regularly assess fall risk, skin integrity risk (Braden scale), and swallowing ability.

Interventions:

1. Toileting Schedule: Establish a regular toileting schedule and address constipation risk.
2. Promote Independence: Encourage independence in ADLs as much as possible.
3. Adequate Meal Time: Allow sufficient time for meals, especially for patients with dysphagia.
4. Assistive Equipment: Provide and train on adaptive equipment (button hooks, reachers, etc.).
5. Rehabilitation Consults: Consult physical and occupational therapy for rehabilitation planning.

Unilateral Neglect

Damage from stroke can lead to neglect of one side of the body and environment.

Nursing Diagnosis: Unilateral Neglect

Related Factors:

• Disease process (stroke)
• Brain trauma/damage
• Cerebral ischemia

As Evidenced By:

• Safety deficits on neglected side
• Failure to move eyes to neglected side
• Limb immobility on neglected side
• Neglecting grooming on affected side
• Unawareness of neglected limb position

Expected Outcomes:

• Patient will demonstrate techniques to minimize neglect.
• Patient will care for both sides of the body safely.
• Patient will achieve optimal functional level.

Assessments:

1. Neglect Signs: Observe for self-care deficits on one side, leaning, eating from only one side of the plate, and lack of response to stimuli on the affected side.
2. Awareness of Neglect: Assess patient’s awareness of their neglect and willingness to learn compensatory strategies.
3. Skin Assessment: Pay close attention to skin integrity on the neglected side due to potential for injury and unawareness.

Interventions:

1. Fall Precautions: Implement fall prevention measures due to one-sided weakness and neglect.
2. Assistive Devices: Encourage the use of assistive devices to promote awareness of the neglected side.
3. Neutral Positioning: Maintain proper body alignment and encourage regular position changes to prevent complications.
4. Environmental Modifications: Position belongings on the unaffected side to encourage interaction with the neglected side.
5. Rehabilitation Program: Coordinate transfer to appropriate rehabilitation services (PT, OT, speech therapy).

References

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Alt text: Illustration depicting ischemic and hemorrhagic stroke types, showing blocked artery in ischemic stroke and ruptured blood vessel in hemorrhagic stroke.

Alt text: NIH Stroke Scale assessment tool, outlining categories such as consciousness, vision, motor function, sensation, language, and attention for neurological stroke evaluation.

Alt text: FAST acronym for stroke recognition: Face drooping, Arm weakness, Speech difficulty, Time to call emergency services.