The World Stroke Organization reports that stroke is one of the leading causes of death and disability worldwide, with the greatest burden in low- and middle-income countries. In an ischaemic stroke, a blocked artery starves the brain of oxygen and around 1.9 million neurons can be lost every minute, a figure often summed up as “time is brain”. Nurses at triage, on wards and in the community are often the first to recognise it.
Types of stroke
- Ischaemic (most common): a clot blocks a brain artery.
- Haemorrhagic: bleeding into or around the brain, often linked to uncontrolled high blood pressure. It makes up a higher proportion of strokes in many African and Asian countries.
- Transient ischaemic attack (TIA): symptoms resolve, usually within minutes to hours, but it is a warning sign of a high risk of stroke in the coming days.
Recognise it: BE FAST
- B – Balance: sudden loss of balance or coordination.
- E – Eyes: sudden loss of vision or double vision.
- F – Face: drooping on one side; ask them to smile.
- A – Arms: weakness or numbness; ask them to raise both arms.
- S – Speech: slurred, confused or unable to speak.
- T – Time: call for help immediately and note the time of onset, or the time the person was last known to be well.
Other signs include sudden severe headache (especially in haemorrhage), confusion, and difficulty swallowing. Always check blood glucose: hypoglycaemia can mimic stroke.
The first hour
- Activate the stroke pathway or call the stroke team, if your hospital has one.
- A–E assessment: protect the airway, give oxygen only if SpO₂ is below target, check blood glucose, record vital signs and GCS.
- Keep the patient nil by mouth until a swallow screen is done.
- Urgent brain imaging (CT) to distinguish ischaemic from haemorrhagic stroke. This decides treatment.
- For eligible ischaemic strokes, thrombolysis (clot-busting drugs such as alteplase or tenecteplase) is generally given within 4.5 hours of onset, and thrombectomy (removing the clot) may be possible in specialist centres, sometimes up to 24 hours in selected patients.
- Nurses prepare the patient, monitor closely during and after thrombolysis (frequent neuro observations and BP), and watch for bleeding or sudden deterioration.
Nursing care in the first 72 hours
Swallowing
Difficulty swallowing (dysphagia) is common after stroke and can cause aspiration pneumonia. A trained nurse should perform a swallow screen before any food, drink or oral medicine, ideally within 4 hours of admission. If the patient fails, keep them nil by mouth, refer to speech and language therapy (where available), and discuss alternative routes for fluids, nutrition and medicines.
Monitoring
- Neurological observations (GCS, pupils, limb power) at the frequency set by your protocol. Report any deterioration immediately. See our GCS guide.
- Blood pressure: targets depend on stroke type and treatment. After thrombolysis, BP must be kept below set limits. In haemorrhagic stroke, BP is often lowered promptly. Follow the prescription.
- Blood glucose: keep within the target range; both high and low glucose worsen outcomes.
- Temperature: treat fever and look for infection.
Positioning and mobility
- Position to support the weak side: support the affected arm on a pillow to prevent shoulder subluxation and pain.
- Reposition regularly to prevent pressure ulcers: see our pressure ulcer guide.
- Mobilise when safe, with physiotherapy input.
- Prevent venous thromboembolism according to protocol (in many guidelines, intermittent pneumatic compression rather than stockings).
Continence, communication and mood
- Avoid routine urinary catheters; use regular toileting.
- For patients with aphasia, use short sentences, yes/no questions, gestures and picture boards. Give time to respond.
- Watch for depression and anxiety, which are very common after stroke.
- Involve the family early; they will often be the main carers.
Secondary prevention: teaching before discharge
- Blood pressure control is the single most important way to prevent another stroke. See our hypertension care plan.
- Antiplatelet or anticoagulant medicines as prescribed, and statins.
- Diabetes control, stopping smoking, reducing alcohol and salt, physical activity.
- Recognising BE FAST signs and calling for help immediately.
Related: Normal vital signs · SBAR escalation
Based on the National Clinical Guideline for Stroke (UK and Ireland), American Heart Association/American Stroke Association guidelines and World Stroke Organization information. Educational content: follow your local stroke pathway.