Stroke Nursing: Ischemic vs. Hemorrhagic Care Priorities

Stroke is a leading cause of disability and death worldwide, and every nurse, especially a registered nurse (RN nurse), must be ready to respond. Understanding the difference between ischemic and hemorrhagic strokes, and knowing how to prioritize care, is essential for safe practice and for success on the NCLEX.

This simplified nursing guide will help you build your nursing bundle and feel confident caring for stroke patients.


🧠 What is a Stroke?

A stroke happens when blood flow to part of the brain is blocked or when a blood vessel in the brain bursts. Without oxygen, brain cells begin to die within minutes.

There are two major types of strokes:

βœ… Ischemic Stroke β€” caused by a clot blocking blood flow
βœ… Hemorrhagic Stroke β€” caused by bleeding in the brain


Ischemic Stroke: Nursing Priorities

Ischemic strokes account for about 85% of strokes. They are caused by a thrombus (stationary clot) or embolus (traveling clot) blocking an artery supplying the brain.

Key NCLEX Nursing Points for Ischemic Stroke:

  • Time is brain β€” get a last known well time for possible tPA treatment
  • Support airway, breathing, and circulation
  • Maintain oxygen saturation above 94%
  • Keep blood pressure within recommended guidelines
  • Prepare for possible thrombolytic therapy (alteplase/tPA)
  • Frequent neuro checks (use NIH Stroke Scale)
  • Monitor for bleeding after tPA administration
  • Prevent aspiration β€” keep patient NPO until swallow evaluation

Signs & Symptoms (FAST):
βœ… Face drooping
βœ… Arm weakness
βœ… Speech difficulty
βœ… Time to call 911


Hemorrhagic Stroke: Nursing Priorities

Hemorrhagic strokes happen when a blood vessel ruptures, causing bleeding in or around the brain.

Common causes include:
βœ… Uncontrolled hypertension
βœ… Aneurysm rupture
βœ… AV malformation rupture

Key NCLEX Nursing Points for Hemorrhagic Stroke:

  • Strict BP control to prevent further bleeding
  • Avoid anticoagulants
  • Prepare for neurosurgical intervention if ordered
  • Keep patient on bedrest with head of bed elevated 30 degrees
  • Monitor for increased intracranial pressure (ICP)
  • Frequent neuro checks and seizure precautions
  • Limit stimulation to reduce blood pressure spikes

Signs & Symptoms:
βœ… Sudden severe headache (β€œworst headache of my life”)
βœ… Nausea/vomiting
βœ… Loss of consciousness
βœ… Seizures


Registered Nurse Priorities for All Strokes

Every RN nurse should remember these stroke essentials:

βœ… ABCs first β€” airway, breathing, circulation
βœ… Get a CT scan STAT to differentiate ischemic vs. hemorrhagic
βœ… Perform frequent neuro assessments
βœ… Keep the patient safe from injury
βœ… Educate the family on stroke warning signs
βœ… Coordinate rehab and therapy referrals


NCLEX & Nursing Bundle Cheat Sheet

Add these to your nursing bundle:

  • FAST stroke recognition poster
  • NIH Stroke Scale quick guide
  • tPA contraindications chart
  • Hemorrhagic vs. ischemic differences cheat sheet
  • Stroke diet and aspiration risk guide

These will help you pass the NCLEX and deliver safe, evidence-based care.


🧩 Quick Memory Tips

πŸ’‘ Ischemic = clot
πŸ’‘ Hemorrhagic = bleed
πŸ’‘ β€œTime is brain” β€” minutes matter
πŸ’‘ Worst headache of my life = think bleed


πŸ“š Patient and Family Education

βœ… Importance of taking antihypertensive medications
βœ… Recognize FAST warning signs early
βœ… Stop smoking and manage cholesterol
βœ… Follow a heart-healthy diet
βœ… Participate in rehab therapy for maximum recovery

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