Recognizing Early Signs of Stroke (FAST Assessment)

Scenario

While assisting a patient with morning hygiene, you notice sudden facial droop and slurred speech.
They are unable to lift their right arm fully and appear confused.
Vital signs: BP 172/98 mmHg, HR 88, SpO₂ 96%, RR 20.

Question: What are your immediate priorities and steps to manage a suspected stroke?

Best Practice Answer

1. Recognize Stroke Symptoms Immediately:
   Apply the FAST assessment — a quick tool for identifying stroke:

   • F – Face: Facial droop or asymmetry
   • A – Arm: Weakness or drift on one side
   • S – Speech: Slurred, nonsensical, or absent speech
   • T – Time: Act immediately — “Time is brain”

   The presence of even one FAST symptom warrants emergency activation.

2. Immediate Nursing Actions:

   • Activate stroke alert / call rapid response immediately.
   • Note the exact time symptoms began or last known normal — this determines eligibility for tPA (thrombolytic therapy).
   • Keep the patient NPO (risk of aspiration).
   • Elevate head of bed 30° to reduce ICP and promote cerebral perfusion.
   • Ensure patent IV access (use large bore if available).
   • Check blood glucose to rule out hypoglycemia, which can mimic stroke.
   • Maintain SpO₂ > 94% — apply O₂ if needed.
   • Monitor vital signs and neuro status every 5–15 minutes.

3. Avoid Actions That Could Delay Care:

   • Do not give oral meds, fluids, or food.
   • Do not lower BP rapidly unless directed — permissive hypertension often maintained for cerebral perfusion.
   • Do not transport without provider direction; await CT readiness.

4. Prepare for Diagnostic and Treatment Steps:

   • Anticipate orders for CT scan without contrast to distinguish ischemic vs. hemorrhagic stroke.
   • Gather medication list and verify no anticoagulant use before tPA consideration.
   • Prepare for possible tPA administration if within 3–4.5 hour window and no contraindications.
   • If hemorrhagic stroke suspected, anticipate neurosurgery consult.

5. Documentation and Communication:

   • Record onset time, presenting symptoms, vitals, and neuro findings.
   • Document provider notification time, stroke alert activation, and diagnostic test completion.
   • Use SBAR format to relay concise, critical details.

Real-World Application

Early recognition and rapid action are life- and brain-saving in stroke management.
This scenario tests your ability to:

• Identify subtle neurological changes
• Initiate stroke alert immediately
• Understand tPA time sensitivity
• Coordinate efficiently with the rapid response and imaging teams

It’s a frequent interview case for ICU, ER, and telemetry nurses.

Tip: In interviews, summarize like this —
“At the first sign of facial droop or slurred speech, I’d perform FAST, note last known normal, activate stroke alert, keep NPO, and prepare for CT scan.”
This demonstrates time-critical judgment, protocol awareness, and decisive leadership under pressure.