Update on transient ischemic attack nursing care.

C onsidered a medical emergency, a transient ischemic attack (TIA) resulting from a focal ischemia in the brain or retina signals a sudden neurological deficit with patient symptoms typically lasting only 1 to 2 hours. The 90-day risk of stroke after a TIA is reported as high as 17% with the highest risk occurring in the first week. Approximately 240 000 US adults each year experience a TIA. 5 The true prevalence of TIAs seems under-reported because patients fail to report their symptoms to healthcare providers. 6,7 Evidence supports when an individual is at risk for TIA or one is suspected, immediate action is required. Nurses play a pivotal role in all phases of patient care. Also, they frequently are on the front line regarding TIA and stroke education of patients/families, recognition of signs/symp-toms, assessment and evaluation of modifiable risk factors, and long-term management of TIA. The purpose of this article is to provide an update of the most salient aspects of evidence-based TIA nursing care. Nurses especially with advance practice training have a unique role in the initial evaluation (eg, identifying symptoms, eliminating mimics, triaging TIA referrals or early access to initial evaluation, assessing risk of acute and long-term complications), diagnosis, management, and patient/family education. Evidence resulting from a 5-year prospective study reveals key clinical characteristics associated with an impending stroke which include first diagnosis of TIA, increased age, deficits lasting >10 minutes, history of gait disturbance, dysarthria, elevated blood pressure (BP), atrial fibrillation (AF) indicated by ECG, and infarction on computed tomog-raphy. 10 Additional findings suggest a decreased likelihood of impending stroke with symptoms lasting <1 minute, light-headedness, vertigo, and visual loss. 10 The American Heart Association's TIA care standard guidelines recommend use of diffusion-weighted MRI and computed tomography if MRI is not available within 24 hours of symptom onset. 2 The ABCD2 score is based on the clinical variables of age, BP, clinical characteristics, duration of symptoms and presence of diabetes mellitus that affect the risk of an early stroke after a TIA. 11 The ABCD2 risk assessment tool was developed to categorize patient at low, moderate, or high risk of stroke at 2, 7, 30, and 90 days after initial symptoms. The ABCD2 score assigns points to the variables: age >60 (1 point); BP ≥140/90 (1); clinical features: unilateral weakness (2), speech impairment without weakness (1); duration ≥60 minutes (2) or 10 to 59 minutes (1); …