Ischemic Stroke

Abstract

Occupational health nurses play a valuable role in educating workers and supervisors about the risk factors and warning signs of ischemic stroke.

Stroke, the fifth leading cause of death in the United States, kills almost 130,000 Americans annually and costs about US$34 billion each year, including the cost of health care services, medications, and lost productivity (Centers for Disease Control and Prevention [CDC], 2015). It is also a leading cause of long-term disability.

More than 795,000 individuals in the United States have a stroke each year. “About 610,000 of these are first or new strokes, and about 185,000 strokes—nearly one of four—are in people who have had a previous stroke” (Mozaffarian et al., 2016, p. e205).

Ischemic stroke is the most common type of stroke and occurs when a blood vessel in the neck or brain is blocked (Wallace, 2016). The blockage can be caused by “the formation of a clot within a blood vessel of the brain or neck, called thrombosis; the movement of a clot from another part of the body such as the heart to the brain, called embolism; or a severe narrowing of an artery in or leading to the brain, called stenosis” (National Institute of Neurological Disorders and Stroke [NINDS], 2016, para 3). Although stroke risk increases with age, strokes can occur at any age. Between 2000 and 2010, hospitalizations for ischemic stroke “dropped nearly 20% overall—but among people ages 25 to 44, there was a sharp 44% increase in the rate” (Wallace, 2016, para 1). This finding has implications for the workforce population as 25 years to 44 years is a prime age group of workers. It is believed that this increase in strokes among younger adults is caused by the same lifestyle factors associated with stroke in older individuals (i.e., hypertension, hypercholesterolemia, diabetes, smoking, and obesity).

The five common signs and symptoms of stroke are sudden numbness or weakness of the face, arm, or leg; sudden confusion or trouble speaking or trouble understanding others; sudden trouble seeing in one or both eyes; sudden dizziness, trouble walking, or loss of balance or coordination; and sudden severe headache with no known cause (CDC, 2015). Sometimes the warning signs may last a short time and go away. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called “mini-strokes” (NINDS, 2016). They indicate an underlying serious health condition.

Immediate action is required to treat the individual and limit the disability caused by stroke. The most effective stroke treatments are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms (CDC, 2015). The following test, using the mnemonic F.A.S.T., can be easily done if someone is having a stroke. Face: Ask the person to smile. Does one side of the face droop? Arms: Ask the person to raise both arms. Does one arm drift downward? Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange? Time: If any of the signs are observed, call 911 immediately.

Occupational health nurses should use this information to lower the risk of death or disability from stroke by controlling risk factors and knowing the warning signs of ischemic stroke. Workers and supervisors should be educated about the signs of stroke and what to do if they notice someone exhibiting them. Programs should be offered to reduce the risk factors associated with stroke including screening and monitoring for hypertension, diabetes, and hypercholesterolemia. Cigarette smoking causes a twofold increase in the risk of ischemic stroke so smoking cessation can reduce this risk. Weight reduction can also be promoted through exercise and nutrition programs.

Occupational health nurses play a valuable role in returning employees to work after a stroke. They can assist with appropriate job placement or reasonable accommodations as needed.