Nursing Best Practices to Prevent Stroke in Women

Abstract

e75S troke remains the third leading cause of death in women affecting 3.8 million women compared with 3 million men.1,2 Almost half of the women surviving stroke are anticipated to have residual deficits, including cognitive dysfunction and weakness 6 months later. 3 With the aging population and increased longevity of women in our society, there is an urgent need to concentrate on stroke prevention for women, identify those most at risk, and then take immediate action. Nurses practice in a variety of clinical settings (eg, hospitals, clinics, schools, community outreach programs, etc), thereby having numerous opportunities to empower others to reduce the likelihood of stroke through education and management of personal risk behaviors. The purpose of this article is to summarize best evidence underpinning essential nursing activities targeting stroke prevention in women. Identification of Key Stroke Risk Factors for WomenA variety of risk factors trigger nurses and other healthcare providers (HCPs) to immediately act. The most prominent stroke risk factors for women are the following:• Hypertension: Stage I hypertension with systolic blood pressure (SBP) 140 to 159 or diastolic blood pressure (DBP) of 80 to 90; stage 2 SBP ≥160 or DBP ≥100. 4• Preeclampsia and eclampsia and pregnancy-induced hypertension. High blood pressure during pregnancy is defined as mild (SBP 140-149 mm Hg or DBP 90-99) and moderate (SBP 150-159 mm Hg or DBP 100-109 mm Hg) or severe SBP ≥160 mm Hg or DBP ≥110 mm Hg). 5• Obesity: defined as a body mass index of ≥30 kg/m 2 is associated with increased risk of stroke even after adjustment for other factors, such as age, physical activity, smoking, alcohol consumption, and conditions, such as hypertension and diabetes mellitus. 1,5 • Atrial fibrillation (AF): note if present recognizing that elderly women (ie, ≥75 years)are at higher risk for stroke if AF is present. 5• Oral contraception: may be harmful to women with additional stroke risk factors, such as cigarette smoking, prior thromboembolic events. 5• Hormone replacement therapy: concerns seem similar to cardiovascular disease and should not be used as primary or secondary prevention of stroke in postmenopausal women. 5• Migraine with aura: increased stroke risk occurs in women who also smoke and have the aura. 5Most research studies indicate no sex differences in treatment seeking time when a stroke is suspected, a few others suggest some women, especially from minority groups, tend to wait longer than men. 6,7 When assessing women, HCPs should always emphasize the importance of seeking immediate treatment (<3 hours) when a stroke or transient ischemic attack is suspected and to review signs and symptoms of stroke or transient ischemic attack during every teachable moment. Ongoing monitoring of these risk factors must occur and women need to understand the significance of assuming responsibility for their own self-care management and adherence to the prescribed evidence-based treatment regimen.Advance practice nurses must refer to the ...