Stroke: BE FAST Recognition, Emergency Response, and Secondary Prevention
Teach BE FAST and calling 911 immediately for any sudden sign, even when symptoms resolve, because a transient ischemic attack (TIA) warns of stroke. Note the time symptoms began or the time the client was last known well, and do not drive to the hospital. Reduce recurrence with blood pressure control (usual target below 130/80 mm Hg), daily prescribed antithrombotic and statin therapy, diabetes control, smoking cessation, alcohol limits, and regular activity.
Who needs this teaching
Clients with a previous stroke or transient ischemic attack (TIA), clients with risk factors such as hypertension, atrial fibrillation, diabetes mellitus, dyslipidemia, and smoking, and their families. Family members need this teaching because aphasia and altered awareness prevent many clients from calling for help.
The priority teaching points
- BE FAST recognition. Balance: sudden loss of balance or coordination. Eyes: sudden vision loss or double vision. Face: unilateral facial drooping. Arm: unilateral arm or leg weakness or numbness. Speech: slurred speech, aphasia, or confusion. Time: call 911 immediately. A sudden severe headache with no known cause also requires 911.
- Immediate emergency response. Call 911 at the first sign; do not wait for symptoms to resolve. Resolved symptoms indicate a TIA and still require emergency evaluation. Do not drive to the hospital; emergency medical services begin assessment and transport the client to a stroke center.
- Time of onset. Note the time symptoms began. If onset was not witnessed, note the last time the client was known to be well. IV thrombolytic therapy has a 4.5-hour window from last known well. Do not give aspirin, food, fluids, or oral medications while waiting. Hemorrhagic stroke is not yet excluded, and dysphagia causes aspiration.
- Blood pressure control. Hypertension is the most important modifiable risk factor for stroke. Take antihypertensives daily and monitor blood pressure at home. The usual target after stroke or TIA is below 130/80 mm Hg, or the target the provider sets.
- Antithrombotic and lipid therapy. Take the prescribed antiplatelet agent, such as aspirin or clopidogrel, or the prescribed anticoagulant for atrial fibrillation every day. Do not stop it without the prescriber's instructions. Report bleeding. Take the prescribed statin; the usual LDL target after atherosclerotic ischemic stroke is below 70 mg/dL.
- Lifestyle risk reduction. Stop smoking. Limit alcohol to no more than 2 drinks daily for men or 1 for women. Keep A1C at the prescribed target. Aim for at least 150 minutes of moderate activity weekly as able, or follow the rehabilitation plan. Follow a Mediterranean-style eating pattern with limited sodium.
- Safety after stroke. Prevent falls with grab bars, no throw rugs, nonslip footwear, and prescribed assistive devices. Clients with unilateral neglect scan toward the affected side. Follow the prescribed swallowing plan: sit upright at 90 degrees, take small bites, and use the taught chin tuck and prescribed liquid consistency. Report choking during meals and symptoms of depression.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| Coughing or choking during meals, or a wet voice after swallowing | Any sudden BE FAST sign, even if it resolves |
| Blood pressure repeatedly above the individualized target | Sudden severe headache with no known cause |
| New bruising or minor bleeding during antiplatelet or anticoagulant therapy | Sudden confusion, seizure, or loss of consciousness |
| A fall without injury, or new difficulty walking safely | Head injury during anticoagulant therapy, or major bleeding |
Teach-back questions
- "What does each letter in BE FAST mean?"
- "What will you do if your face droops and returns to normal 10 minutes later?"
- "Why will you not drive to the hospital?"
- "What time will you tell the emergency team?"
- "Which daily medicines lower your risk of another stroke?"
Teaching tips
- Teach BE FAST to every family member, post it near the phone, and rehearse the 911 call.
- Write the blood pressure target and medication schedule on the handout.
- Use pictures and short phrases for clients with aphasia.
Read more on NCLEXPace
- Stroke: Ischemic vs Hemorrhagic, tPA Windows and Nursing Priorities
- Neuro Map: Stroke, Increased ICP, Seizures, and Spinal Cord Injury
- Anticoagulants on the NCLEX: Heparin vs Warfarin vs DOACs
Sources
- Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Stroke.
- Kleindorfer DO, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467.
- Powers WJ, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke. Stroke. 2019;50(12):e344-e418.
Why this matters for the NCLEX
Teaching is effective when the family member states, "If his face droops, I will call 911 right away and note the time," and "I will call even if the weakness goes away." Statements requiring further teaching include, "I will drive her to the hospital myself," "I will give him an aspirin while we wait," and "I will stop my clopidogrel once I feel better."
Frequently asked questions
Does a TIA that resolves within minutes still require 911?
Yes. A TIA indicates high stroke risk in the following days. Emergency evaluation identifies the cause and starts prevention.
Should the family give aspirin while waiting for emergency services?
No. Imaging must first exclude hemorrhagic stroke, and the client's swallowing has not been assessed.
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