Background: - acute stroke is a heterogeneous, neurological syndrome characterized by the abrupt or gradual nonconvulsive onset of neurological deficits resulting from interruption in blood flow or hemorrhage in an area of the brain.Therefore, the aim is to identify the effect of implementing nursing guidelines on acute stroke patient outcomes. Quasi-experimental research design was used to conduct this research .A convenient sample of 60 patients with acute stroke they were enrolled into study group (n=30) and control group (n=30) at Emergency department at Assiut University Hospitals. Tool used in this study comprised three main parts: part I: - Neurological assessment. Part II: - Assessment of homodynamic parameters part Ш: - Assessment of acute stroke complications. The main results: result revealed that majority of the sample was <55years in both groups. The study result revealed that there is improvement in patient vital signs (Systolic blood pressure SBP and Temperature) in the study group versus the control group as effect of guidelines implemented. In addition current study revealed significant decrease in study group regard chest infection occurrence (p<0.04) than control group and for epileptic seizure (p<0.03). Conclusion: - Efficient and active nursing management in the initial hours after acute stroke phase increased recovery chance and decrease patient complications.