What to do when pt comes into ER with stroke?

[xmilkncookiesx, RN]

I have sim lab in a few days and I'd like to prepare for it (well I already am, but want to make sure if theres anything I am missing to anything to add onto my assessment).

the paper says that the pt was working and noticed acute-onset facial drooping on the right side of her face, right sided weakness, dysarthria, and aphasia at 1000. EMT got alerted and brought the pt to the ER approximately 20min after stroke sx occurred.

The pt weighs 190lbs. and is 6'2". She has a hx of HTN, arrhythmias, obesity, asthma, chronic low back pain, and a smoker since 13 (1ppd since).

This is how I would go about my assessment:

1. ask the pt if they can tell me their name, date of birth, any allergies (this will also help me in assessing her airway)

2. assessing airway, breathing, circulation (ABCs). get vitals running on her and if O2 is low, I will administer O2 via nasal cannula per doctors order.

3. I would ask when they were last known normal (well, if there is someone with her like employee or something), but I am thinking 1000 since it says thats when she noticed those symptoms.

4. ask them what they were doing prior to, what other symptoms they experienced, any visual changes, etc.

5. I would perform the Cincinnati and NIH stroke screening (according to what my professor said in her lecture, if any of the Cincinnati tests are positive, you move onto the NIH??). So facial drooping (smile, show teeth, frown, stick tongue out and move it up/down and side to side) arm drift (have them hold their arms up for 10sec with their eyes closed), slurred speech (slurring of words or unable to speak).

6. Obtain 2 IV lines (for any BP meds, etc. and the other line for tPA if indicated and because it doesn't mix with any med). I would administer a antihypertensive med PER ORDER if BP is >180/>105 so that way we can give the tPA per order.

7. Obtain labs, CT results with doctor and if the CT comes back negative for no hemorrhaging stroke, and with the positive results from the stroke tests, AND obtaining a history on if she's had UNCONTROLLED hypertension, recent surgeries, recent strokes, basically the tPA protocol .. if she is eligible for tPA, then we can go ahead and go forward with the tPA orders.

8. We would continue monitoring her vitals throughout the therapy.

Now .. before I go forward with the tPA, I understand I have to ask the tPA protocol questions to make sure she's eligible for it or else I could cause the pt to bleed. BP has to be

So this is how I got my dose for the tPA. PLEASE correct me if I did anything wrong:

190/2.2= 86.36kg

MAX dose of tPA is 90mg

0.9mg x 86.36kg = 77.724 x 0.10% = 7.77 over 1min bolus

Then the rest, 69.95 over 1 hour

I feel like I am missing something in my post, or it is out of order, or incorrect info. PLEASE correct me, I do not mind.

Also, on my powerpoint it says all invasive procedures need to be done before tPA (foley, etc.) My question with this is, it says insert foley per MD if unresponsive or consider and ask MD for it. Why would a foley be inserted in someone unresponsive? d/t urinary incontinence?

thank you! :)

[edmst]

If the patient is having aphasia, how can the patient verbalize their name, date of birth, allergies, symptom onset, medical history, etc.?

Real world, stroke team would meet the potentially stroke patient at the ambulance bay. Weight HAS to be obtained in case tpa has to be given. Glucose and vitals obtained. History is obtained from family or rescue as best as we can as well as any blood thinners the individual may be on which would contraindicate tpa. When was the last time seen normal? The ER physician conducts NIH and the patient is IMMEDIATELY taken to C/T of the brain to rule out a stroke...and if it is a stroke whether it is ischemic/hemorrhagic or negative. Right after the C/T is done and is being read by the radiologist/neurologist, 2 large bore IV's are placed and labs are drawn, specifically coag's. From there, the patient may have to have a CTA and MRI and all the while assessing the patients condition. Also didn't care that you have a sim lab and made the the comment you're already prepared for it without any experience and didn't mention the most crucial aspects...but you're already prepared for it..............scary

[Silverdragon102, BSN]

Moved to the General Student discussion forum