Stroke/TPA

  1. Hi,

    I am a new nursing student (first semester). What are the initial steps when a patient is admitted for a possible stroke?

    What qualifications do they need for he or she to be eligible for TPA? Thanks in advanced,

    Meredith
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  2. 7 Comments

  3. by   Do-over
    Just curious... What does your textbook say?
  4. by   melissacarey
    The text so detailed, it scares me. I have Black/Hawk.

    From my powerpoints, the professor stated:

    What are our priorities?
    • Assess!
    • General survey: Airway: Is her airway stable is she working to breath, what level of oxygen if any do the paramedics have her on? Is tongue falling back? Get RR
    ED priorities of care (< 10 min from arrival)
    • ABCs
    • VS (blood pressure cuff on strong side)
    • Oxygen by NC
    • ECG (tell you if they have any cardiac problems, constantly monitoring HR) 12 lead EKG
    • Pulse oximetry monitoring
    • IV access, NS at TKO
    • Check blood sugar/AccuCheck takes 30 seconds
    • Labs: CBC, Chem 20, PT, INR, PTT
    • General neurological assessment
    • Ask her/him to move your L or R side
    • Alert stroke team, neurology (make sure you know it is a stroke)
    • Drugs and Alcohol (get tox screens)
    • Verify time of symptom onset
    • CT Scan lactate?
    • Get a History from Family if they are there:
    • Onset of symptoms: WHEN WAS THE LAST TIME YOU SAW HER NORMAL (sometimes last night)
    • Last seen normal:
    • History of stroke?
    • Allergies?
    • On any Medications?
    • Place her on frequent VS checks, continuous pulse oximetry, get a cardiac monitor on to evaluate the heart rhythm. An irregular heart rhythm can cause clot formation in the left ventricles that can move out of the heart and up the right or left carotid artery.
    • Should be done in 25 minutes

    But every patient is different. On the test I know she will give different scenarios. How do different patient affect the algorithm/protocol?
  5. by   Do-over
    If that is all from your professor's lecture, then I would say you have your answer. I could tell you what I would do with a stroke patient, but the important thing for you is what your professor wants you to do.

    As for different scenarios -- different than what? Are you only talking about stroke patients here? The only thing I can think of is to determine the cause, and that leads the physician to the treatment.

    With the TPA - I would look that drug up, and always consider the cause of the stroke symptoms - clot or bleed?
    Last edit by Do-over on Mar 5, '12
  6. by   msjellybean
    There is some excellent information on the Activase website about indications/contraindications for tPA.

    Your list is pretty accurate.

    Pt will get an NIHSS upon ED arrival (and subsequently throughout stay), to evaluate the progression or resolution of symptoms.
  7. by   tnbutterfly
    Moved to Nursing Student Assistance for more discussion.
  8. by   Esme12
    What are our priorities?
    * Assess! Every patient will be assessed. It is here where it may vary according to the patient. If there are symptoms for CVA you continue...
    * General survey: Airway: Is her airway stable is she working to breath, what level of oxygen if any do the paramedics have her on? Is tongue falling back? Get RR If they can't maintain their airway that needs to be addressed before anything else. If they can't breathe they won't live. If they ain't breathin they ain't leavin.....

    ED priorities of care (< 10 min from arrival)
    * ABCs Airway Breathing Circulation. Is their airway open? Are they breathing? Do they have a pulse? Everyone needs this
    * VS (blood pressure cuff on strong side) everyone gets vitals
    * Oxygen by NC O2 will never hurt.
    * ECG (tell you if they have any cardiac problems, constantly monitoring HR) 12 lead EKG Another .....everyone gets this and there arfe certain cardiac issues that can produce stroke like presentation.
    * Pulse oximetry monitoring standard vital sign
    * IV access, NS at TKO IV is a life line everyone gets one
    * Check blood sugar/AccuCheck takes 30 seconds low/high glucose can mimic stroke like symptoms. If it's a glucose issue you correct that....they don't need TPA
    * Labs: CBC, Chem 20, PT, INR, PTT everyone gets baseline labs
    * General neurological assessment Everyone gets assessed to determine treatment.
    * Ask her/him to move your L or R side Ask the patient to move their extermeties and squeeze your hands, stick out their tongue.
    * Alert stroke team, neurology (make sure you know it is a stroke) Time is function
    * Drugs and Alcohol (get tox screens) Again......drug/alcohol can mask/mimic a strokse like slurred speech and Again decreased level of consiciuoness may not mean stroke R/O other causes
    * Verify time of symptom onset there is a very specific time window for ctroke and thrombolytics.
    * CT Scan lactate? Determine if there is a bleed....you don't want to give clot busting drugs if they afre bleeding in the brain.
    * Get a History from Family if they are there: Timeline which is important to treatment interventions and is thi9s new for them.....you don't want to treat a pre-existing CVA.
    * Onset of symptoms: WHEN WAS THE LAST TIME YOU SAW HER NORMAL (sometimes last night)
    * Last seen normal: Timeline
    * History of stroke? Previous paralysis
    * Allergies? very important for appropriate treatment.
    * On any Medications? history, clue to diagnosis
    * Place her on frequent VS checks, continuous pulse oximetry, get a cardiac monitor on to evaluate the heart rhythm. An irregular heart rhythm can cause clot formation in the left ventricles that can move out of the heart and up the right or left carotid artery.
    * Should be done in 25 minutes

    Thrombolysis (MGH Stroke Service)

    http://sleeperem.files.wordpress.com...-algorithm.pdf
    Activase (Alteplase) for Acute Ischemic Stroke Treatment

    I hope this helps...
  9. by   Esme12

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