Stroke Treatment and Nursing Care

tPA is an effective emergency treatment for eligible patients with acute ischemic stroke and should be administered within the therapeutic time window, generally 3 to 4.5 hours from the first onset of symptoms. Nursing care is central to ensuring the safety and effectiveness of this treatment and includes the following:

1. Rapid Assessment and Early Recognition of Stroke Symptoms

·       Use the F.A.S.T. protocol (Face, Arms, Speech, Time).

·       Obtain an accurate medical history, particularly the exact time when symptoms began or the last known well time.

·       Notify the medical team immediately to expedite transfer and brain imaging with CT or MRI.

2. Preparation for tPA Administration

·       Confirm that the patient meets the eligibility criteria for tPA:

o   Age: 18 years or older.

o   Clinical diagnosis: confirmed acute ischemic stroke.

o   Symptom onset: within the 3- to 4.5-hour treatment window.

o   Brain imaging: CT or MRI shows no intracranial hemorrhage.

o   Neurological deficit: clinically evident and functionally significant; the NIH Stroke Scale is used to determine severity.

o   Weight: used to calculate the tPA dose (0.9 mg/kg; maximum dose 90 mg).

·       Confirm that the patient has no contraindications to tPA, including:

o   Current or previous intracranial hemorrhage.

o   History of cerebral hemorrhage or an untreated cerebral aneurysm.

o   Brain surgery, head injury, or stroke within the previous three months.

o   Uncontrolled blood pressure of 185/110 mmHg or higher at presentation.

o   Bleeding disorder or platelet count below 100,000/µL.

o   Use of anticoagulants, such as heparin within the previous 48 hours, with an elevated INR or aPTT.

o   Blood glucose below 50 mg/dL or above 400 mg/dL.

o   Intracranial tumors or serious vascular disease.

·       Obtain informed consent from the patient or family whenever possible.

·       Collect blood samples for the required investigations, including coagulation studies, liver-function tests, and complete blood count (CBC).

·       Insert an appropriate intravenous cannula and monitor vital signs.

3. Monitoring During tPA Administration

·       Administer the dose according to the hospital protocol: 10% of the total dose as an IV bolus and the remainder by infusion over 60 minutes.

·       Monitor vital signs every 15 minutes during the first hour, every 30 minutes during the next two hours, and then hourly for 24 hours.

·       Monitor neurological status closely to detect any sudden deterioration.

4. Rapid Recognition of Potential Complications

o   Monitor for signs of internal or intracranial bleeding, including decreased level of consciousness, sudden headache, vomiting, or new neurological changes.

o   Inspect needle and catheter sites for external bleeding.

o   Monitor for allergic manifestations or a severe medication reaction; these are uncommon but possible.

5. Care After tPA Administration

·       Do not administer anticoagulant or antiplatelet medication during the first 24 hours after tPA unless explicitly prescribed by the physician.

·       Avoid invasive procedures or punctures, such as lumbar puncture or catheter insertion, during the first 24 hours whenever possible.

·       Repeat brain imaging after 24 hours to exclude hemorrhage before starting additional antithrombotic medication.

·       Continue close monitoring of neurological status and vital functions.

6. Patient Education and Psychological Support

·       Explain the treatment to the patient and family, including the importance of timely tPA administration.

·       Provide psychological support during the acute phase.

·       Follow the rehabilitation plan after treatment according to the patient’s condition.