ISCHEMIC STROKE & HEMORRHAGIC STROKE

Question 1

Drug of Choice for Ischemic Stroke

Answer 1

rT-PA (Recombinant Tissue Plasminogen Activator)

Question 2

What’s the mechanism of action of rT-PA?

Answer 2

dissolves the blood clot that is blocking flow to the brain

Question 3

Goal for rT-PA

Answer 3

-Give IV rT-PA within 60 minutes of patient arriving to the ED

Question 4

How long rT-PA stays in the body?

Answer 4

24 hours

Question 5

Major adverse effects of rT-PA?

Answer 5

Bleeding

Question 6

Nursing Management when patient is taking rT-PA?

Answer 6

-Avoid aspirin/anticoagulants for the next 24 hours
-Monitor for any bleeding (IV site, urinary catheter site, ET tube, NG tube, urine, stool, emesis other secretions)
-Delay placement of tubes and catheters for 24 hours

Question 7

Must be given to ALL patients with ischemic stroke after brain imaging has ruled out hemorrhagic etiology

Answer 7

Aspirin Therapy

Question 8

Aspirin Therapy Management

Answer 8

-Start within 24 hours of dx (ideally within 12 hours)
- If on thrombolytics, delay admin until secondary bleeding is ruled out

Question 9

Dose for Aspirin

Answer 9

160 mg as loading dose, then 80 mg as maintenance dose

Question 10

What’s the adverse effect of Aspirin?

Answer 10

GI bleed

Question 11

Nursing Responsibility of Aspirin Therapy?

Answer 11

-Administer with meals
- DO not administer within 2 hours of PPI

Question 12

Used only if with atrial fibrillation and ischemic stroke

Answer 12

Direct Oral Anticoagulant (DOAC) Therapy

Question 13

What’s the drug of anticoagulant?

Answer 13

-Rivaroxaban (Xarelto)
- Apixaban (Eliquis)
- Dabigatran (Pradaxa)

Question 14

Adverse Effect of Anticoagulant

Answer 14

Bleeding

Question 15

Nursing Responsibility of Anticoagulant

Answer 15

-Administer at the same time each day
-Rivaroxaban may be crush and given with food or via NGT
- Dabigatran should not be crushed or chewed before swallowing

Question 16

What’s the Management of Hemorrhagic Stroke?

Answer 16

-Seizure Management and Control
- Blood Pressure Management and Control

Question 17

For rapid control of Hemorrhagic Stroke

Answer 17

-Diazepam (Valium) or Lorazepam (Ativan)

Question 18

For long term control of Hemorrhagic Stroke

Answer 18

Phenytoin (Dilantin)

Question 19

What’s the indication of internal bleeding?

Answer 19

Iced tea colored

Question 20

Blood Pressure Management and Control of Hemorrhagic Stroke

Answer 20

-Intensive BP reduction (target <140 mmHg systolic)

Question 21

The rationale of Intensive BP reduction (target <140 mmHg systolic)

Answer 21

To reduce the absolute growth of hematoma

Question 22

First line drug of BP management and control

Answer 22

Beta-blockers (e.g Labetalol)

Question 23

Second line drug of BP management and control

Answer 23

ACE Inhibitors (e.g Enalapril)

Question 24

For refractory

Answer 24

Calcium Channel Blockers (Nicardipine) -using infusion pump

Question 25

Heparin is administered through

Answer 25

IV

Question 26

Warfarin is administered through

Answer 26

PO

Question 27

What time of the day will you administer aspirin?

Answer 27

After Lunch must be given

Question 28

When do we usually give omeprazole?

Answer 28

Before breakfast