ISCHEMIC STROKE & HEMORRHAGIC STROKE Flashcards
Drug of Choice for Ischemic Stroke
rT-PA (Recombinant Tissue Plasminogen Activator)
What’s the mechanism of action of rT-PA?
dissolves the blood clot that is blocking flow to the brain
Goal for rT-PA
-Give IV rT-PA within 60 minutes of patient arriving to the ED
How long rT-PA stays in the body?
24 hours
Major adverse effects of rT-PA?
Bleeding
Nursing Management when patient is taking rT-PA?
-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
Must be given to ALL patients with ischemic stroke after brain imaging has ruled out hemorrhagic etiology
Aspirin Therapy
Aspirin Therapy Management
-Start within 24 hours of dx (ideally within 12 hours)
- If on thrombolytics, delay admin until secondary bleeding is ruled out
Dose for Aspirin
160 mg as loading dose, then 80 mg as maintenance dose
What’s the adverse effect of Aspirin?
GI bleed
Nursing Responsibility of Aspirin Therapy?
-Administer with meals
- DO not administer within 2 hours of PPI
Used only if with atrial fibrillation and ischemic stroke
Direct Oral Anticoagulant (DOAC) Therapy
What’s the drug of anticoagulant?
-Rivaroxaban (Xarelto)
- Apixaban (Eliquis)
- Dabigatran (Pradaxa)
Adverse Effect of Anticoagulant
Bleeding
Nursing Responsibility of Anticoagulant
-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
What’s the Management of Hemorrhagic Stroke?
-Seizure Management and Control
- Blood Pressure Management and Control
For rapid control of Hemorrhagic Stroke
-Diazepam (Valium) or Lorazepam (Ativan)
For long term control of Hemorrhagic Stroke
Phenytoin (Dilantin)
What’s the indication of internal bleeding?
Iced tea colored
Blood Pressure Management and Control of Hemorrhagic Stroke
-Intensive BP reduction (target <140 mmHg systolic)
The rationale of Intensive BP reduction (target <140 mmHg systolic)
To reduce the absolute growth of hematoma
First line drug of BP management and control
Beta-blockers (e.g Labetalol)
Second line drug of BP management and control
ACE Inhibitors (e.g Enalapril)
For refractory
Calcium Channel Blockers (Nicardipine) -using infusion pump
Heparin is administered through
IV
Warfarin is administered through
PO
What time of the day will you administer aspirin?
After Lunch must be given
When do we usually give omeprazole?
Before breakfast
