Continue treatment after admission
Watch for the bleed in stroke patients
The acute post-ICU care of the patient who has suffered an acute ischemic stroke and has been treated with recombinant tissue-type plasminogen activator (TPA) is vitally important. The nurses in the acute care department have to be particularly vigilant for bleeding complications and assess patients’ neural status, as outlined in the TPA package insert. A National Institute of Neurological Disorders and Stroke (NINDS) study group concluded that there is an increased incidence of symptomatic intracerebral hemorrhage following TPA administration.1
"The risk of intracranial hemorrhage in the acute stroke patient is much greater than in a cardiac patient," says Laura Sauerbeck, RN, at The Greater Cincinnati-Northern Kentucky Stroke Research Center in Cincinnati. She recommends using the National Institutes of Health Stroke Scale. Formerly a research tool, the scale gives a snapshot of the patient’s status at the time of administration.
"There’s no EKG to put on the brain," says Sauerbeck. "The scale was designed specifically for acute ischemic stroke and monitors improvements and declines in the patient’s status. It was tested across a multitude of disciplines; it’s reliable. A doctor’s or nurse’s opinion of what they think they see in a patient can never compete with an objective tool like the scale."
Reference
1. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333:1,581-1,587.
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