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ischemic stroke protocol for nurses.docx

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Communication with ER Nurse ☐ Age and clinical condition ☐ previous disease ☐ Time of symptom onset and arrived to the ER ☐ CT/CTA or MRI/MRA results and lab results (remarkable) ☐ IV t-PA administration (time) or contraindication(s) to IV t-PA Approach to the patient Airway status Vital signs Saturation 94 % Temperature
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  Communication with ER Nurse ☐  Age and clinical condition ☐  previous disease ☐  Time of symptom onset and arrived to the ER ☐  CT/CTA or MRI/MRA results and lab results (remarkable) ☐  IV t-PA administration (time) or contraindication(s) to IV t-PA Approach to the patient Airway status Vital signs Saturation > 94 % Temperature <37.5 NIHSS Peripheral lines Check swallow, nasogastric tube and urine catheter * Post ischemic stroke Management Patients after rTPA (Thrombolysis) 1.   Blood pressure Hypertension If SBP >185mmHg and/or DBP> 110mmHG (NEEDS INTERVENTION) Start: labetalol IV 10-20mg IV for 1-2 minutes may be repeat every 10mniutes (maximun 300mg) or infusion: 2-8 mg/min NTG (buscar) Monitoring of blood pressure and neurological status Fisrt 2 hours: every 15 minutes Follow 6 hours: every 30minutes Last 16 hours: every 60 minutes  Hypotension ( SBP <140mmHg DBP < 90 mmHG) Fluid management. 2.   Antithrombotic therapy Antiplatelet (aspirine or clopidrogel) should not be given within 24 hours of atleplase administration 3.   Nasogastric tube, urinary catheterization should not be place during first 6 hours after thrombolysis. 4.   Arterial lines and central venous line should not be place during 24 hours after thrombolysis 5.   Monitor for adverse reaction after thrombolisys (hemoptysis, hematemesis, melena, hematuria, abdominal pain, dyspnea) 6.   Glucose control a.   Treat Hypoglicemia (<50mg/dl) Dextrose 10-20% IV b.   Hyperglicemia: heep serum glucose < 180mg/d; with insulin 7.   Check temperature 4dd (during first 72 hours) patient with >37.5 start antipyretic (paracetamol) 8.   Nutrition: a.   NPO no more than 24 hours b.   Assess and document swallowing (first 3 hours) c.   If swallowing is unsafe: place nasogastric tube 9.   All the staff should be training to keep appropriated oral hygiene 10.   DVT prophylaxys a.   During the first 24 hours after rTPA: compressive socks b.   LMWH: 24 hours after stroke 11.   Early mobilization (first 48 hours) 12.   Not routinely recommended prophylaxis with antiepileptic drugs or antibiotics Patients NO candidate for rTPA (Thrombolysis) 1.   Blood pressure If SBP >220mmhg or DBP >120mmG (INTERVENTION) Labetalol IV 10-20mg IV for 1-2 minutes infusion: 2-8 mg/min  If SBP <220mmH or DBP < 120mmHg The goal of intervention is a reduction in blood pressure of 10-15%. Restarting antihypertensive medications is reasonable after the first 24 hours for patients who have preexisting hypertension and are neurologically stable unless a specific contraindication to restarting treatment is known Hypotension ( SBP <140mmHg DBP < 90 mmHG) Fluid management. 2.   Antithrombotic therapy Antiplatelet (aspirine or clopidrogel) should not be started within 24 hours 3.   Glucose control a.   Treat Hypoglicemia (<50mg/dl) Dextrose 10-20% IV b.   Hyperglicemia: heep serum glucose < 180mg/d; with insulin 4.   Check temperature 4dd (during first 72 hours) patient with >37.5 start antipyretic (paracetamol) 5.   Nutrition: a.   NPO no more than 24 hours b.   Assess and document swallowing (first 3 hours) c.   If swallowing is unsafe: place nasogastric tube 6.   All the staff should be training to keep appropriated oral hygiene 7.   DVT prophylaxys a.   During the first 24 hours after rTPA: compressive socks b.   LMWH: 24 hours after stroke 8.   Early mobilization (first 48 hours) 9.   Not routinely recommended prophylaxis with antiepileptic drugs or antibiotics

pone.0015326.pdf

Apr 16, 2018

3 Vida Que Liberta

Apr 16, 2018
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