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Thrombolysis Nursing Competencies PowerPoint Presentation

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Description : In this session you learn about Nursing Care of a Thrombolysed patient

Tags : CVA,Nursing

Published on : Oct 12, 2022 | Views : 905 | Downloads : 3

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Slide 1-

Thrombolysis Nursing Competencies Objectives Nursing Care of a Thrombolysed patient
Slide 2-

“There is a massive and regular failure to respond to the emergency of stroke” Low public awareness of symptoms, prevention & management Slow admission to hospital, Difficult access to imaging, Insufficient specialist resources Less than 1% of pts thrombolysed
Slide 3-

Stroke is a Medical Emergency ’Time is Brain’ Speedy diagnosis Rapid access to imaging Thrombolysis Rapid access to supportive therapy Rapid secondary prevention Rapid surgical/ radiological intervention in arterial disease (carotid / vertebral)
Slide 4-

80% of Strokes = Ischaemic 80% of Ischaemic stroke caused by embolism from Heart Aortic arch Extracranial arteries to the brain
Slide 5-

Thrombolysis Thrombus= clot Lysis = destruction of cells Thrombolysis is achieved by using rt-PA (alteplase) rt-PA reverses underperfusion, allowing ischaemic penumbra to recover
Slide 6-

Thrombolysis rt-PA= recombinant tissue plasminogen activator Plasmin is the enzyme that degrades fibrin, the protein which is the main constituent of blood clots rt-PA activates the release of plasmin as plasminogen
Slide 7-

Thrombolysis Must be given within 4.5 hours of stroke Strict inclusion criteria Licensed for IV use in under 80’s Consultant decision: intra-arterial, 80+ Dramatic increase in post-stroke quality of life
Slide 8-

Cerebral infarct - onset Onset Infarct Ischaemic penumbra
Slide 9-

Cerebral infarct – 6 hours 6 Hours Infarct Ischaemic penumbra
Slide 10-

Cerebral infarct – 24 hours 24 Hours Infarct Ischaemic penumbra
Slide 11-

Thrombolysis - The Evidence Fewer complications Frequently, dramatic lack of disability Quicker recovery Reduction in LOS
Slide 12-

‘Time is Brain’ - Stroke Pathway Triage, FAST test Speedy call to Stroke Team (whatever severity) Rapid admission to ASU
Slide 13-

ABC Airway Breathing Circulation
Slide 14-

After ABC GCS ECG Blood glucose Fluid access Hydration Bloods Nil by Mouth Transfer to CT-continue ABC
Slide 15-

Time is brain 1.9 million neurons are lost each minute after a stroke Protect ischaemic penumbra
Slide 16-

CT Known time of symptoms <4 hours NIHSS score No haemorrhage No contraindications Consent Age
Slide 17-

Thrombolysis Alteplase rTPA 0.6-0.9mg /Kg 10% of total dose –Bolus 2-3 mins 90% of total dose –Infuse over 60 mins
Slide 18-

rTPA Alteplase Do not mix t-PA with any other medications. Do not use IV tubing with infusion filters. All patients must be on a cardiac monitor When infusion is complete, saline flush with Normal saline t-PA must be used within 8 hours of mixing when stored at room temperature or within 24 hours if refrigerated
Slide 19-

Complications of Thrombolysis Intra -cerebral haemorrhage-1.7% (1 in 77 patients) 0.28% fatal Bleeding-minor bleeding is common (IV site) Anaphylaxis- 1% Ace inhibitors Frontal & insular lesions Angiodoema 1.3% Canadian study 1,135 pts Major Heamorrhage 0.4%
Slide 20-

Angioedema
Slide 21-

First 24 hours 30% of all stroke patients will deteriorate in the first 24hours Stroke 2009
Slide 22-

Monitor GCS Ability to engage with immediate surroundings Standardised stimuli E1-E4 V1-V5 M1-M6
Slide 23-

Best and Worst Score GCS 15- E4 V5 M6 Awake, alert and fully responsive GCS 3-E1 V1 M1 No cerebrally mediated response to stimulus
Slide 24-

NIHSS - A Research Tool Fifteen item impairment scale Neurological outcome Degree of recovery
Slide 25-

Physiological Monitoring 1. Hypoxia Respirations Saturations <92% Associated with neurological deterioration 2. Temperature >38C must be treated. -associated with infarct volume 3. Arrhythmias Continuous ECG Early detection and treatment of AF Right hemisphere /insular lesions
Slide 26-

Physiological Monitoring contd 4.Blood pressure Non thrombolysed patients BP Not treated unless: Systolic >220mmHg or Diastolic >120mmHg with 2 consecutive readings Thrombolysed patients BP is treated if: Systolic >185mmHg or Diastolic >110mmHg with 2 consecutive readings Abrupt fall in BP may affect cerebral perfusion pressure
Slide 27-

Physiological Monitoring contd 5.Blood Sugar Hyperglycaemia treat & monitor Hypoglycaemia –immediate treatment with glucose Hyperglycaemia is associated with poor clinical outcome
Slide 28-

Complications of Stroke Aspiration Pneumonia Urinary infection DVT Pulmonary Embolus Shoulder subluxation Depression Malnourishment Pressure sores Falls Seizures
Slide 29-

Swallow Complications(Dysphagia) Chest Infection Aspiration Pneumonias 50% are silent Swallow screen Nil by mouth first 24hours Guided eating & drinking regime Encourage to cough Sitting out of bed Mobilisation
Slide 30-

Mouth Care Increased risk of infection Pain and discomfort Effects swallow Gentle mouth care Adequate hydration Gentle tooth brushing
Slide 31-

Head Position Controversial Head in a neutral position Flat if tolerated. Or 30 –40 degrees Aids venous drainage & improves cerebral perfusion
Slide 32-

Bladder &Bowels Urinary incontinence Urinary infection Avoid catheters Early plan of care Adequate hydration Bowels Privacy & dignity
Slide 33-

Psychological Support Assess mood Recognise grief/loss Talk Engage with family Interests Timely realistic goals Refer
Slide 34-

Pressure Sores Air mattress Two hourly turns Nutrition Hydration Personal hygiene
Slide 35-

Deep Vein Thrombosis Early mobilisation Low molecular weight heparin Compression devices TED stockings not beneficial in stroke patients Clots Trial 2009
Slide 36-

Positioning Loss of sensation Loss of power Subluxation Supportive IV lines and BP cuffs avoided on affected limb Assess moving and handling Good technique
Slide 37-

Nutrition Malnourishment associated with poor outcome Weight MUST assessment Naso gastric tube History of patients eating habits Controversial When to commence invasive feeding regime