Alteplase IV Procedure for Management of Acute Stroke
In minutes, some or all the brain cells will eventually die mostly due to lack of oxygen. A lot of studies have concluded that absence of oxygen in the blood is due to hinderance in the flow of blood (Powers Et Al 2018). There are many types of stroke but the most dominant one is the ischemic stroke which take up to 85% of all strokes. Ischemia occurs when there is a rapture in the artery that feed the brain with blood or if the artery is blocked resulting to reduced blood flow. Transient ischemic attack refers to a minor stroke that takes place when the blood clot blocks the artery for five minutes or less. Summary of Presence Health Policy Presence Health has developed an important policy for the use of Alteplase IV Procedure for Management of Acute Stroke.
The purpose of this policy is too specific the requirements of Presence Health that a holistic, patient-centered approach to care be provided throughout the continuum of clinical services for all patients who receive Alteplase (Presence Healthcare, 2015). The policy has clearly described the care processes for Alteplase IV administration in the operating ministries to be initiated for patients who are admitted after presenting to the Emergency Department or developing acute signs and/or symptoms of a stroke when admitted as an inpatient (Presence Healthcare, 2015). Alteplase is used for the lysis of a clot in acute ischemic stroke in adults. It shall be initiated within a window of time after the onset of stroke symptoms and after exclusion of intracranial hemorrhage by CT scan or other diagnostic imaging.
Finally, Alteplase is either prepared in the pharmacy or by nursing in the Emergency Department or Critical Care Units (Presence Healthcare, 2015). The patient should be properly prepared for Alteplase before its administration. Monitoring and documentation of the patient’s progress is the final step and should be done from the admission of the patient till full recovery. Summary of Clinical Practice Guideline (Neurosciences and the Senses Health Network) The guideline aims to: • Provide evidence-based practice guidelines for stroke care. • Support early intervention in stroke management and develop a consistent statewide approach to stroke care. 5 hours) after the onset of the stroke (Neurosciences and the Senses Health Network, 2011). The alteplase clinical guideline outlines the assessment for acute stroke, the eligibility criteria for alteplase, directions for care, and counseling for patients and families post-stroke.
If a patient presents with any of the symptoms below, with a duration of fewer than 4 hours and an acute stroke is suspected, the patient should be triaged as Level 2 (Neurosciences and the Senses Health Network, 2011). • Facial weakness • Arm weakness • Speech disturbance (Aphasia/Dysarthria) • Hemiparesis or hemisensory disturbance • Ataxia • Diplopia / visual loss The following actions ought to be taken: • Patient must be seen by a doctor within 10 minutes. • Call stroke or neurology medical staff according to hospital protocol The Stroke team staff ought to; • Confirm time of onset and review history. • After administration of alteplase, the patient should be transferred to the Stroke Unit, High Dependency Unit (HDU) or the ICU depending on nursing availability to provide required frequent observations. • Alteplase is licensed for use in appropriate patients with symptom duration up to 4.
5 hours. Cases of acute basilar thrombosis may be treated with intra-arterial thrombolysis up to 24 hours from symptom onset due to the devastating nature of this condition. However, Alteplase should not be administered or should be administered with caution in case of the following situations: • Severe neurological impairment with NIHSS score >22 • Age >80 years • CT evidence of extensive middle cerebral artery (MCA) territory infarction (sulcal effacement or blurring of the grey-white junction in greater than 1/3 of MCA territory). Additionally, both guidelines offer a number of situations where alteplase should not be offered, or proper care should take during the procedure. Some of these situations include: only minor or rapidly improving stroke symptoms (clearing spontaneously), pregnancy, seizure at onset with postictal residual neurological impairments, major surgery or serious trauma within previous 14 days, recent gastrointestinal or urinary tract hemorrhage (within previous 21 days), recent acute myocardial infarction (within previous three months) etc.
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