ASSESSMENT
A patient presents with sudden unilateral weakness and slurred speech. What type of stroke is most likely occurring?
Ischemic stroke.
What is the FIRST priority when a patient presents with stroke symptoms?
Activate stroke protocol / rapid assessment and obtain immediate CT scan.
What is the mechanism of action of Alteplase?
Converts plasminogen to plasmin, which breaks down fibrin clots.
What is the most serious complication after thrombolytic therapy?
Intracranial hemorrhage.
Why should glucose be checked in all suspected stroke patients?
Hypoglycemia can mimic stroke symptoms.
A patient with a stroke has right-sided weakness. Where is the most likely location of the brain injury?
Left hemisphere of the brain.
Why must a CT scan be obtained before administering Alteplase?
To rule out hemorrhagic stroke, since thrombolytics would worsen bleeding.
What is the major risk associated with Alteplase therapy?
Bleeding, especially intracranial hemorrhage.
A stroke patient develops difficulty swallowing. What complication is the nurse most concerned about?
Aspiration.
Why is oxygen administered to stroke patients?
To ensure adequate oxygenation and prevent further brain injury.
A patient has expressive aphasia but understands commands. Which area of the brain is affected?
Broca’s area (left frontal lobe).
A patient is a candidate for Tenecteplase. What is the critical time window for administration?
Within 3–4.5 hours of symptom onset.
Why is Labetalol used in stroke patients?
To lower blood pressure safely when indicated, especially before or during thrombolytic therapy.
Why are stroke patients at high risk for aspiration pneumonia?
Impaired swallowing and decreased gag reflex.
Why is it important to determine the exact time of symptom onset?
Determines eligibility for thrombolytic therapy.
A patient presents with a sudden severe headache described as “the worst headache of my life.” What type of stroke is most concerning?
Hemorrhagic stroke.
A patient receiving Alteplase develops a sudden headache and vomiting. What is the priority action?
Stop the infusion and notify provider immediately (suspected intracranial hemorrhage).
To lower blood pressure safely when indicated, especially before or during thrombolytic therapy.
Hydralazine
A patient develops worsening neurologic deficits after initial improvement. What should the nurse suspect?
Hemorrhagic transformation or re-occlusion.
A patient asks why they cannot receive Alteplase after 6 hours. What is the best response?
The risk of bleeding outweighs the benefit beyond the treatment window.
A patient becomes increasingly drowsy after a stroke. What complication should the nurse suspect?
Increased intracranial pressure or hemorrhagic transformation.
A patient with acute stroke has BP 210/110. Should the nurse immediately lower the blood pressure?
No — permissive hypertension is allowed unless BP is extremely high or patient is receiving thrombolytics.
Why must invasive procedures (e.g., Foley, IM injections) be avoided after giving Alteplase?
Increased risk of bleeding due to systemic fibrinolysis.
What is cerebral edema and why is it dangerous after a stroke?
Swelling of brain tissue that increases ICP and decreases cerebral perfusion.
A patient with stroke symptoms wakes up with deficits. Why is this significant?
Unknown onset time → not eligible for thrombolytics.