Post TNK Care
Must be done within 24-32 hours post TNK
What is an MRI (or CT if MRI not possible)
Chronic uncontrolled hypertension
The most common cause of ICH
Gold standard test for stroke
What is a non-contrast CT brain
Assessment tool to identify severity of stroke symptoms
What is NIH
Blood pressure goal of 180/105
The blood pressure goal before and after TNK is given
“Worst H/A of my life,” N/V, decreased LOC
This is done if a patient is experiencing new neuro changes, including following a CEA procedure
What is calling a stroke alert
This needs to be documented prior to any PO intake with new stroke admissions or any neuro changes
What is the bedside swallow screen
Swelling of the tongue or lips, sudden appearance of red welts (especially near eyes and lips), breathing problems, stridor, and hoarse voice
What is angioedema
Goal of SBP <150
What is the blood pressure goal for spontaneous ICH
Decreased LOC is the most reliable symptom of this
What is brain swelling
Medications, s/sx of stroke, personal risk factors, how to contact EMS/call 911, and f/u with a provider.
What are the 5 key stroke education “survival skills?”
Q 15mins x2hrs (and tongue checks), Q 30mins x6hrs (and tongue checks x2hrs), Q 1hr x 16hrs
What is the frequency of VS and neuro checks following Tenecteplase administration
Goal of SBP <160
What is the blood pressure goal for SDH and traumatic SAH/ICH
When blood extravasates across the disrupted blood brain barrier into tissues
What is hemorrhagic conversion
Full NIHSS at assumption of care, Q 4hrs and prn. SNAP Q 4hrs (to alternate with NIHSS) = neuro checks every 2hrs.
What is the frequency of neuro checks 24hrs after TNK or pt who did not receive thrombolytic
10 units of cryoprecipitate (infused over 10-30 min), Tranexamic acid100mg IV (infused over 10min), consider platelet transfusion
What is the reversal agent for TNK
Mannitol or 3% NS STAT
What is the treatment for high ICP
HOB elevated, IV osmotic diuretics, hyperventilation to PC02 of 26-30
What is a posterior stroke, emergent treatment for cerebral edema
Every one hour until discontinued or modified by provider (even if order is missing).
What is the frequency of neuro checks and VS for head bleed patients