A client arrives in the emergency department with an ischemic stroke and receives tissue plasminogen activator (t-PA) administration. Which is the priority nursing assessment?
A. Time of onset of current stroke
B. Complete physical and history
C. Current medications
D. Upcoming surgical procedures
Correct Answer: A. Time of onset of current stroke
The time of onset of a stroke to t-PA administration is critical. Administration within 3 hours has better outcomes. Tissue plasminogen activator (tPA) is classified as a serine protease (enzymes that cleave peptide bonds in proteins). It is thus one of the essential components of the dissolution of blood clots. Its primary function includes catalyzing the conversion of plasminogen to plasmin, the primary enzyme involved in dissolving blood clots.
Option B: A complete history is not possible in emergency care. For the management of acute myocardial infarction in adults, administer alteplase as soon as possible after the onset of symptoms. The patient’s weight determines the dose to be administered, which is not to exceed 100 mg irrespective of the selected administration method (accelerated infusion preferred by the AHA/ACCA or slower, 3-hour infusion as per manufacturer’s labeling).
Option C: Current medications are relevant, but the onset of current stroke takes priority. Monitor closely with any drug that causes anticoagulation as there is an increased risk of bleeding. Through pharmacodynamic synergism, defibrotide increases the effects of tPA drugs and is thus contraindicated. Prothrombin complex concentrate, human can cause pharmacodynamic antagonism of the tPA drugs. Nitroglycerin could decrease the serum concentration of tPA drugs. Salicylates could enhance the toxic effects of thrombolytic drugs. Monitor therapy, as there is an increased risk of bleeding.
Option D: Upcoming surgical procedures will need to be delayed if t-PA is administered. tPA is a thrombolytic (i.e., it breaks up blood clots) formed by aggregation of activated platelets into fibrin meshes by activating plasminogen. More specifically, it cleaves the zymogen plasminogen at its Arg561-Val562 peptide bond to form the serine protease, plasmin. Plasmin, an endogenous fibrinolytic enzyme, breaks the cross-links between fibrin molecules, which are the structural support of the blood clot, and its activity is extremely short-lived.
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