nurs212 code brain attack
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TRANSCRIPT
- 1. Code Brain Attack Good Samaritan Hospital Written by: Diane King, Staff Nurse IV RN, MS, PHN, CEN
- 2.
- Goals and Objectives
- Goals
- By the end of this presentation will be able to describe:
- Basic stroke facts.
- Types of stroke.
- How staff members affect patient outcomes.
- Roles and responsibilities of primary nurse during. patient management.
- 3. Goals and Objectives
- Objectives
- What will learn and skills aught in this training deliver significant improvement in areas such as:
- Performance-Clinical implications of relevance.
- Productivity-Time lost is brain lost.
- Teamwork-Calling a brain attack, EKG, CT, Lab work, etc.
- Change Management-Agreement with other team members when patient situations change or resolve.
- Quality-Productive processes that are eagerly implemented, such as door to t-PA time 110 (antihypertensive treatment OK)
- Pregnancy, lactation, or parturition (childbirth) within previous 30 days
- 23. t-PA Inclusion/Exclusion
- Relative Contraindications:
- History of intracranial hemorrhage
- History of major trauma in the last 2 weeks
- Seizure at onset of stroke
- Active bacterial endocarditis
- 24. t-PA Administration
- Goal is door to t-PA time < 1 hour
- 25. t-PA Administration
- NIH stroke scale upon ER admission
- and prior to t-PA
- Establish 2 IV lines
- Primary line for t-PA
- Connect directly to IV tubing to infuse via pump
- Do not use t-PA as piggyback bag with
- .9NS as primary bag. Flush after t-PA is complete.
- 26. t-PA Administration
- Make sure that no other solutions or medications are running through t-PA line.
- Secondary line with .9NS
- Obtain established or actual body weight in kg
- Complete Inclusion/Exclusion criteria for t-PA
- 27. t-PA Administration
- Total dose (weight in _kg x 0.9 mg
- = total dose. Not to exceed 90 mg
- t-PA bolus 10% of total calculated dose given IV push over 1 minute
- t-PA remainder dose infused via separate pump/separate channel over 60 minutes
- 28. t-PA Administration
- Insert catheter tip into port closest to IV insertion site
- Visual confirmation of t-PA infusion every 15 minutes until infusion complete
- When t-PA infusion complete, follow with 50 ml .9NS at t-PA infusion rate through t-PA tubing
- 29. t-PA Administration
- Patient Management
- Patient to be staffed 1:1 ratio while in ER
- Vital signs TPR/BP, neuro checks every 15 minutes for 2 hours, then every 30 minutes
- No automatic BPs to be used until 24 hours after t-PA
- NIHSS every shift and STAT for significant changes
- 30. Time Clock
- The time clock should be started when the brain attack is called. The goal is door to t-PA time