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NIH Stroke Scale & Tips For tPA: Ahren Dosch, M.S., RN Stroke Coordinator Essentia Health - Fargo

This document discusses the NIH Stroke Scale (NIHSS) and provides tips for administering intravenous tissue plasminogen activator (tPA) to treat acute ischemic stroke. It defines the NIHSS as a systematic tool to assess stroke severity and predict outcomes. It also outlines who is eligible for tPA based on time of last known well and criteria. Guidelines are provided for mixing, administering, and closely monitoring tPA to watch for side effects. The importance of thorough hand-off communication between emergency medical services and receiving hospitals is stressed.

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163 views17 pages

NIH Stroke Scale & Tips For tPA: Ahren Dosch, M.S., RN Stroke Coordinator Essentia Health - Fargo

This document discusses the NIH Stroke Scale (NIHSS) and provides tips for administering intravenous tissue plasminogen activator (tPA) to treat acute ischemic stroke. It defines the NIHSS as a systematic tool to assess stroke severity and predict outcomes. It also outlines who is eligible for tPA based on time of last known well and criteria. Guidelines are provided for mixing, administering, and closely monitoring tPA to watch for side effects. The importance of thorough hand-off communication between emergency medical services and receiving hospitals is stressed.

Uploaded by

Y-F K46 Le Thi Dep
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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NIH Stroke Scale &

Tips for tPA


Ahren Dosch, M.S., RN
Stroke Coordinator
Essentia Health – Fargo
Stroke & Neurovascular Center
Outline
• Define the NIHSS and understand its role in
stroke assessment
• Break down the NIHSS into more easily
understandable terms
• Identify helpful tips for IV tPA administration in
acute ischemic stroke
NIHSS
• National Institute of Health Stroke Scale
(NIHSS)
• Systematic assessment tool
• Predictive of lesion size and measure of severity
• Predictor of short and long term outcome
• Data collection tool for planning patient care
• Provides a common language for healthcare
providers
NIHSS
• “…designed to be a simple, valid, and reliable
tool that can be administered at the bedside
consistently by physicians, nurses or therapists.”
• “…requires less than 10 minutes to complete.”
NIHSS
• 15-item neuro exam stroke scale
1. LOC
2. Language
3. Neglect
4. Visual fields
5. EOM
6. Motor strength
7. Ataxia
8. Dysarthria
9. Sensory loss
NIHSS Demonstration
Tips for tPA
• r-tPA: recombinant tissue plasminogen activator
• alteplase (generic name)
• Only drug approved by the FDA for treatment of
acute ischemic stroke
How does it work?

Alteplase: Mechanism of Action

Source: cathflo.com
Who can receive it?
• FDA approved for acute ischemic stroke
Last Known Well (LKW) ≤ 3 hours ago
• Research shows effectiveness: ≤ 4.5 hours LKW
for patients less than 80 years old
• Inclusion / Exclusion criteria
How to mix
• Calculate dose (double check)
• Total dose not to exceed 90mg
• 0.9 mg/kg
• 10% of total dose given as IV bolus (push over 1
minute)
• Remaining 90% given as IV drip (infuse over 1
hour)
Monitoring your patient
• Watch closely for:
1. Decline in LOC, sudden neuro deterioration
2. Sudden rise in BP
3. New headache
4. Nausea / vomiting
• In any of above noted, STOP infusion
immediately and notify provider!
Vital Signs & Neuro Checks
• Monitor closely:
 Obtain baseline before giving drug, then
 Every 15 min x 2 hours, then
 Every 30 min x 6 hours, then
 Every 1 hour x 16 hours
______________________________________________

 24 hours close VS & neuro checks


• Use Flowsheets provided in ND Acute Stroke
Treatment Guideline packet
• Send with EMS providers!
Drip and Ship
EMS Providers
• Continue close VS and Neuro checks
• Document on flowsheet provided in
ND Acute Stroke Treatment Guideline packet
• Hand off packet to receiving hospital for
accurate, continued monitoring
Hand-Off Communication
• What’s the story?
• LKW
• NIHSS
• Describe the deficits
• Meds: what was given at what time?
• Imaging (head CT result)
• Family contact info (provide cell phone #s)
Key Points
• Quick NIHSS
• IV tPA:
– Appropriate candidates
– Mechanism of action
– Tips for mixing
– Monitoring and documentation
– Hand-off communication
Questions

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