Neuro 4

Question 1

4 inclusion criteria for tPA

Answer 1

-18-80 yo
-acute ischemic stroke
-no significant improvement before tx
-present w.in 4.5 hr of last seen normal

Question 2

exclusion criteria for tPA (lots)

Answer 2

-hemorrhagic stroke
-time of sx unknown
-improvement of sx
-sz + stroke
-head trauma in past 3 mo
-previous stroke + DM
-heparin w.in past 48 hr
-platelet < 100,000
-sbp > 185
-dbp > 110
-aggressive tx needed to get bp parameters
-bg < 50 or > 400
-sx suggestive of SAH even if CT normal
-oral anticoagulant use
-major trauma or surgery in past 3 mo
-bleeding disorder

Question 3

before tPA, you can lower bp by a max of __

Answer 3

10%

Question 4

2 meds used to lower bp

Answer 4

lebatalol
nacardipine

Question 5

imaging for stroke work up

Answer 5

MRI head and neck with contrast
EKG

Question 6

complete neuro/vitals assessment guidelines after tpa administration

Answer 6

q 15 minutes x 2 hr
q 30 min x 6 hours
q 1 hr x 16 hours

Question 7

what do you need to do for stroke pt before giving PO meds

Answer 7

swallow study

Question 8

bp guidelines for tPA

Answer 8

sbp < 185
dpb < 110

Question 9

bg exclusion guidelines for tPA

Answer 9

< 50
OR
> 400

Question 10

platelet exclusion criteria for tPA

Answer 10

< 100,000

Question 11

heparin exclusion criteria for tPA

Answer 11

w.in past 48 hr

Question 12

always do __ in primary survey for stroke pt

Answer 12

BG check

hypoglycemia is a major stroke mimic

Question 13

plan for stroke pt (5)

Answer 13

stroke alert
neuro consult
tPA if meeds inclusion criteria
swallow study
frequent monitoring