Page 261 - Critical Care Nursing Demystified

246 CRITICAL CARE NURSING DeMYSTIFIED

receive thrombolytic therapy if it can be provided within a 3-hour time frame
from the onset of symptoms and if a CAT scan is negative for hemorrhage. t-PA
is given initially as an intravenous bolus over 1 minute and the remainder of the
maximum dosage of 90 mg is infused over 1 hour. The recommended dosage is
0.9 mg/kg. Thrombolytic therapy acts by degrading the fibrin that is present in
clots. Therefore, a complication of thrombolytic therapy can be active internal
bleeding and an increase in CNS hemorrhaging. Other treatment modalities might
include carotid endarterectomy, embolectomy, or angioplasty. Medications such as
steroids, barbiturates, and antihypertensives can be used to treat stroke victims.

Prognosis
The degree of recovery varies according to the amount of stroke insult suffered
by the individual. Residual damage such as paralysis and difficulty speaking
may forever alter the quality of life and lifestyle of the patient.

1 and 4 Nursing Diagnosis Expected Outcomes
Risk of aspiration related to Patient will be able to cough, chew, and
dysphagia swallow unimpeded
Patient will maintain clear lung sounds Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Nursing Interventions
Assess lung sounds.
Turn and position frequently.

Maintain patient in an upright position at mealtimes.
Monitor oral secretions.
Provide adequate hydration to promote moist secretions.
Maintain a patent airway and provide suctioning if needed.
Provide good oral hygiene.
Assess for adequate chewing, swallowing, and pocketing of food.

Provide a mechanical soft diet for easier chewing, swallowing, and digestion.
Allow sufficient time to complete meals in an unhurried manner.

Hemorrhagic Stroke

What Went Wrong?
Six to seven percent of all CVAs occur as a result of an SAH or subarachnoid
hemorrhage, which is bleeding into the subarachnoid space usually from rupture