Admission order, TPA not given
- Admit to Critical care bed, notify Neurologist of Room #
- Telemetry
- Diagnosis: Acute stroke, TPA NOT given
- Diet: NPO for 24 hours except medication and small amount of water
- If unable to swallow, place NG
- Notify Neurologist if change in neurological status or bleeding
- Activity: Bedrest for 24 hours, bed rail up
- SCD both legs
- Aspirin 325 mg now then one daily
- Speech therapy evaluation asap
- Physical therapy, Occupational therapy evaluation
- Social Service tomorrow: discharge planning
BP and Neuro check:
- every 15 minutes x 2 hours
- every 30 minutes x 6 hours
- every 60 minutes x 16 hours
For Systolic >220 mm Hg or diastolic >120 mm Hg
- Labetalol 10 to 20 mg IV over 1 to 2 minutes, may repeat x1
- or Nitropaste 1 to 2 inches
- or Nicardipine infusion, 5 mg/h
- Blood pressure may need to be less than above limits
if patient has active ischemic coronary disease, heart failure,
aortic dissection, hypertensive encephalopathy, acute renal failure,
or pre-eclampsia/eclampsia.
- When treatment is indicated,
cautious lowering of blood pressure by approximately 15 percent
during the first 24 hours after stroke onset
- If blood pressure still not controlled, call physician
Other medical illnesses
- Diabetes: sliding scale insulin
- Infection: cultures, antibiotics
- Fever: Acetaminophen, cooling blanket
- Volume depletion: IV fluid
- Respiratory problem: treatment
- Atrial fibrillation: control rate, do not start IV Heparin
(Delete or cross out those not needed)
- Carotid doppler
- MRA of head
- Echocardiogram