Medical Surgical Stroke #5

Question

A client was brought into the ER for a stroke, but did not receive tissue plasminogen activator (tPA). Which answer below is the best rationale for this?

Answers

  1. The client is on aspirin therapy
    • Rationale:

      This answer is not correct since there is no association between aspirin therapy and tPA treatment. Although the antiplatelet properties of aspirin can make bleeding worse in hemorrhagic strokes, it is not the best rationale as to why the client did not receive tPA.

  2. The client was brought in 4 hours after symptom onset
    • Rationale:

      This answer is not correct because the client was within the window of treatment for administration of tPA. TPA should be administered no longer than 3 to 4.5 hours of symptoms onset for a more positive outcome.

  3. The client experienced an ischemic stroke
    • Rationale:

      This answer is not correct because the most effective treatment for ischemic stroke is tPA. It is given intravenously to dissolve the blood clot causing the stroke.

  4. The client experienced a hemorrhagic stroke
    • Rationale:

      This answer is correct because a hemorrhagic stroke is caused by a weak blood vessel that ruptures and bleeds into the brain. TPA is a thrombolytic and works by dissolving clots to restore perfusion to the brain after a stroke. Since tPA resolves clots, it is not given because it will make the hemorrhage worse.

Overview

Tissue plasminogen activator (tPA) is a drug given intravenously that dissolves blood clots in ischemic strokes. It is contraindicated in clients having hemorrhagic strokes due to worsening of the bleeding.

Explanation

Learning Outcomes

A hemorrhagic stroke is caused by a weak blood vessel that ruptures and bleeds into the brain. Two types of hemorrhagic strokes are intracerebral (within the brain) and subarachnoid (surrounding the brain). TPA is a thrombolytic and works by dissolving clots to restore perfusion to the brain after a stroke. Hemorrhagic strokes are not clots, they are vessels that have ruptured. Giving tPA to a client experiencing hemorrhagic stroke will make the hemorrhage worse. Data reveals it is most effective if given within 3 to 4.5 hours of symptom onset of an ischemic stroke. Strict blood pressure monitoring is necessary during and after administration of tPA due to the risk of intracranial hemorrhage within the first 24 hours of tPA administration.

Test Taking Tip

Know the parameters of when to give tPA and the time-frame with the most effective outcome. Understanding the difference between an ischemic and hemorrhage stroke.

Video Rationale