Question

Before the client can become a candidate for TPA, what information is important for the nurse to gather in the emergency room?

Upon the admission of to the emergency room what areas would be addressed in the initial nursing assessment of the client with a Cerebrovascular accident?

Answer 1

The information which has to be collected by the nurse in the emergency room before the client becomes the candidate for TPA are

• Any allergic history
• History of any illness like diabetes, recent stroke, surgery,head trauma
• Any medications like blood thinner
• The symptoms should be less than three hours for effective treatment
• Age of client (>18<80)

The areas which has to be addressed in the initial nursing assesment of the client with CVA are

• Check for airway , breathing because of increased risk for obstruction and no gag reflex
• Assess the pupil size because it can reveal any changes in the cranial nerve
• Focused assesment on neurological status
• Chief complaints
• Family history, smoking, alcohol, substance abuse
• Assess for nausea and vomiting
• Mental status examination
• Pain assessment
• Psychosocial and cultural understanding.