Template for plan of management (Ischemic Stroke after tPA)
Stroke acute management:
- Admit to stroke unit
- Frequent neuro-checks (q15min for 4h then q1h for 24h then q4h)
- Permissive HTN up to SBP 180
- Baseline EKG and CXR
- Basic labs: CBC,CMP, coagulation panel and troponin
- Intravenous hydration with normal saline at 75cc per hour
- Patient passed the bedside swallow eval, started on dysphagia diet. ***
- Head of bed > 30 degrees for aspiration prevention and aspiration precautions ordered.
After tPA administration (Started at ------):
>Neurochecks: Every 15 mins x two hours, then every 30 mins x6 hours, then every hour x 16 hours.
>No foley removal or placement for 24 hours
>No venous/arterial puncture at non-compressible site
>No anticoagulation or anti-platelet agents for 24 hours
>Cardene drip as needed to keep BP < 180/105
-Continuous cardiac telemetry to monitor for arrhythmia
-Stroke labwork: HgbA1C, lipid panel, urine drug screen
Secondary prevention of stroke:
-Aspirin 325mg daily will be started 24h after tPA
-Atorvastatin 40 mg daily (long-term goal LDL < 70)
-Tight glucose control (long-term goal HgbA1c < 6%)
-Stroke education and counseling
-Rehabilitation: physical therapy, occupational therapy, speech therapy consults
-Consulted social work and case management for help with discharge
Other medical issues:
Prophylaxis: SCDs (DVT), will start heparin 24h after tPA, famotidine, docusate (GI)
Patient was discussed with the stroke attending, will be formally staffed in morning rounds.
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