NR 340Critical Care SiM

1. Family-centered care is the concept of treating the patient and family as an inseparable entity, recognizing that illness or injury of one family member invariably affects all other family members. Allowing family members to be involved in plan of care of patient. 2. Ischemic stroke Thrombolytic candidates Early thrombolysis is recommended when possible. rt-PA is the only approved therapy for acute ischemic stroke and must be given within 3 hours of symptom onset.20 Administration after 3 hours has not shown to be beneficial and increases the risk for hemorrhagic transformation of the infarct. Unfortunately, only about 5% of eligible patients actually receive the treatment.20 rt-PA does not affect the infarcted area, but by lysing the clot, it revitalizes the ischemic penumbra and improves overall neurological function. Careful assessment of patients potentially eligible for thrombolytic therapy must be made. Before the administration of rt-PA, two peripheral IV lines are inserted—one for the administration of rt-PA and one for fluids. Any catheters that are needed (e.g., urinary catheters, nasogastric tubes) are ideally placed before the administration of rt-PA to reduce the risk for bleeding. After the administration of rt-PA, invasive procedures may be performed; however, the risk of bleeding is higher. Anticoagulants, such as heparin or warfarin, and