UNION HOSPITAL EMERGENCY DEPARTMENT
COMPETENCY EVALUATION
Tissue Plasminogen Activator (tPA) for Ischemic Stroke
Name ______Title ______Unit ______Date______
Competency Statement: / Primary Method of Assessment:Verbalizes and demonstrates the ability to manage a patient receiving tPA for stroke / 1. Verbalizes
2. Demonstrates
Performance Criteria / Met / Retraining
Needed / Met after
Retraining / N/A
1. Lists all signs and symptoms of a stroke
2. What are the treatment options available for strokes
<3 hrs and strokes > 3hrs from onset?
3. What are the UH Stroke Team’s time guidelines for acute stroke care?
4. What labs would you draw on a Stroke Alert patient and how are these tubes sent to the lab?
5. What is the maximum B/P for safe tPA administration?
6. Where would you find the tPA dosing card to double-
check the dose received from pharmacy?
7. Based on the patient’s weight (will be given to you),
what is the waste, bolus, and infusion dose of tPA?
8. Using the same tPA tubing, what is hung after tPA is
infused, how much should be infused, and why?
9. What is the frequency of NIHSS,B/P, P, and RR
post-tPA for the first 24 hrs?
10. List the signs and symptoms of an intracranial
hemorrhage
Dev 10/10 KM
Recommendations: Competent to perform: Yes No
Needs more: practice study instructions
Reassessment date (within 1 month): ______
Comments:______Evaluator:______
Tissue Plasminogen Activator (tPA) for Ischemic Stroke
Competency Review Module
1. List all signs and symptoms of a stroke
A sudden onset of:
· weakness, numbness or paralysis, especially on one side
· dizziness, loss of balance, or coordination
· speech difficulty, trouble speaking or understanding
· headache with no known cause
· vision problems
2. What are the treatment options available for an ischemic stroke <3 hrs and an ischemic stroke > 3hrs from onset?
· The only FDA approved treatment option available for an ischemic stroke < 3 hrs from onset is intravenous tPA. Within 3-6 hrs from onset, intra-arterial tPA can be given at a comprehensive stroke center. Up to 8 hrs after onset, the Merci Retriever or Penumbra can be utilized to recover the blood clot.
3. What are the UH Stroke Team’s time guidelines for acute ischemic stroke
· Door to CT = 20 min
· CT to interpretation= 45 min
· Door to Drug = 60 min
4. What labs would you draw on a Stroke Alert patient and how are these labs sent?
· Labs required for a Stroke Alert patient include CBC, CMP, PT, PTT, and Finger stick Glucose. Possibly also a UA, HCG.
5. What is the maximum B/P for safe tPA administration?
· 185/110
6. Where would you find the tPA dosing card to double-check the tPA dose
received from pharmacy?
Stroke Folders
7. Based on the patient’s weight (will be given to you), what is the waste, bolus,
and infusion dose of tPA? (you may use the tPA dosing card for this criteria)
· tPA dose for any patient is 0.9 mg/kg with max dose of 90 mg
· tPA is packaged as 100 mg/100 ml (1mg / 1ml)
· Example: Patient weighs 100 kg
· Patient will require 90 mg of tPA = 90 ml
· Waste = 10 mg = 10ml (will be done by pharmacy)
· Bolus = 10% of total patient dose = 9 mg = 9 ml (over one minute)
· Infusion = 81 mg = 81ml (over one hour on IV pump)
· Remember someone must call and notify pharmacy when a potential tpa candidate arrives and call back with treatment decision
8. Using the same tPA tubing, what is hung after tPA is infused, how much
should be infused, at what rate should it infuse, and why?
· Using the same tPA tubing, normal saline 100 ml is hung without changing the rate on the IV pump until at least 50 ml of saline has infused. The IV tubing contains 17.3 ml of tPA that must infuse in the patient for the patient to receive the correct dose.
9. What is the frequency of NIHSS, B/P, P, and Resp Rate post-tPA for the first 24
hrs?
· The frequency is Q 15 min x 2 hrs from start of infusion, then Q 30 min x 6 hrs, then Q 1hr x 18 hrs.
10. List the signs and symptoms of an intracranial hemorrhage.
· Any acute neurological change which can include new or worsening headache, acute hypertension, nausea, and/or vomiting.
Tissue Plasminogen Activator (tPA) for Ischemic Stroke Name:______
Competency Review Module Employee #:______
Date:______
1.List all signs and symptoms of a stroke
2. What are the treatment options available for an ischemic stroke <3 hrs and an ischemic stroke > 3hrs from onset?
3. What are the UH Stroke Team’s time guidelines for acute ischemic stroke
4. What labs would you draw on a Stroke Alert patient and how are these labs sent?
5. What is the maximum B/P for safe tPA administration?
6. Where would you find the tPA dosing card to double-check the tPA dose
received from pharmacy?
7. Based on the patient’s weight (will be given to you), what is the waste, bolus,
and infusion dose of tPA? (you may use the tPA dosing card for this criteria)
Weight 100 KG
8. Using the same tPA tubing, what is hung after tPA is infused, how much
should be infused, at what rate should it infuse, and why?
9. What is the frequency of NIHSS, B/P, P, and Resp Rate post-tPA for the first 24
hrs?
10. List the signs and symptoms of an intracranial hemorrhage.