Pharmacological and Parenteral Therapies Q 108
A client has an order for streptokinase. Before administering the medication, the nurse should assess the client for:
A. A history of streptococcal infections
B. Allergies to pineapples and bananas
C. Prior therapy with phenytoin
D. A history of alcohol abuse
Correct Answer: A history of streptococcal infections
Clients with a history of streptococcal infections could have antibodies that render the streptokinase ineffective. Due to streptokinase’s thrombolytic mechanisms of action, patients need monitoring for bleeding. The patient’s thrombin time, prothrombin time, partial thromboplastin time, complete blood count, and any signs of bleeding demand careful surveillance. Patients also need monitoring for signs and symptoms of reinfarction or vessel occlusion.
Option B: There is no reason to assess the client for allergies to pineapples or bananas. Streptokinase can precipitate an allergic reaction. Symptoms include fever, shivering, and rash. Patients in rare instances have developed nonfatal anaphylactic reactions. In cases of anaphylaxis, patients should be administered epinephrine immediately and discontinue streptokinase therapy. The toxicity of streptokinase is believed to be because it is a polypeptide derivative of beta-hemolytic streptococci bacteria.
Option C: There is no correlation to the use of phenytoin and streptokinase. The thrombolytic nature of streptokinase makes it contraindicated in patients with active internal bleeding, as it can worsen bleeding in some patients. It is also contraindicated in patients with severe uncontrolled hypertension, intracranial neoplasms, surgery within two months, recent stroke, and intraspinal surgery.
Option D: A history of alcohol abuse is also not a factor in the order for streptokinase. Streptokinase administered with extreme caution to those who have experienced recent trauma, coagulopathies or hematologic diseases, gastrointestinal bleeding, infective endocarditis, obstetric deliveries, diabetic hemorrhagic retinopathy, organ biopsies, or previous puncture of a non-compressible vessel. Streptokinase is a pregnancy Category C medication. The effects of streptokinase on a fetus are unknown, and patients who are pregnant should only receive streptokinase to prevent life-threatening injury.