Pharmacological and Parenteral Therapies Q 85
A client with myocardial infarction is receiving tissue plasminogen activator, alteplase (Activase, tPA). While on the therapy, the nurse plans to prioritize which of the following?
A. Observe for neurological changes
B. Monitor for any signs of renal failure
C. Check the food diary
D. Observe for signs of bleeding
Correct Answer: D. Observe for signs of bleeding
Bleeding is the priority concern for a client taking thrombolytic medication. The primary mechanism of all thrombolytics is the conversion of plasminogen to the active form, plasmin, which then degrades fibrin. This proteolysis can occur with fibrin-bound plasminogen on the surface of thrombi and the unbound form within the plasma. The unbound plasmin generated degrades fibrin but also fibrinogen, factor V, and factor VIII.
Option A: During therapy, perform a neurologic assessment every 15 minutes during the 1-hour infusion. After therapy, check every 15 minutes for the first hours after cessation of infusion, then every 30 minutes for the next 6 hours.
Option B: Although current guidelines do not include renal dysfunction as a contraindication to tPA therapy, some clinicians hesitate to administer tPA because of a tendency of bleeding in these patients.
Option C: Having a food diary is not related to the use of medication. Thrombolytic therapy is indicated in patients with evidence of ST-segment elevation MI (STEMI) or presumably new left bundle-branch block (LBBB) presenting within 12 hours of the onset of symptoms if there are no contraindications to fibrinolysis.