Quality Point of View on Nursing Care of Patients on Thrombolytic Therapy

This is focusing on how Nursing Quality can deal with Thrombolytic  Patients …

Thrombolytic Therapy Definition – also known as Thrombolysis, is a treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs. Thrombolysis may involve the injection of clot-busting drugs through an intravenous (IV) line or through a long catheter that delivers drugs directly to the site of the blockage. Thrombolysis is often used as an emergency treatment to dissolve blood clots that form in arteries feeding the heart and brain.

From Quality Department point of view a registered nurse should (Nursing Quality):

• Assess and record baseline data i.e. vital signs, skin color, and temperature; CNS: orientation, reflexes; CVS: peripheral perfusion.
• Review medical history for existing or previous conditions that:
  • Require cautious use of thrombolytic agents
  • Contraindicate use of thrombolytic agents
• Ensure that one-nurse remains at patient’s bedside observing the patient during the administration of a thrombolytic agent.
• Establish minimum two peripheral venous lines, with gauge #18 or gauge #20 cannula prior to the administration of a thrombolytic agent.
• Arrange for ECG and lab work before starting thrombolytic therapy.
• Ensure emergency trolley is at bedside and ready for use.
• Follow thrombolytic therapy standing order once it is filled, signed, stamped and timed by the Medical resident on duty.
• Monitor patient for vital signs every 15 minutes during the therapy and then hourly.
• Monitor patient for any potential internal or external bleeding.
• Monitor patient for any signs of allergic reactions and inform doctor promptly.
• Avoid arterial invasive procedures and IM injections before and during the therapy.
• Maintain patient on bed rest during the entire course of therapy and avoid handling patient unnecessarily because bruising occurs readily.
• Document appropriately in the Nurses’ Progress Notes and other adjunct/relevant forms.