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48+ Hours after Alteplase: SBAR Report – Stroke Nursing Care in ICU

by Rhonda Lawes

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    00:01 Sweet. We made it through the first 24 hours. Now, for 48 hours plus after alteplase, this is the goals we're going to look for Mr. Johnson's care.

    00:11 Good news. Mr. Johnson's blood pressures remain consistently 140/50 mm Hg systolic and 90/98 mm Hg diastolic.

    00:18 Sweet. His facial drooping has resolved. That is awesome. I told you this drug is really beautiful when it works. He's still got some right-sided weakness of his arm and leg, but we're seeing some improvement, so that's pretty exciting. Shortly after he came to ICU, he spontaneously converted from atrial fibrillation to sinus rhythm/ sinus tachycardia, and he's now in sinus rhythm. Man, Mr. Johnson, you're like a rock star patient that we got going on there. His blood pressure is good.

    00:47 His facial drooping is resolved. He still has some right-sided weakness, but we can work with that. That's some physical therapy. We can get on top of that.

    00:56 After he came into ICU, he went from atrial fibrillation -- remember, that's a -- That's the atrium that kind of quivers and isn't really efficient at completely contracting and pushing all that blood out.

    01:08 People in atrial fib are at an increased risk for a clot to break loose from that atrium, and to travel through to the brain, which is likely what happened with Mr. Johnson. So, now that he's out of that rhythm, he spontaneously converted to sinus rhythm.

    01:24 And that's the pretty rhythm, right? That's the normal rhythm.

    01:27 The only difference between sinus rhythm and sinus tach is the rate.

    01:32 So you've got a beautiful P wave, QRS, just sinus rhythm. It's < 100, sinus tach is > 100. Now he's in sinus rhythm. So I'm telling you, So I'm telling you, I wish everybody's stay went this way.

    01:46 So the healthcare provider has written transfer orders for the Med-Surg unit.

    01:50 He is ready to go. Now before we move forward, think about why did Mr. Johnson have to come to ICU in the first place? Yeah, he needed very close monitoring for complications from the stroke or from the thrombolytic therapy. So we're watching his blood pressures, neuro status very closely. Now, what things make him eligible or stable enough to go to Med-Surg? Everything we just talked about here.

    02:16 His blood pressure is stable, his neuro status is better, and he's not showing us signs of deteriorating, and now he's now in a normal heart rhythm. So it's very appropriate for the healthcare provider to write orders to transfer to Med-Surg. See, that's another part of our role as an ICU nurse is to help identify patients that are ready to safely be transferred and patients that need to stay.

    02:39 That's another example of when you would use SBAR. When you're communicating with a physician about the patient's need to stay on the unit for further monitoring or to be transferred to a -- we call it a lower-level care, but it's really a different level of care, because every level of care is an area of specialty. So now your job is to practice in SBAR.

    03:01 You, from the role of the ICU nurse, wants you to get prepared to give report in an SBAR format for the Med-Surg nurse. So, pause the video, you can use our script to help remind you of the things that go with situation, background, assessment, and recommendation.

    03:19 And then we'll come back and I'll give you an example of what you could have said in your SBAR.

    03:27 Welcome back. Okay, I hope you took advantage of this opportunity because by you doing the hard work now, you're going to be that much better and effective as a nurse communicator in your own practice. Now, we've provided for you an example, an idea of what you could have said in your SBAR.

    03:43 Take our example and compare your answers to what you see on the screen.

    03:47 This will give you an idea of things that you could have said as a nurse in preparing to give report and pursuing continuity of care with the next level in Med-Surg.


    About the Lecture

    The lecture 48+ Hours after Alteplase: SBAR Report – Stroke Nursing Care in ICU by Rhonda Lawes is from the course Neurology Case Study: Nursing Care of Stroke Patient.


    Included Quiz Questions

    1. Situation, background, assessment, recommendation
    2. Setting, briefing, analysis, reiterate
    3. Staging, breach, awareness, recognize
    4. Status, biographical, appraisal, redirect
    1. Past the first 24 hours post alteplase administration
    2. Blood pressure controlled within parameters
    3. Stable and consistent
    4. All symptoms of stroke resolved
    5. The client should not be transferred out of the ICU until time of discharge.

    Author of lecture 48+ Hours after Alteplase: SBAR Report – Stroke Nursing Care in ICU

     Rhonda Lawes

    Rhonda Lawes


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