During tissue plasminogen activator (tPA) administration for acute ischemic stroke, which action should the nurse prioritize?

• A. Frequent neurologic assessments to monitor for intracranial hemorrhage
• B. Administer additional analgesia as needed
• C. Document intake and output every 8 hours
• D. Initiate physical therapy immediately

Answer: (A)

Close neurologic monitoring is the top priority during tPA administration for an acute ischemic stroke because this treatment dissolves clots but markedly increases the risk of intracranial hemorrhage. The most important sign to watch for is a sudden change in neurologic status—new or worsening weakness, aphasia, decreased levels of consciousness, or a severe new headache—that could indicate bleeding in the brain. Detecting these changes early allows immediate intervention, which is crucial to improve outcomes and prevent catastrophic damage.

Analgesia needs may arise, but they don’t address the central danger of bleeding. Recording intake and output is important for overall care, yet it does not directly prevent or detect a life-threatening hemorrhage during the critical infusion period. Initiating physical therapy right away is inappropriate during thrombolytic therapy because it can increase bleeding risk and destabilize the patient; therapy is typically delayed until the patient is stable and the risk window has passed.

In short, vigilant, frequent neurologic assessments during and after tPA infusion are essential to catch intracranial hemorrhage early and ensure prompt management.