70 Transient Ischemic Attack
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Transient Ischemic Attack
1. Admit to:
2. Diagnosis: Transient ischemic attack
3. Condition:
4. Vital signs: q1h with neurochecks. Call physician if BP >160/90, <90/60; P
>120, <50; R>25, <10; T >38.5
C; or change in neurologic status.
5. Activity: Up as tolerated.
6. Nursing: Guaiac stools.
7. Diet: Dysphagia ground with thickened liquids or regular diet.
8. IV Fluids: Heparin lock with flush q shift.
9. Special Medications:
-Aspirin 325 mg PO qd OR
-Clopidogrel (Plavix) 75 mg PO qd OR
-Ticlopidine (Ticlid) 250 mg PO bid OR
-Heparin (only if recurrent TIAs or cardiogenic or vertebrobasilar source for
emboli) 700-800 U/h (12 U/kg/h) IV infusion without a bolus (25,000 U in
500 mL D5W); adjust q6-12h until PTT 1.2-1.5 x control.
-Warfarin (Coumadin) 5.0-7.5 mg PO qd for 3d, then 2-4 mg PO qd. Titrate
to INR of 2.0-2.5.
10. Symptomatic Medications:
-Ranitidine (Zantac) 150 mg PO bid.
-Docusate sodium (Colace) 100 mg PO qhs.
-Milk of magnesia 30 mL PO qd prn constipation.
11. Extras: CXR, ECG, CT without contrast; carotid duplex scan, echo-
cardiogram, 24-hour Holter monitor. Physical therapy, neurology consults.
12. Labs: CBC, glucose, SMA 7&12, fasting lipid profile, VDRL, drug levels,
INR/PTT, UA.
Subarachnoid Hemorrhage
Treatment:
-Stat neurosurgery consult.
-Head of bed at 20 degrees, turn patient q2h, range of motion exercises qid,
Foley catheter, eggcrate mattress. Guaiac stools.
-Keep room dark and quiet; strict bedrest. Neurologic checks q1h for 12
hours, then q2h for 12 hours, then q4h. Call physician if abrupt change in
neurologic status.
-Restrict total fluids to 1000 mL/day; diet as tolerated.
-Nimodipine (Nimotop) 60 mg PO or via NG tube q4h for 21d, must start
within 96 hours.
-Phenytoin (seizures) load 15 mg/kg IV in NS (infuse at max 50 mg/min), then
300 mg PO/IV qAM (4-6 mg/kg/d).
Hypertension:
-Nitroprusside sodium, 0.1-0.5 mcg/kg/min (50 mg in 250 mL NS), titrate to
control blood pressure.
