Evaluation of Patients’ Nursing Care Outcomes Following Thrombolytic Therapy – a Retrospective Study

Introduction. Nursing documentation is an indicator of healthcare quality. After extensive data analysis, it has been shown that nursing documentation has become an assessment tool and a tool to change clinical practice. Stroke is the most significant individual cause of disability in the adult population. In instances of ischemic stroke, brain circulation is abruptly disconnected. Causes of this break in blood flow may be blockage or compression of blood vessels due to thrombosis, embolism or systemic hypoperfusion. Therapy administered in cases of acute ischemic stroke includes intravenous thrombolytic therapy – recombined tissue activator of plasminogen within 180, i.e. 270 minutes of the stroke. Aim. To determine the quality of outcomes as regards patient care after administering thrombolytic therapy in a display of progress notes of patients’ condition during their stay in the hospital, both before and after administering thrombolytic therapy. Methods. A retrospective study was carried out at the neurology department of „Dr. Ivo Pedišić“ General Hospital in Sisak during 43 months from January 1, 2013 to May 31, 2017. 85 patients participated in the study. Data were obtained from one component of nursing documentation in electronic form, namely progress notes on the patients’ conditions. Results. With a 95% confidence level, a statistically significant difference (p<0.05) was found for parameters of hygiene, feeding, elimination, dressing, walking, moving, sitting, standing, turning, nutrition diet, strain tolerance, Braden scale and categorization, before and after thrombolytic therapy. Statistical significance was not found in the parameters of pain (p=0.067), GCS/ Trauma score scale (p=0.339), risk of fall (p=0.072). Conclusion. The implementation of the healthcare process, continued monitoring of the patient’s condition and progress, as well as validation of nursing activities provide an imperative for the application of nursing documentation as an essential tool in describing regular nursing activities. Application of documentation enables a more permanent insight into a patient’s general state, data availability, care continuity, progress chronology and result evaluation, as well as a material background for professional, expert and scientific development of nurses through studies in the field of nursing. Evaluation of Patients’ Nursing Care Outcomes Following Thrombolytic Therapy – a Retrospective Study Croat Nurs J. 2018; 2(2): 87-97 88 Kurtović J. et al. Evaluation of Patients’ Nursing Care Outcomes Following Thrombolytic Therapy. Croat Nurs J. 2018; 2(2): 87-97 surrounding it. According to localization, we can differentiate bleeding within the cerebral parenchyma when smaller arteries are prone to arteriosclerosis and epidural, subdural and subarachnoid bleeding (11). Stroke is a multi-factor condition caused by a combination of vascular risk factors, the environment and genetic predisposition. Stroke risk factors can be divided into those we have the capacity to influence and those we cannot control (12,13). Stroke presents a medical emergency. Therapy administered in cases of acute ischemic stroke includes intravenous thrombolytic therapy – recombined tissue plasminogen activator within 180, i.e. 270 minutes of the stroke and under the condition it meets the criteria of NIHSS (National Institute of Health Stroke Score) (14-17). Plasmin is an enzyme which dissolves fibrin, a protein which constitutes the main part of the blood clot. In that way circulation is re-established and nerve cells dying prevented. The objective of thrombolytic therapy is to re-establish circulation, i.e. reperfusion of the ischemic area (8). In June 1996 a recombined tissue plasminogen activator (rt-PA) became the first drug approved by the FDA (Food and Drug Administration) for the treatment of stroke. It has been proven that the drug is efficient only within the 180 minutes from the first symptoms, making stroke a medical emergency (18). The short time period to administer the drug demands a fast assessment of patients who are suspected of suffering a stroke. Two-stage research on the utility of the intravenously administered thrombolytic therapy was completed in 1995 and in the same year the results were published in the National Institute of Neurological Disorders and Stroke, (NINDS) in the United States of America (19). Both research stages included 624 respondents who were administered either thrombolytic therapy (0.9 mg/ kg) or a placebo within three hours of the first symptoms. The research showed that the patients who were given thrombolytic therapy had a significantly higher likelihood of functional independence with minimum or no disability within three months of the treatment. The share of patients with minimum or no disability grew from 38 percent of placebo patients to 50 percent of those administered rt-PA, indicating a 12-percent increase in improved condition. Intracerebral haemorrhaging connected to administering rt-PA caused a worse final outcome in only 1 percent of all patients. In total, in every 100 patients treated in the first three hours, 32 had a better outIntroduction In a year, around 17 million people around the world suffer a stroke, with 6 million dying of the consequences caused by a stroke. One third of all stroke survivors have a certain level of temporary disability to function independently on a daily basis, one third recovers and one third stays permanently disabled (1). As many as 1 in 6 persons aged 15-60 are at risk of suffering a stroke (2). Considering population’s aging, it is estimated that by 2020 stroke will be the leading cause of loss of health (3). Stroke is the single largest individual cause of disability in adult population. If a person has already survived a stroke, it is highly likely that a potential second one will either be fatal or cause a high level of disability (4). According to statistical data, every year approximately 750 thousand people suffer a stroke in Europe, and the number is similar in the United States of America. Stroke is a major health issue, not only in developed, but also in developing countries (5). Stroke has been both the leading cause of mortality and the leading cause of disability in the Republic of Croatia in the last few years. Stroke is not only a health problem, it is also a major economic and socio-economic problem. In the Republic of Croatia, about 25 thousand people per year suffer a stroke, and 8 thousand die from a stroke, meaning that alongside coronary conditions, it is one of the leading causes of mortality (6). World Health Organization defines a stroke as “suddenly developing clinical signals of focal or global disruption of cerebral function, with symptoms lasting 24 hours or longer, or leading to death, without an evident other cause apart from signs of blood vessels damage” (7). 75 to 80 percent of all strokes are caused by a clot in blood vessels (8). In instances of ischemic stroke, brain circulation is abruptly disconnected. Causes of this break in blood flow may be blockage or compression of blood vessels due to thrombosis, embolism or systemic hypoperfusion (9). The remaining 20-25 percent of cases of stroke are caused by various forms of blood hemorrhaging prompted by a rupture in one of the brain’s blood vessels due to high blood pressure, natural weakness in the wall of the blood vessels or arteryvein malformation (10). A hemorrhaging stroke indicates blood pooling within the brain tissue or areas Kurtović J. et al. Evaluation of Patients’ Nursing Care Outcomes Following Thrombolytic Therapy. Croat Nurs J. 2018; 2(2): 87-97 89 of progress notes for monitoring patients’ condition, this paper investigates the quality of outcomes of patient care after the administration of thrombolysis therapy.