Introduction
Stroke is among the five leading causes of death and severe long-term disabilities across the world. Approximately, more than one million individuals experience a new or a recurrent stroke every year and one out of ten deaths in the world are as a result of stroke in the world. Noteworthy interventions to lessen mortality and morbidity linked with ischemic stroke have been adopted centering on the early identification of stroke signs and management with clot dissolving substances, particularly, recombinant tissue plasminogen activator (rt-PA) (Graves et al, 2013). Research indicates that when rt-PA is dispensed within 4 and half hours after the first commencement of stroke signs, the mortality and morbidity of the person is lessened. Intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is the customary care for individuals showing symptoms of heightened ischemic stroke. IV rt-PA utilizes weight-oriented drugging, and frequently an approximate weight is employed (Graves et al, 2013). Research indicates that patients were more likely to accurately approximate their own weight equated to providers, yet patients were frequently not able to approximate their weight within 5kg. The medical effects of employing approximate weight in administering IV rt-PA are uncertain. The purpose of the expressive study was to establish whether there is a considerable dissimilarity in actual and approximated weight drugging of rt-PA (Graves et al, 2013).
Since the medical consequences of using approximately and actual weight in administering IV rt-PA is uncertain, this research will assist in establishing the possible chances of overdosing or under dosing, which may result to an increase in complications such as excessive bleeding, intracerebral hemorrhage and a decrease in drug effectiveness (Graves et al, 2013).
Methods of study
This research employed the use of qualitative research methods where a retrospective chart review was carried out to contrast the approximate and actual patient weight when administering IV rt-PA in the acute ischemic stroke population. Creswell (2003) denotes that quantitative research method refers to a method of research where quantifiable data is collected. The research design also indicated where the research was carried out. It was carried out in a 450-bed capacity academic health center (Graves et al, 2013).
The research also articulated its sample, which engrossed patients from the health center’s stroke database admitted to the emergency department and administered IV rt-PA between June 2009 and June 2010. The sample was selected after having attained the required criteria requirements. For the elements within the population to qualify, he or she had to have shown symptoms of stroke to the emergency department, have been administered IV rt-PA while at the emergency department, and have his or her weight written down and recorded in the medical documents (Graves et al, 2013).
The procedures carried out in obtaining data were well delineated with the information obtained from the paper and electronic charts contained in the medical records and analyzed by a team of five. The data obtained was evaluated by the team simultaneously to ensure consistency of the information obtained. The data obtained was arranged in terms of age, gender, ethnicity, actual weight, approximated weight and the IV rt-PA dose administered. The recorded drugging of IV rt-PA was contrasted with the recommended drugging utilizing the admission weight. The dosing calculations used a standard practice where 0.9mg/kg with an upper limit of dose of 90 mg for individuals heavier than 100kg was employed. The dissimilarities between the doses and the weights were evaluated and classified as either overdosed or under dosed (Graves et al, 2013). The information obtained was entered into SPSS and evaluated using tests of difference and descriptive statistics.
The results
Using the tests of difference and descriptive statistics, the analysis showed the mean of the estimated and the actual weights. The mean estimated weight was 79.9kg (/- 3.92kg), and the mean actual weight was 78.5kg (/- 3.92kg). Four of the sample elements had an approximate weight difference of greater than 5kg. Among the sample elements, six had accurate approximated drugging (Graves et al, 2013). Eleven of the sample elements had under estimated weights, which resulted to under dosing of IV rt-PA. In addition, nine approximated weights were overestimated, which resulted to overdosing of the medicine. The results of the study also revealed that there were no statistical connotations between the two groups’ approximate weights or drugging mistakes. The results of the research revealed that the approximated weight was close to the actual weight of the patients. However, the research also recommends that medical practitioners in the emergency department should endeavor to attain the most appropriate weight possible with the first choice being a scale weight (Graves et al, 2013).
This research contributes immensely to the nursing practice. It agitates for the designing of practice processes to acquire actual weights to administer rt-PA in order to avert over dosage and under dosage of this thrombolytic agent.
Ethical considerations
Carrying out a research not only necessitates diligence and expertise but also integrity and honesty. This is performed to protect the rights of people. To render the research ethically satisfying, the rights to anonymity and privacy were considered in this study. This is because patient privacy was protected as the names of the patients were not published and were not used in the data classification phase (Kothari, 1985). Additionally, an institutional review board authorization was acquired before the research was carried out.
Conclusion
This study indicates that acquiring the most appropriate weight in emergency departments poses a difficulty to patients with stroke and nurses. The study articulates the background of the problem, the methodology, and the results of the study and ethical considerations of the research. In addition, it gives a recommendation on how to maximize patient outcome and overcome the barrier to accurate weights in emergency departments.
References
Creswell, J. W. (2003). Research design: Qualitative, quantitative, and mixed method approaches 2nd ed. London: SAGE Publications.
Graves, A., Makic, M. B., Richlik, B., & VerHage, A. (2013). Estimated Versus Actual Weight When Dosing rt-PA in Acute Ischemic Stroke: Is There a Difference? Journal of Neuroscience Nursing, 45(4), 180-185.
Kothari, C.R.,(1985). Research Methodology- Methods and Techniques, New Delhi,Wiley Eastern Limited.
