Nursing care for patients with Ischemic Stroke treated with rt-PA thrombolytic therapy during the Acute phase at Kalasin Hospital: A case study

Abstract

     This compare two case study aimed to investigate the nursing care of patients with acute ischemic stroke combined with thrombolytic therapy (rt-PA) at Kalasin Hospital. Purposively selected case studies of patients diagnosed with ischemic stroke who were admitted to Kalasin Hospital between July 2025 and December 2025. The FANCAS framework was applied to identify nursing problems, develop nursing care plans, and continuously evaluate nursing outcomes.

     The study results showed that: Case Study 1: A 52-year-old Thai female presented with right-sided weakness for 3 hours prior to admission. Her medical history included hypertension for 2 years with a history of non-compliance with follow-up appointments and medication. She was referred from a community hospital under the Stroke Fast Track protocol. Upon assessment, GCS was E4V5M6, motor power was grade V on the left and grade IV on the right, with right facial palsy. The NIHSS score was 5, initial ADL was 90, and MRS was 2. She presented with hypertension and was treated with antihypertensive medication and intravenous rt-PA. A post-thrombolytic complication occurred involving non-active gingival bleeding. The patient was transferred for close observation in the Stroke Unit; her condition improved progressively, and she was subsequently discharged.

          Case Study 2: A 55-year-old Thai male presented with left-sided hemiparesis and slurred speech for 30 minutes. His medical history included diabetes mellitus and dyslipidemia. Diagnosed under the Stroke Fast Track protocol, his initial GCS was E4VTM6. During treatment, his condition changed: motor power was grade V on the right and grade 0 on the left, with left facial palsy and mild dysarthria. Assessment revealed an NIHSS score of 12, ADL of 7, and MRS of 4. He received intravenous rt-PA and was transferred to the Stroke Unit. His condition improved steadily, and he was eventually discharged.