A nurse in an emergency department is reviewing the medical record of a client who is having an acute myocardial infarction.
Which of the following findings places the client at risk if he receives alteplase?
A.
Family history of malignant hypertension.
B.
Hip arthroplasty 1 week ago.
C.
Chronic obstructive pulmonary disease.
D.
Acute renal failure 6 months ago.
The Correct Answer and Explanation is:
The correct answer is B. Hip arthroplasty 1 week ago.
Explanation:
Alteplase, a thrombolytic agent, is used to dissolve blood clots that cause acute myocardial infarctions (AMIs). While it can be life-saving, it also carries significant risks, particularly bleeding complications. One of the primary contraindications and considerations when administering alteplase is the recent history of major surgery or trauma, which can increase the risk of bleeding.
Reasoning for Option B:
Hip Arthroplasty 1 Week Ago: A recent hip arthroplasty (surgical replacement of the hip joint) is a significant risk factor when considering alteplase administration. Major surgeries, such as hip arthroplasty, can cause extensive tissue damage and might lead to bleeding complications. The healing period following such a surgery is crucial because the risk of bleeding is heightened due to possible recent internal bleeding, compromised coagulation, and the trauma of the surgical site. The use of thrombolytics like alteplase could exacerbate these bleeding risks, potentially leading to serious complications like internal bleeding or hemorrhagic stroke.
Reasons Other Options Are Less Relevant:
A. Family History of Malignant Hypertension: While a family history of malignant hypertension indicates a predisposition to severe hypertension, it is not a direct contraindication for alteplase. However, malignant hypertension itself (if present in the patient) would be a concern due to the risk of bleeding complications.
C. Chronic Obstructive Pulmonary Disease (COPD): COPD is not directly related to the risks of bleeding associated with alteplase. Although COPD can complicate overall health status and management, it does not specifically affect the bleeding risk related to thrombolytics.
D. Acute Renal Failure 6 Months Ago: While renal failure can impact overall health and medication metabolism, acute renal failure from six months ago is not an immediate contraindication for alteplase. Chronic renal impairment or ongoing renal failure might be more concerning, but a past event alone does not pose an acute risk in the same way recent major surgery does.
In summary, the primary concern with alteplase is the increased risk of bleeding, especially following recent major surgeries. Hence, a recent hip arthroplasty is a significant risk factor when considering the use of thrombolytic therapy.