A nurse is monitoring a client who is receiving streptokinase, a first-generation thrombolytic agent, for a pulmonary embolism. The nurse observes that the client has developed a rash, fever, and hypotension after receiving the medication.

Which of the following actions should the nurse take first?

The nurse should notify the health care provider because an activated partial thromboplastin time (aPTT) of 120 seconds is significantly elevated and indicates a high risk of bleeding.The normal range for aPTT is 25 to 35 seconds. A thrombolytic agent is a medication that dissolves blood clots and restores blood flow to the brain after an acute ischemic stroke. However, it can also cause excessive bleeding and hemorrhage, which can be life-threatening.

Choice A is wrong because the finding is not normal and requires immediate intervention.

Choice B is wrong because vitamin K is an antidote for warfarin, an oral anticoagulant, not for a thrombolytic agent.

Vitamin K would not reverse the effects of a thrombolytic agent.

Choice C is wrong because protamine sulfate is an antidote for heparin, an injectable anticoagulant, not for a thrombolytic agent.

Protamine sulfate would not reverse the effects of a thrombolytic agent.

These are all contraindications for thrombolytic therapy, which is the administration of agents directly into an artery to break down thrombus.Thrombolytic therapy presents a serious risk for bleeding and requires careful monitoring.

Therefore, any condition that increases the risk of bleeding or hemorrhage would make the client ineligible for this therapy.

These conditions include:

• History of peptic ulcer disease: Peptic ulcers are erosions in the lining of the stomach or duodenum that can bleed and perforate.

Thrombolytic therapy could worsen the bleeding and cause life-threatening complications.

• Recent dental extraction: Dental extraction involves removing a tooth from its socket in the bone.

This can cause bleeding and infection in the oral cavity.

Thrombolytic therapy could increase the bleeding and delay the healing process.

• Chronic atrial fibrillation: Atrial fibrillation is an irregular and often rapid heart rate that can cause blood clots to form in the heart chambers.

Thrombolytic therapy could dislodge these clots and cause embolism in the brain, lungs, or other organs.

• Pregnancy: Pregnancy is a state of hypercoagulability that increases the risk of thrombosis.However, thrombolytic therapy is contraindicated in pregnancy because it can cause bleeding complications for both the mother and the fetus.

Choice E, diabetes mellitus, is not a contraindication for thrombolytic therapy.Diabetes mellitus is a chronic condition that affects the metabolism of glucose and insulin.It can increase the risk of cardiovascular diseases and stroke, but it does not directly affect the clotting cascade or the risk of bleeding.

Therefore, diabetes mellitus alone would not make the client ineligible for thrombolytic therapy.However, other factors such as blood pressure, blood glucose level, and renal function should be monitored closely during thrombolytic therapy.