A client with an acute stroke must receive Alteplase 0.9 mg/kg. The client weighs 220 pounds. How should the client receive? (Round to the nearest whole number, do not use trailing zeros)

A) Respiratory compromise
A spinal cord injury (SCI) at the level of C-3 (cervical spine) results in the loss of function of the diaphragm, which is innervated by the phrenic nerve originating from C-3 to C-5. As a result, the patient is at high risk for respiratory compromise and may require mechanical ventilation. Respiratory failure is a leading cause of death and complications in individuals with high cervical spinal cord injuries, particularly when the injury is at or above C-4.

B) Hypertension
Although spinal cord injuries can cause autonomic dysreflexia (a condition where the body’s autonomic nervous system overreacts to stimuli, leading to dangerously high blood pressure), this condition is more common in individuals with injuries above T6. At C-3, respiratory issues are the primary concern, and hypertension is not the leading cause of complications.

C) Septic shock
Septic shock can occur after any significant injury, especially if the individual develops infections (e.g., from urinary retention, pressure ulcers, or pneumonia). However, septic shock is not the main cause of complications or death related to a C-3 spinal cord injury.

D) Bradycardia
Bradycardia (a slow heart rate) can indeed be a concern in patients with SCI, especially those with injuries at or above the T1 level. However, at the level of C-3, the main cause of complications is respiratory failure, not bradycardia. While bradycardia can occur due to disruption of sympathetic nervous system control, respiratory compromise is the most critical immediate concern.

Given:

Ordered dose of Heparin: 20 units/kg

Patient weight: 132 lbs

Concentration of Heparin: 25,000 units/250 mL (100 units/mL)

Step 1: Convert patient weight from pounds to kilograms:

1 pound (lb) = 0.453592 kilograms (kg)

Patient weight in kg = 132 lbs x 0.453592 kg/lb = 59.87424 kg

Step 2: Calculate the total dose of Heparin:

Total dose (units) = Ordered dose (units/kg) x Patient weight (kg)

Total dose (units) = 20 units/kg x 59.87424 kg

Total dose (units) = 1197.4848 units

Step 3: Calculate the volume to be administered:

Volume (mL) = Total dose (units) / Concentration (units/mL)

Volume (mL) = 1197.4848 units / 100 units/mL

Volume (mL) = 11.974848 mL

Step 4: Round to the nearest whole number:

Volume (mL) ≈ 12 mL