Continue emergency department orders for t-PA infusion and monitoring vital signs and neurologic checks until two hours after start of t-PA infusion.
Check vital signs (blood pressure, pulse, respiration) and make neurologic checks (level of consciousness, arm/leg weakness) every 30 minutes for 6 hours, then every 60 minutes for 16 hours after starting t-PA.
Bleeding precautions: check puncture sites for bleeding or hematomas. Apply digital pressure or pressure dressing to active compressible bleeding sites. Evaluate urine, stool, emesis or other secretions for blood. Perform occult blood testing (guaiac) if there is evidence of bleeding.
Call stroke-team physician (pager #_______) immediately to seek evidence of bleeding, neurologic deterioration or vital signs outside the following parameters:
	Systolic blood pressure greater than 185 mm Hg or systolic blood pressure less than 110 mm Hg
	Diastolic blood pressure greater than 105 mm Hg or diastolic blood pressure less than 60 mm Hg
	Pulse less than 50
	Respirations greater than 24
	Decline in neurologic status or worsening of stroke signs
0.45 normal saline or normal saline IV, to keep vein open, at 50 mL per hour for 24 hours
Oxygen at 2 L per minute by nasal cannula
Continuous cardiac monitoring
Intake and output
Diet: nothing by mouth except medications for 24 hours
Bed rest
Medications: acetaminophen, 650 mg orally for pain every 4 to 6 hours, as needed
Patient's previously prescribed regular medications, if appropriate.
No heparin, warfarin or aspirin for 24 hours. After 24 hours: CT to exclude intracranial hemorrhage before any anticoagulants are administered.