Final answer:
A nurse should apply direct pressure to the puncture site for a period ranging from 5 to 30 minutes following the administration of alteplase, depending on institutional protocols and patient-specific factors. The duration may be extended based on the patient's bleeding risk and coagulation status.
Step-by-step explanation:
When administering alteplase, a thrombolytic agent used to dissolve blood clots, it's crucial to manage the puncture site properly to prevent bleeding complications. Alteplase can impair the clotting process, increasing the risk of bleeding. Therefore, a nurse should apply direct pressure to the puncture site for a period recommended by institutional protocols and based on patient-specific factors, which can range from 5 to 30 minutes. While general guidelines exist, the duration may be extended if the patient shows signs of continued bleeding or has other risk factors that impair hemostasis.
After administration of alteplase, the patient's coagulation status should be monitored closely, and any ongoing bleeding must be addressed promptly. If longer pressure is deemed necessary due to inadequate clotting, this should be done under close observation.
The vascular spasm response helps to control bleeding by constricting the blood vessels temporarily, which can last from 30 minutes up to several hours. However, due to the action of alteplase, reliance on the vascular spasm response alone is not sufficient for hemostasis.
Given these considerations, a nurse should apply direct pressure to the puncture site following institutional protocols and consider extending pressure time if needed while monitoring the patient carefully for signs of bleeding or hematoma formation.