A client with STEMI is prescribed tissue plasminogen activator (tPA/alteplase). Which assessment finding is an ABSOLUTE CONTRAINDICATION to administration?

THROMBOLYTIC THERAPY (tPA, alteplase, tenecteplase) for STEMI carries a serious risk of HAEMORRHAGE — including intracranial haemorrhage (ICH), which can be fatal or permanently disabling. ABSOLUTE CONTRAINDICATIONS to thrombolytics: PRIOR HAEMORRHAGIC STROKE at any time — a prior haemorrhagic stroke indicates brain blood vessels that have previously bled; thrombolytics would lyse any existing clots maintaining fragile vessel integrity; ISCHAEMIC STROKE within the past 3 months — recent ischaemic stroke with potential haemorrhagic transformation; INTRACRANIAL NEOPLASM, AVM, or ANEURYSM — these lesions are at high risk of haemorrhage; ACTIVE INTERNAL BLEEDING (excluding menses); SIGNIFICANT CLOSED HEAD TRAUMA or FACIAL TRAUMA within 3 months; SUSPECTED AORTIC DISSECTION — thrombolytics would be catastrophic if the underlying condition is aortic dissection rather than MI; RELATIVE CONTRAINDICATIONS (risk-benefit decision): BP above 180/110 despite treatment; pregnancy; active peptic ulcer; recent surgery (within 2 weeks); prolonged CPR with rib fractures; INR above 2 or heparin use with elevated aPTT.

Nursing role: Know the contraindications; verify history before administration; neurological monitoring every 30 minutes during and after infusion; stop immediately if neurological changes occur; do NOT give IM injections or perform arterial puncture in non-compressible sites within 24 hours; minimise vascular access attempts.