Materiały źródłowe

• #1 Nursing Care Plan For Subarachnoid Hemorrhage – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-subarachnoid-hemorrhage/

  A subarachnoid hemorrhage (SAH) is a medical emergency characterized by bleeding in the subarachnoid space surrounding the brain. It is typically caused by the rupture of a cerebral aneurysm, head trauma, or other vascular abnormalities. The sudden and critical nature of this condition demands immediate and specialized nursing care to optimize patient outcomes and minimize potential complications. […] The nursing care plan for subarachnoid hemorrhage is a comprehensive and systematic approach that focuses on providing timely and evidence-based interventions to manage the condition effectively. It centers on closely monitoring the patients neurological status, preventing secondary brain injury, and promoting cerebral perfusion to support the brains recovery. […] In this nursing care plan for subarachnoid hemorrhage, early detection of complications, such as vasospasm and increased intracranial pressure, is paramount. Nurses closely monitor vital signs, and neurological changes, and perform frequent assessments to promptly identify any signs of deterioration and take necessary actions to stabilize the patients condition.

• #2 Subarachnoid Hemorrhage (SAH): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17871-subarachnoid-hemorrhage-sah

  Subarachnoid hemorrhage (SAH) is a medical emergency that requires immediate treatment. […] A subarachnoid hemorrhage is life-threatening. Get immediate medical care if you’re experiencing symptoms of it. […] The hospital care following the diagnosis of subarachnoid hemorrhage focuses on both discovering and treating the cause of the SAH, as well as managing its complications. […] As subarachnoid hemorrhage (SAH) is a life-threatening, emergency condition, it’s typically treated in the intensive care unit (ICU) in a hospital with neurological expertise. The goals of treatment are to: Save your life. Repair the cause of the bleeding (hemorrhaging). Relieve symptoms. Prevent complications, such as vasospasm, hydrocephalus and permanent brain damage. […] The length of stay in the hospital varies based on your health status. Most people who have a subarachnoid hemorrhage are admitted to the hospital anywhere from 10 to 20 days based on their condition and their need for rehabilitation. […] If you’ve had a subarachnoid hemorrhage (SAH), you’ll likely need to see your healthcare team regularly to monitor your health and progress. You may also need physical, occupational and/or speech therapy after an SAH if you’ve experienced complications due to it.

• #3

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11108670/

  Traumatic subarachnoid hemorrhage (tSAH) is a critical condition that requires comprehensive management to optimize patient outcomes. Nursing care plays a key role in the overall management of patients with tSAH via various aspects of care, including neurological assessment, monitoring, intervention, and education. […] Nurses perform initial neurological assessments, including the glasgow coma scale, pupil reactivity, vital signs, and sensory-motor evaluations. These assessments provide valuable information for early identification of deteriorating neurological status and prompt intervention. Additionally, nurses closely monitor intracranial pressure (ICP), cerebral perfusion pressure, and other hemodynamic parameters, assisting in the prevention and timely detection of secondary brain injury.

• #4 Nursing Care Plan For Subarachnoid Hemorrhage – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-subarachnoid-hemorrhage/

  By conducting a comprehensive nursing assessment for subarachnoid hemorrhage, healthcare providers can promptly identify potential complications, monitor the patients condition closely, and intervene appropriately to optimize patient outcomes and promote their overall well-being. The assessment serves as the foundation for developing an individualized care plan that addresses the specific needs of each patient and supports them throughout their journey to recovery. […] These nursing diagnoses provide a basis for developing a comprehensive care plan that addresses the specific needs of patients with subarachnoid hemorrhage. The interventions associated with each diagnosis aim to prevent complications, manage symptoms, and support the patients recovery. […] By closely monitoring the patients condition and implementing evidence-based nursing interventions, healthcare providers can optimize patient outcomes and promote their overall well-being in the context of a subarachnoid hemorrhage.

• #5 Intracranial (Cerebral) Aneurysm Nursing Care Management and Study Guide

  https://nurseslabs.com/intracranial-aneurysm/

  All patients should be monitored in the intensive care unit after an intracerebral aneurysm. […] A complete neurologic assessment is performed initially and includes evaluation for the following: Altered level of consciousness, Sluggish pupillary reaction, Motor and sensory dysfunction, Cranial nerve deficits (extraocular eye movements, facial droop, presence of ptosis), Speech difficulties and visual disturbance, Headache and nuchal rigidity or other neurologic deficits. […] Based on the assessment data, the patients major nursing diagnoses may include the following: Ineffective tissue perfusion related to bleeding or vasospasm, Disturbed sensory perception related to medically imposed restrictions, Anxiety related to illness and/or medically imposed restrictions (aneurysm precautions).

• #6 Subarachnoid hemorrhage

  https://www.myamericannurse.com/subarachnoid-hemorrhage/

  Astute assessment prevents a poor outcome […] Nursing care includes consistent assessment to monitor level of consciousness, urine output, and vital signs. […] Nursing care includes consistent assessment to monitor level of consciousness, urine output, and vital signs. Spiking and dropping blood pressure may indicate cerebral edema, vasospasm, or rebleeding. […] To prevent temperature fluctuations, which can lead to delayed cerebral ischemia and are associated with increased morbidity and mortality, nurses should ensure the patient remains normothermic.

• #7 Intracranial (Cerebral) Aneurysm Nursing Care Management and Study Guide

  https://nurseslabs.com/intracranial-aneurysm/

  The goals for the patient may include: Improve cerebral tissue perfusion, Relief of sensory and perceptual deprivation, Relief of anxiety, Absence of complications. […] All patients should be monitored in the intensive care unit after an intracerebral hemorrhage. […] Monitor closely for neurologic deterioration, and maintain a neurologic ow record. […] Implement aneurysm precautions (immediate and absolute bed rest in a quiet, nonstressful setting; restrict visitors, except for family). […] Assess for and immediately report signs of possible vasospasm, which may occur several days after surgery or on the initiation of treatment (intensied headaches, decreased level of responsiveness, or evidence of aphasia or partial paralysis). […] Maintain seizure precautions. Also, maintain airway and prevent injury if a seizure occurs. Administer antiseizure medications as prescribed (phenytoin [Dilantin] is the medication of choice). […] Monitor for and report symptoms of aneurysm rebleeding. Rebleeding occurs most often in the rst 2 weeks. […] Provide the patient and family with information to promote cooperation with the care and required activity restrictions and prepare them for the patients return home.

• #8

  https://www.nhs.uk/conditions/subarachnoid-haemorrhage/treatment/

  You’ll usually be transferred to a specialist neurosciences unit if a subarachnoid haemorrhage is suspected. […] If your condition is severe, you may be transferred to an intensive care unit (ICU). […] You’ll usually be given a medicine called nimodipine to reduce the chances of this happening. […] Medicine can be effective in relieving the severe headache pain associated with a subarachnoid haemorrhage. […] Other medicines that may be used to treat a subarachnoid haemorrhage include anticonvulsants, such as phenytoin which can help prevent seizures (fits) and antiemetics, such as promethazine which can help stop you feeling sick and vomiting. […] Whichever treatment you have, you will need to be closely monitored for some time to avoid complications.

• #9 Subarachnoid Hemorrhage Treatment & Management: Approach Considerations, Initial Management, Rebleeding and Clipping/Coiling Aneurysms

  https://emedicine.medscape.com/article/1164341-treatment

  Ideally, management of the complications of SAH should take place in a neurologic ICU or in an ICU similarly equipped. […] Blood pressure must be maintained with consideration of the patient’s neurologic status. […] Indwelling catheters include an arterial line, central venous access, and Foley catheter. […] Surgical treatment to prevent rebleeding consists of clipping the ruptured berry aneurysm. […] The initial management of patients with SAH is directed at patient stabilization. […] Endotracheal intubation should be performed for patients presenting with coma, depressed level of consciousness, inability to protect their airway, or increased intracranial pressure (ICP). […] For prevention of vasospasm, maintenance of normovolemia, normothermia, and normal oxygenation are paramount.

• #10 The critical care management of poor-grade subarachnoid haemorrhage | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1193-9

  Monitoring brain tissue oxygenation allows regional and continuous monitoring of PtiO2, which may detect early changes in cerebral tissue oxygenation that precede ischaemic damage. […] The invasive monitoring of brain tissue oxygenation allows regional and continuous monitoring of PtiO2, which may detect early changes in cerebral tissue oxygenation that precede ischaemic damage.

• #11 Subarachnoid Hemorrhage Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/subarachnoid-hemorrhage-nursing-diagnosis/

  Desired Outcomes: The patient will report decreased pain intensity […] The patient will maintain optimal neurological status. […] Nursing Diagnosis Statement: Risk for ineffective cerebral tissue perfusion related to vasospasm and increased intracranial pressure. […] Nursing Interventions and Rationales: Monitor cerebral perfusion pressure Rationale: Ensures adequate brain tissue oxygenation […] Desired Outcomes: The patient will maintain adequate cerebral perfusion […] The patient will show no signs of neurological deterioration. […] Nursing Diagnosis Statement: Anxiety related to acute illness and uncertain prognosis as evidenced by expressed concerns and physiological responses. […] Nursing Interventions and Rationales: Provide clear, concise information Rationale: Reduces fear of the unknown

• #12 Intensive Care of Aneurysmal Subarachnoid Hemorrhage: An Update | IntechOpen

  https://www.intechopen.com/chapters/1195161

  Patients with aSAH should be admitted to and managed in the intensive care unit (ICU), where they can receive appropriate monitoring and therapy tailored to their presentation, severity, and any local or systemic complications. […] All aSAH patients require adequate analgesia, hydration, and prophylaxis against gastric ulcers. Given the severity and multifactorial nature of their headaches, effective pain control is paramount. Multimodal analgesia is recommended, with our practice typically initiating therapy with regular paracetamol and fentanyl as needed. […] aSAH patients often present with elevated blood pressure, a significant risk factor for rebleeding. Conversely, hypotension increases the risk of cerebral vasospasm. Therefore, it is crucial to maintain blood pressure within a target range, typically around 140 mmHg systolic, using shorter-acting antihypertensives such as labetalol or clevidipine.

• #13 10. Subarachnoid Hemorrhage (SAH) | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/10-subarachnoid-hemorrhage-sah/10-subarachnoid-hemorrhage-sah

  Consult neurology and neurosurgery early. If not available, patient will require transfer to center with neurosurgeons or interventional radiologists to identify and then secure the ruptured aneurysm with either surgical clipping or endovascular coiling […] Keep SBP 160 mmHg using nicardipine or labetalol until aneurysm is secured […] Maintain euvolemia, normothermia, and normoglycemia […] Nimodipine 60 mg q4 hours (or 30 mg q2h if hypotensive after higher dose) for 21 days to avoid delayed cerebral ischemia from vasospasm […] Monitor for hyponatremia with goal Na level at least 135 but may higher and require 3% hypertonic saline or sodium chloride tablets to maintain […] Monitor mental status closely; if patient becomes drowsy, stat head CT and call neurosurgery for possible external ventricular drain to relieve hydrocephalus […] Start DVT prophylaxis 24 hours after aneurysm has been secured.

• #14 Subarachnoid Hemorrhage Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/subarachnoid-hemorrhage-nursing-diagnosis/

  Evaluate Pain Status: Assess headache intensity […] Monitor for Complications: Check for signs of vasospasm […] Review Risk Factors: Document medical history […] Nursing Diagnosis Statement: Decreased intracranial adaptive capacity related to subarachnoid hemorrhage as evidenced by increased intracranial pressure and altered level of consciousness. […] Nursing Interventions and Rationales: Monitor neurological status q1-2h Rationale: Allows early detection of neurological deterioration […] Desired Outcomes: The patient will maintain stable ICP readings […] The patient will demonstrate an improved level of consciousness. […] Nursing Diagnosis Statement: Acute pain related to increased intracranial pressure as evidenced by severe headache and neck pain. […] Nursing Interventions and Rationales: Administer prescribed pain medications Rationale: Controls pain while monitoring neurological status

• #15 Subarachnoid Hemorrhage Treatment & Management: Approach Considerations, Initial Management, Rebleeding and Clipping/Coiling Aneurysms

  https://emedicine.medscape.com/article/1164341-treatment

  The traditional treatment of subarachnoid hemorrhage (SAH) from a ruptured cerebral aneurysm included strict blood pressure control, with fluid restriction and antihypertensive therapy. This approach was associated with a high rate of morbidity and mortality from the ischemic complications of hypovolemia and hypotension. […] Current recommendations advocate the use of antihypertensive agents when the mean arterial pressure (MAP) exceeds 130 mm Hg. […] Patients must be admitted to the intensive care unit (ICU) with strict bed rest until the etiology of hemorrhage is determined. Patients should not be allowed out of bed for any reason. All patients should receive frequent neurologic evaluation. Use sedatives and analgesics cautiously to avoid masking the neurologic examination findings. […] Additional medical management is directed to prevent and treat the following common complications of SAH: Rebleeding, Vasospasm, Hydrocephalus, Hyponatremia, Seizures, Pulmonary complications, Cardiac complications.

• #16 subarachnoid hemorrhage | PPT

  https://www.slideshare.net/slideshow/subarachnoid-hemorrhage-47364550/47364550

  Position patient in semi fowler position. […] Encourage patient to rest in bed. […] Provide quiet and calm environment. […] Teach relaxation and deep breathing techniques. […] Administer supplemental oxygen as indicated. […] After 2 hr patient will able to maintain improved level of consciousness, cognition, and sensory function. […] Discharge Plan Activity You will need to have someone with you for the next several days to watch for worsening of symptoms (see below) and to allow you to rest. […] Follow up with your primary care physician for all medical issues. […] Call your doctor or return to the emergency room if you experience any of the following symptoms: Clear or bloody drainage from your nose or ears Worsening headache Changes in vision or differently sized pupils Seizure activity or jerking / twitching of the face, arms, or legs Sleepiness or difficulty waking up Memory loss Irritability Nausea or vomiting that wont stop Confusion or difficulty talking A fever above 100 degrees F Arm, leg, or facial weakness Difficulty walking, loss of balance, and dizziness Stiff neck.

• #17

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11108670/

  For example, some strategies to manage ICP include elevating the head of the bed, maintaining adequate oxygenation and ventilation, administering proper medications, and ensuring fluid and electrolyte balance. Also, through careful monitoring, early recognition, and appropriate preventive measures, nursing care could prevent complications, including infections, deep vein thrombosis, and pressure ulcers. Furthermore, nursing care extends beyond physical management and encompasses psychosocial support for patients and their families. Nurses establish therapeutic relationships, providing emotional support, education, and counseling to alleviate anxiety, address concerns, and facilitate coping mechanisms. […] Education regarding medication management, lifestyle modifications, and the importance of regular follow-up enhances patient compliance and promotes long-term recovery.

• #18 Subarachnoid Hemorrhage Nursing Diagnosis & Care Plan – NurseStudy.Net

  https://nursestudy.net/subarachnoid-hemorrhage-nursing-diagnosis/

  Desired Outcomes: The patient will demonstrate reduced anxiety […] The patient will verbalize understanding of the condition. […] Nursing Diagnosis Statement: Risk for falls related to neurological deficits and altered mobility. […] Nursing Interventions and Rationales: Implement fall precautions Rationale: Prevents injury […] Desired Outcomes: The patient will remain free from falls […] The patient will demonstrate safe mobility practices.

• #19 Subarachnoid Hemorrhage – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/subarachnoid-hemorrhage-treatment/

  Specific management of aneurysmal SAH includes blood pressure control, correct coagulopathy, brain supportive care, treat suspected herniation, antifibrinolytics, seizure prophylaxis, nimodipine, treat hydrocephalus, and secure the aneurysm. […] Hydrocephalus affects 20-30% of patients with SAH and usually presents within the first few minutes to hours after SAH. Immediate CSF diversion using EVD for communicating hydrocephalus or LP for non-communicating hydrocephalus is recommended in patients with deteriorating LOC. […] The most important goal of SAH management is the prevention of rebleeding as it is associated with a high mortality of 70%. Early repair of the unsecured aneurysm with surgical clipping or endovascular coiling is recommended within 24 hours.

• #20 Intensive Care of Aneurysmal Subarachnoid Hemorrhage: An Update | IntechOpen

  https://www.intechopen.com/chapters/1195161

  Early intervention to secure the cerebral aneurysm is paramount to prevent rebleeding. It is recommended to perform aneurysm coiling or clipping within 24 to 72 hours of the ictus. […] Hydrocephalus following aSAH can be of various types (communicating or non-communicating) and may occur acutely, sub-acutely, or chronically. Acute hydrocephalus requires immediate intervention, often through external ventricular drain (EVD) insertion, lumbar drainage, or ventriculostomy, to prevent and treat increased intracranial pressure. […] DCI is a concerning complication occurring in approximately 30% of patients with aSAH. Its etiology lies in cerebral vasospasm, triggered by the presence of blood and blood products surrounding cerebral vessels. […] Early detection, prevention, and treatment of cerebral vasospasm before it progresses to DCI are crucial.

• #21 Subarachnoid hemorrhage Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/subarachnoid-hemorrhage

  Subarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space. Subarachnoid bleeding is an emergency and prompt medical attention is needed. […] The goals of treatment are to: Save your life, Repair the cause of bleeding, Relieve symptoms, Prevent complications such as permanent brain damage (stroke). […] If the person is critically ill, surgery may have to wait until the person is more stable. […] A person who is conscious may need to be on strict bed rest. The person will be told to avoid activities that can increase pressure inside the head, including: Bending over, Straining, Suddenly changing position. […] Treatment may also include: Medicines given through an IV line to control blood pressure, Medicine to prevent artery spasms, Painkillers and anti-anxiety medicines to relieve headache, Medicines to prevent or treat seizures, Stool softeners or laxatives to prevent straining during bowel movements.

• #22 The critical care management of poor-grade subarachnoid haemorrhage | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1193-9

  It is important to mention that long-term outcome after acute brain injury is markedly improved when patients are managed in a dedicated neurologic/neurosurgical intensive care unit. […] Delayed neurological deterioration occurs frequently in the first 2 weeks after SAH. […] DCI occurs in up to 30 % of SAH patients surviving the initial haemorrhage. […] These symptoms can be reversible if treated promptly and aggressively; otherwise, DCI tends to progress to cerebral infarction, which is associated with higher rates of disability and mortality. […] The key management of patients with acute brain injury, including the SAH population, is the minimisation of a complex cascade of ischaemic and apoptotic cellular events, oedema, and excitotoxicity that can result in delayed and often progressive secondary brain injury.

• #23 Subarachnoid Hemorrhage, Vasospasm, and Delayed Cerebral Ischemia

  https://practicalneurology.com/diseases-diagnoses/stroke/subarachnoid-hemorrhage-vasospasm-and-delayed-cerebral-ischemia/30142/

  Oral nimodipine (60 mg every 4 hours) improves neurologic outcomes for patients with vasospasm or DCI. […] For patients who do not respond to nimodipine, prompt stepwise therapy starting with hemodynamic optimization (euvolemia plus hypertension) progressing to urgent aggressive therapy with balloon angioplasty and infusion of vasodilators may be needed.

• #24 Subarachnoid Hemorrhage, Vasospasm, and Delayed Cerebral Ischemia

  https://practicalneurology.com/diseases-diagnoses/stroke/subarachnoid-hemorrhage-vasospasm-and-delayed-cerebral-ischemia/30142/

  Prevention, effective monitoring, and early detection are the keys to successful management after subarachnoid hemorrhage. […] Early detection of neurologic deterioration with both clinical and radiologic assessment is the mainstay of vasospasm management. Every patient with SAH should be in a neurocritical care unit, intensive care unit (ICU), or comprehensive stroke unit that has specific protocols for continued clinical and radiologic assessment. […] Clinical monitoring consists of repeated neurologic assessment at least every 2 hours to identify new neurologic deficits, deterioration of consciousness indicative of possible ischemia, or an unexpected rise in blood pressure, all of which may indicate DCI. […] Close neurologic and TCD monitoring are essential parts of daily care, and CT/CTA/CTP are important for symptomatic patients in danger of cerebral infarction.

• #25 Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)—part 2 | Journal

  https://janesthanalgcritcare.biomedcentral.com/articles/10.1186/s44158-022-00049-4

  We recommend, in case of DCI associated with cerebral vasospasm (symptomatic vasospasm) refractory to an increase in arterial blood pressure (MAP not greater than 120 mmHg), the utilization of invasive intra-arterial procedures (agreement 95.5%, strong recommendation). […] We recommend that the choice of intra-arterial procedure (i.e., vasodilators, angioplasty) be individualized after discussion with the interventional neuroradiologist (see recommendation 25) (agreement 95.5%, strong recommendation). […] We recommend the maintenance of an Hb level 9 gr/dl in case of DCI associated with cerebral vasospasm (agreement 91%, strong recommendation). […] We recommend the maintenance of normothermia (a BCT between 36 and 37 C) in case of DCI associated with cerebral vasospasm (agreement 95.5%, strong recommendation).

• #26 Subarachnoid Hemorrhage Treatment & Management: Approach Considerations, Initial Management, Rebleeding and Clipping/Coiling Aneurysms

  https://emedicine.medscape.com/article/1164341-treatment

  Oral nimodipine is the most studied calcium channel blocker for prevention of vasospasm after SAH. […] Treatment for acute hydrocephalus includes external ventricular drainage, depending on the severity of clinical neurologic dysfunction or CT scan findings. […] Symptomatic cases of hydrocephalus may be managed by temporary lumbar CSF drainage, serial LPs, or placement of a permanent ventricular shunt. […] Agents used for seizure prophylaxis include the following: Phenytoin, the agent of choice, can achieve rapid therapeutic concentrations when loaded intravenously, and it does not cause alterations in consciousness. […] Acute pulmonary edema and hypoxia are almost universal in severe subarachnoid hemorrhage. […] Cardiac dysfunction is common in subarachnoid hemorrhage, particularly in the first 48 hours, but it is typically benign.

• #27 Subarachnoid Haemorrhage: Initial Management • LITFL • CCC

  https://litfl.com/subarachnoid-haemorrhage-initial-management/

  Initial management includes supportive care and monitoring […] Treat seizures (occur in 18% of patients) with benzodiazepines and load with phenytoin 18 mg/kg IV […] Treat hydrocephalus if obtunded then needs emergency EVD placement if no neurosurgeon on site then consider mannitol and urgent retrieval […] routine monitoring […] treat pain and anxiety (e.g. fentanyl +/- benzodiazepines) […] best managed at high volume centers with neurosurgical and IR services […] ICU if intubated or Neuro HDU prior to securing aneurysm.

• #28 Subarachnoid Hemorrhage – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/subarachnoid-hemorrhage-treatment/

  Stabilization – Initial care for patients with SAH involves ABCs and treatment of seizures. […] Intravascular volume resuscitation with isotonic fluids is recommended with a target for euvolemia (while monitoring for hyponatremia). […] Acute seizures affect 6-18% of patients with SAH and are treated with levetiracetam or benzodiazepines. Avoid phenytoin as associated with worse cognitive outcomes in patients with aneurysmal SAH. […] Pain control with short-acting opiates. […] Initial management of aneurysmal SAH includes patient stabilization, grading the severity of the SAH, and admitting the patient to an appropriate centre for SAH management. […] Admit versus transfer to expert center – Improved outcomes, including lower mortality, are associated with treating patients in centres with neurosurgical and IR capabilities.

• #29 The critical care management of poor-grade subarachnoid haemorrhage | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-016-1193-9

  Poor outcomes are usually secondary to early brain injury (EBI) or to delayed cerebral ischaemia (DCI). […] The initial approach to raised ICP includes head of bed elevation (between 30 and 45) to optimise cerebral venous drainage, normoventilation (arterial partial pressure of carbon dioxide (PaCO2): 3540 mm Hg), use of sedation and analgesia to achieve a calm and quiet state, and surgical intervention in the presence of mass-occupying lesions. […] Cerebrospinal fluid (CSF) drainage is a mainstay in ICP management of patients with SAH, especially when hydrocephalus is present. […] Hyperosmolar agents, such as mannitol and hypertonic saline, are usually considered when the above strategies fail to control ICP. […] The last line of treatment includes the use of barbiturates, induced hypothermia, and decompressive craniectomy.

• #30 NCP For Subarachnoid Hemorrhage | PDF | Breathing | Clinical Medicine

  https://www.scribd.com/doc/38048260/Ncp-for-Subarachnoid-Hemorrhage

  o Assist with ADLs as o Assist with turning needed based on q2hrs. individual condition and abilities. […] o Prevent skin breakdown and contractures. Also reduces risk of pneumonia from pooling of secretions. […] o Assist with range of o Maintain joint motion exercises as mobility and prevent tolerated. contractures. Also stimulates circulation and prevents complications of immobility. […] o Assist with feeding as o Ensure adequate needed. nutrition and hydration. May need supplemental feeding depending on level of consciousness and ability to swallow. […] o Provide oral care as o

• #31 Nursing a patient after subarachnoid haemorrhage | Nursing Times

  https://www.nursingtimes.net/neurology/nursing-a-patient-after-subarachnoid-haemorrhage-23-08-2001/

  After having a subarachnoid haemorrhage, patients often experience ongoing severe headache. Pain is well documented as a cause of raised intracranial pressure and it is important to make pain relief a priority for such patients (Hickey, 1996). […] It is vital that patients do not become dehydrated as this increases haemoconcentration, which is in turn thought to increase the incidence of cerebral vasospasm (Hickey, 1996). […] Patients should be nursed in bed to minimise the risk of rebleed, although some units allow them out of bed to use the commode. […] It is vital for nurses to keep their knowledge and skills up to date to ensure that patients who have had a subarachnoid haemorrhage receive optimal care.

• #32 Subarachnoid Hemorrhage | Nurse Key

  https://nursekey.com/subarachnoid-hemorrhage/

  Clinical Pearl: When educating the patient, family, or significant other, use the term stroke in addition to the term subarachnoid hemorrhage to help them understand that aSAH is a type of stroke. […] The interprofessional team, and especially nursing, must keep in mind multiple considerations for patients with EVDs, including accurate monitoring of ICP and cerebral perfusion pressure (CPP), assessment of the ICP waveform, and correlating the neurological examination findings with ICP changes or changes in level of consciousness when the level of the EVD is raised or the drainage system is closed in the presence of hydrocephalus. Prompt notification to the physician by the nurse is critical to prevent further deterioration. […] Pain management is an important aspect of patient care. Given the worst headache of my life complaint, the interprofessional health care team needs to provide interventions to make the patient as comfortable as possible. Nonopioid medications such as acetaminophen (650 mg PO or 1,000 mg IV) can be administered every 4 to 6 hours; however, consideration must be given to contraindications, that is, liver disease. Accurate monitoring by the pharmacist and nurse to ensure that the patient does not receive more than the maximum allowable dose of 3 g in a 24-hour time period is essential. Opioid medications such as fentanyl (12.5 to 25 mg IV every hour as needed), Dilaudid (0.2 to 4 mg IV every 3 to 4 hours as needed), and morphine sulfate (2 to 4 mg IV every 1 to 2 hours as needed) may provide pain relief as well as a degree of sedation and serve to decrease anxiety. Patient effect must be monitored closely to avoid oversedation and an inability to accurately assess the patients neurological status. Pain management is essential but with caution so that worsening in neurological status is not masked (Green et al., 2013).

• #33 Nursing Care Plan For Subarachnoid Hemorrhage – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-subarachnoid-hemorrhage/

  Pain management is crucial in providing comfort and enhancing the patients overall well-being during the recovery process. […] The nursing care plan also prioritizes communication support and anxiety reduction, recognizing the emotional toll the condition takes on both the patient and their family. […] By providing emotional support and utilizing effective communication techniques, nurses facilitate better understanding and coping with the uncertainty surrounding the recovery process. […] By addressing the physical, emotional, and psychosocial aspects of care, nurses play a crucial role in supporting patients and their families during the challenging journey of recovery. […] Through their expertise, vigilance, and continuous assessment, nurses significantly contribute to improving patient outcomes and optimizing their overall well-being following a subarachnoid hemorrhage.

• #34

  https://www.nhs.uk/conditions/subarachnoid-haemorrhage/recovery/

  The time it takes to recover from a subarachnoid haemorrhage depends on its severity. […] Recovery can be a frustrating process. You may make a lot of progress and then have setbacks you’ll have good days and bad days. […] There are many specialists who may be involved in your recovery, including rehabilitation specialists, physiotherapists, speech and language therapists, and occupational therapists. […] A training and exercise plan carried out under the supervision of a physiotherapist can help restore feeling and movement to affected limbs. […] If you’re caring for someone recovering from a subarachnoid haemorrhage, you may find it a challenging prospect. […] They can often have complex needs and engage in challenging and sometimes upsetting behaviour.

• #35 Subarachnoid Hemorrhage (Discharge Care)

  https://www.drugs.com/cg/subarachnoid-hemorrhage-discharge-care.html

  SAH is a type of hemorrhagic stroke that causes bleeding in the subarachnoid space. This space is under the protective tissues that cover the brain. SAH happens when a blood vessel bursts. SAH is a life-threatening condition that needs immediate medical care. […] You may need any of the following: Antihypertensives help lower your blood pressure. This may help prevent another SAH. It is also used to prevent stroke, bleeding inside your brain, or heart or kidney damage caused by SAH. […] You may be referred to stroke rehabilitation (rehab). Rehab is a program run by specialists who will help you recover abilities you may have lost. Specialists include physical, occupational, and speech therapists. Physical therapists help you gain strength or keep your balance. Occupational therapists teach you new ways to do daily activities, such as getting dressed. Your therapy may include movements for everyday activities. An example is being able to raise yourself from a chair. A speech therapist helps you improve your ability to talk and swallow.

• #36 Subarachnoid Hemorrhage (Discharge Care)

  https://www.drugs.com/cg/subarachnoid-hemorrhage-discharge-care.html

  Talk to your healthcare provider if you have concerns about your recovery process. You may not fully recover after SAH. You may not sleep well, think clearly, or be able to work as you did before. You may also be anxious, tired, or depressed. You may be worried about having another SAH. This may affect your relationships. […] SAH is often caused by medical conditions that you cannot control. Healthcare providers will help you create goals for your recovery. The following lifestyle changes can help you reach your goals and lower your risk for a stroke: Manage health conditions. A condition such as diabetes can increase your risk for a stroke. Control your blood sugar level if you have hyperglycemia or diabetes. Take your prescribed medicines and check your blood sugar level as directed. […] Check your blood pressure as directed. High blood pressure can increase your risk for a stroke. Follow your healthcare provider’s directions for controlling your blood pressure.

• #37 Subarachnoid Hemorrhage (Discharge Care)

  https://www.drugs.com/cg/subarachnoid-hemorrhage-discharge-care.html

  Do not use nicotine products or illegal drugs. Nicotine and other chemicals in cigarettes and cigars can cause blood vessel damage and raise your risk for an aneurysm. A burst aneurysm is one of the main causes of SAH. Nicotine and illegal drugs both increase your risk for a stroke. Ask your healthcare provider for information if you currently smoke or use drugs and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products. […] Do not drink alcohol. Alcohol increases your risk for a stroke. Alcohol may also raise your blood pressure or thin your blood. Blood thinning can cause a hemorrhagic stroke. […] Maintain a healthy weight. Ask your healthcare provider what a healthy weight is for you. Ask him or her to help you create a weight loss plan if you are overweight. He or she can help you create small goals if you have a lot of weight to lose.

• #38 Subarachnoid Hemorrhage (Discharge Care)

  https://www.drugs.com/cg/subarachnoid-hemorrhage-discharge-care.html

  Exercise as directed. Exercise can lower your blood pressure, cholesterol, weight, and blood sugar levels. Healthcare providers will help you create exercise goals. They can also help you make a plan to reach your goals. For example, you can break exercise into 10 minute periods, 3 times in a day. Find an exercise that you enjoy. This will make it easier for you to reach your exercise goals. […] Talk to your healthcare provider if you have depression that continues or is getting worse. Your provider may be able to help treat your depression. Your provider can also recommend support groups for you to join. A support group is a place to talk with others who have had a stroke. It may also help to talk to friends and family members about how you are feeling.

• #39 Key Patient Messages: Aneurysmal Subarachnoid Hemorrhage Guideline – Professional Heart Daily | American Heart Association

  https://professional.heart.org/en/science-news/patient-resources/key-patient-messages-aneurysmal-subarachnoid-hemorrhage-guideline

  Patient discharge planning should be done by a team of clinicians including physicians, nurses, therapists, and others. […] This team approach should also be used to develop a care plan for patients who require rehabilitation after leaving the hospital. […] A strong support team, ideally family and friends, is crucial to help with medication administration, driving, appointment assistance, and social needs. […] Patients should be screened for depression and anxiety, and psychotherapy and pharmacotherapy are recommended to reduce symptoms.

• #40 Nursing Care Plan For Subarachnoid Hemorrhage – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-subarachnoid-hemorrhage/

  By implementing these nursing interventions, healthcare providers can effectively manage subarachnoid hemorrhages, prevent complications, and optimize patient outcomes. The care provided by nurses plays a crucial role in supporting the patients recovery and promoting their overall well-being during this critical phase of managing a subarachnoid hemorrhage. […] Through their expertise, vigilance, and compassionate care, nurses significantly contribute to improved patient outcomes and overall quality of life following a subarachnoid hemorrhage. […] The nursing care plan emphasizes the importance of neurological monitoring, pain management, and preventing complications such as increased intracranial pressure and infections. […] By closely monitoring the patients neurological status and promptly identifying any changes, nurses can intervene early and prevent further brain injury.

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