Page 157 - Critical Care Notes

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■ Prepare patient for craniotomy or evacuation of hematoma to lessen the
pressure in the brain if necessary.
■ Assess for vision and hearing impairment and sensory function.
■ Assess for hypothermia and hyperthermia. Control fever.
■ Institute seizure precautions. Administer anticonvulsants. Minimize stimuli
and excessive suctioning.
■ Monitor ECG for cardiac arrhythmias.
■ Institute DVT precautions.
■ Assess fluid and electrolyte balance. Control hemorrhage and hypovolemia.
■ Administer stool softeners to prevent Valsalva maneuver.
■ Administer corticosteroids.
■ Consider prophylactic antibiotics.
■ Refer to Increased ICP Management for list of drugs for sedation.
■ Keep head and neck in neutral alignment; no twisting or flexing of neck.
■ Keep HOB elevated.
■ Maintain adequate nutrition orally or enterally.
■ Assess and maintain skin integrity.
■ Institute aspiration precautions as necessary.
■ Provide DVT and stress ulcer prophylaxis.
■ Patient may be OOB when ICP controlled.
Subarachnoid Hemorrhage (SAH) or
Hemorrhagic Stroke and Aneurysm
Subarachnoid Hemorrhage (aSAH)
SAH is bleeding into the subarachnoid space between the arachnoid membrane
and the pia mater of the brain primarily. SAH is a medical emergency.
Pathophysiology
■ SAH is caused by cerebral aneurysm (usually in the area of circle of Willis),
cerebral/head trauma, HTN, or arteriovenous malformation (AVM). AVM is a
tangle of blood vessels without a capillary system. Aneurysms are caused
by a weakening and thinning of the arterial wall → balloon or distended
blood vessel and can rupture over time. Generally, aneurysms are more
likely to bleed or rupture if >7 mm. Approximately 50% of aneurysms
rebleed within 6 hr of initial bleeding.
■ Blood rapidly passes into the subarachnoid space and then spreads over
the brain and to the spinal cord leading to ↑ ICP → coma → death. Bleeding
can also occur intracerebrally and subdurally depending on the cause of the
bleeding.

NEURO