CEREBROVASCULAR DISORDERSCEREBROVASCULAR DISORDERS

functional ability of the central nervous system that occurs when the functional ability of the central nervous system that occurs when the normal blood supply to the brain is disrupted.normal blood supply to the brain is disrupted.

2 MAIN CATEGORIES:2 MAIN CATEGORIES:

Ischemic stroke – Ischemic stroke – vascular occlusion and vascular occlusion and significant hypoperfusion occur significant hypoperfusion occur

Hemorrhagic stroke – Hemorrhagic stroke – there is there is extravasations of blood into the brain or extravasations of blood into the brain or subarachnoid spacesubarachnoid space

ISCHEMIC STROKEISCHEMIC STROKE

““brain attack”brain attack”sudden loss of functional resulting from disruption of the blood supply to the sudden loss of functional resulting from disruption of the blood supply to the

part of the brain.part of the brain.

5 DIFFERENT TYPES:5 DIFFERENT TYPES: Large artery thrombotic strokesLarge artery thrombotic strokes – – caused by atherosclerotic plaques in the largecaused by atherosclerotic plaques in the large blood vessels of the brain. blood vessels of the brain. Small penetrating artery thrombotic strokesSmall penetrating artery thrombotic strokes – – affect one or more vessels and are the mostaffect one or more vessels and are the most common type of ischemic stroke. common type of ischemic stroke. Cardiogenic embolic strokesCardiogenic embolic strokes – – associated with cardiac dysrhythmias, associated with cardiac dysrhythmias, usually atrial fibrillation usually atrial fibrillation Cryptogenic strokesCryptogenic strokes – – no known cause no known cause Strokes from other causesStrokes from other causes

PATHOPHYSIOLOGYPATHOPHYSIOLOGYCell injury and deathCell injury and death

↓↓Intracellular calcium increasedIntracellular calcium increased

↓↓Cell membranes and proteins break downCell membranes and proteins break down

↓↓Formation of free radicalsFormation of free radicals

↓↓Protein production decreasedProtein production decreased

↓↓GlutamateGlutamate

↓↓DepolarizationDepolarization

↓↓ Ion imbalanceIon imbalance

↓↓AcidosisAcidosis

↓↓Energy failureEnergy failure

    This is how blood flows through a This is how blood flows through a healthy vesselhealthy vessel.    .    

Ischemic strokeIschemic stroke can happen when a blood vessel is  can happen when a blood vessel is narrowed due to the build-up of fatty deposits on the walls narrowed due to the build-up of fatty deposits on the walls of the vessel. This can cause blood to collect and clot.    of the vessel. This can cause blood to collect and clot.    

Embolic StrokeEmbolic Stroke, a type of ischemic stroke, happens when , a type of ischemic stroke, happens when a wandering blood clot from another part of the body gets a wandering blood clot from another part of the body gets stuck in a vessel leading to or in the brain. Such clots often stuck in a vessel leading to or in the brain. Such clots often come from diseased areas of the heart.    come from diseased areas of the heart.    

Hemorrhagic StrokeHemorrhagic Stroke happens when a weakened vessel in  happens when a weakened vessel in the brain bursts, flooding the area with blood. The brain the brain bursts, flooding the area with blood. The brain cells die because bloodcells die because blood

Numbness or weakness of the face, arm Numbness or weakness of the face, arm or leg, especially on one side of the body or leg, especially on one side of the body

Confusion or change in mental status Confusion or change in mental status Trouble speaking or understanding speech Trouble speaking or understanding speech Difficulty walking, dizziness or loss of Difficulty walking, dizziness or loss of

balance or coordination balance or coordination Sudden severe headache Sudden severe headache

SIGNS and SYMPTOMSSIGNS and SYMPTOMS

NEUROLOGIC DEFICITSNEUROLOGIC DEFICITS

Visual Field Deficits Visual Field Deficits Motor DeficitsMotor Deficits Sensory DeficitsSensory Deficits Verbal DeficitsVerbal Deficits Cognitive DeficitsCognitive Deficits Emotional DeficitsEmotional Deficits

Visual DeficitsVisual Deficits Homonymous HemianopsiaHomonymous Hemianopsia – loss of half of the visual field – loss of half of the visual field             Manifestations: Manifestations: Unaware of persons or objects on side of visual loss.. Unaware of persons or objects on side of visual loss.. Neglect of one side of the body. Neglect of one side of the body. Difficulty judging distances. Difficulty judging distances. Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Place objects within intact field of vision. Place objects within intact field of vision. Approach the patient from side of intact field of vision. Approach the patient from side of intact field of vision. Instruct/ remind the patient to turn head in the direction of visual loss of compensate for loss of Instruct/ remind the patient to turn head in the direction of visual loss of compensate for loss of

visual field. visual field. Encourage the use of eyeglasses if available. Encourage the use of eyeglasses if available. When teaching the patient, do so within patient’s intact visual field. When teaching the patient, do so within patient’s intact visual field.

Loss of peripheral visionLoss of peripheral vision       Manifestation: Manifestation: Difficulty seeing at night. Difficulty seeing at night. Unaware of objects or the borders of objects. Unaware of objects or the borders of objects. Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Place objects in center of patient’s intact visual field. Place objects in center of patient’s intact visual field. Encourage the use of a cane or other object to identify objects in the periphery of the visual field. Encourage the use of a cane or other object to identify objects in the periphery of the visual field. Driving ability will need to evaluated. Driving ability will need to evaluated.

Diplopia Diplopia       Manifestation:Manifestation: Double vision. Double vision.             Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Explain to the patient the location of an object when placing it near the patient. Explain to the patient the location of an object when placing it near the patient. Consistently place patient care items in the same location. Consistently place patient care items in the same location.

Motor DeficitsMotor Deficits Hemiparesis Hemiparesis Manifestation:Manifestation: Weakness of the face, arm, and leg on the same side (due to a lesion in the opposite hemisphere) Weakness of the face, arm, and leg on the same side (due to a lesion in the opposite hemisphere) Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Place objects within the patient’s reach on the non affected side. Place objects within the patient’s reach on the non affected side. Maintain body alignment in functional position. Maintain body alignment in functional position. Exercise unaffected limb to increase mobility, strength, and use. Exercise unaffected limb to increase mobility, strength, and use.

Ataxia Ataxia Manifestation:Manifestation: Staggering, unsteady gait. Staggering, unsteady gait. Unable to keep feet together; need a broad base to stand. Unable to keep feet together; need a broad base to stand. Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Support patient during the initial ambulation phase. Support patient during the initial ambulation phase. Provide supportive device for ambulation (walker, cane) Provide supportive device for ambulation (walker, cane) Instruct the patient not to walk without assistance or supportive device. Instruct the patient not to walk without assistance or supportive device.

Dysarthria Dysarthria Manifestation:Manifestation: Difficulty in forming words Difficulty in forming words Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Provide the patient with alternative methods of communicating. Provide the patient with alternative methods of communicating. Allow the patient sufficient time to respond to verbal communications. Allow the patient sufficient time to respond to verbal communications. Support patient and family to alleviate frustration related to difficulty in communicating. Support patient and family to alleviate frustration related to difficulty in communicating.

Dysphagia Dysphagia Manifestation:Manifestation: Difficulty in swallowing Difficulty in swallowing Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Test the patient’s pharyngeal reflexes before offering food and fluids. Test the patient’s pharyngeal reflexes before offering food and fluids. Assist the patient with meals. Assist the patient with meals. Place food on the unaffected side of the mouth. Place food on the unaffected side of the mouth. Allow ample time to eat. Allow ample time to eat.

Sensory DeficitsSensory Deficits

ParesthesiaParesthesia (occurs on the side opposite the lesion) (occurs on the side opposite the lesion) Manifestation:Manifestation: Numbness and tingling of extremity. Numbness and tingling of extremity. Difficulty with proprioception Difficulty with proprioception Nursing Implications/ Patient Teaching Nursing Implications/ Patient Teaching

Applications:Applications: Instruct patient that sensation may be altered. Instruct patient that sensation may be altered. Provide range of motion to affected areas and Provide range of motion to affected areas and

apply corrective devices as needed. apply corrective devices as needed.

Verbal DeficitsVerbal Deficits Expressive aphasiaExpressive aphasia Manifestation:Manifestation: Unable to form words that are understandable; may be able to speak in single-Unable to form words that are understandable; may be able to speak in single-

word responses. word responses. Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Encourage patient to repeat sounds of the alphabet. Encourage patient to repeat sounds of the alphabet. Explore the patient’s ability to write as an alternative means of communication. Explore the patient’s ability to write as an alternative means of communication.

Receptive aphasiaReceptive aphasia Manifestation:Manifestation: Unable to comprehend the spoken word; can speak but may not make sense. Unable to comprehend the spoken word; can speak but may not make sense. Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Speak slowly and clearly to assist the patient in forming the sounds. Speak slowly and clearly to assist the patient in forming the sounds. Explore the patient’s ability to read as an alternative means of communication. Explore the patient’s ability to read as an alternative means of communication.

Global (mixed) aphasiaGlobal (mixed) aphasia Manifestation:Manifestation: Combination of both receptive and expressive aphasia. Combination of both receptive and expressive aphasia. Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Speak clearly and in simple sentences; use gestures or pictures when able. Speak clearly and in simple sentences; use gestures or pictures when able. When alternative means of communication. When alternative means of communication.

Cognitive deficitsCognitive deficits

Manifestation:Manifestation: Short and long term memory loss. Short and long term memory loss. Decreased attention span. Decreased attention span. Impaired ability to concentrate. Impaired ability to concentrate. Poor abstract reasoning. Poor abstract reasoning. Altered judgement. Altered judgement. Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Reorient patient to time, place, and situation, frequently. Reorient patient to time, place, and situation, frequently. Use verbal and auditory cues to orient patient. Use verbal and auditory cues to orient patient. Provide familiar objects (family photographs, favorite objects) Provide familiar objects (family photographs, favorite objects) Use non complicated language. Use non complicated language. Match visual tasks with a verbal cue; holding a toothbrush, simulate Match visual tasks with a verbal cue; holding a toothbrush, simulate

brushing of teeth while saying , “ I would like you to brush your teeth now” brushing of teeth while saying , “ I would like you to brush your teeth now” Minimize distracting noises and views when teaching the patient. Minimize distracting noises and views when teaching the patient. Repeat and reinforce instructions frequently. Repeat and reinforce instructions frequently.

Emotional DeficitsEmotional DeficitsManifestation:Manifestation: Loss of self-control Loss of self-control Emotional ability Emotional ability Decreased tolerance to stressful situations Decreased tolerance to stressful situations Depression Depression Withdrawal Withdrawal Fear, hostility, and anger Fear, hostility, and anger Feelings of isolation. Feelings of isolation. Nursing Implications/ Patient Teaching Applications:Nursing Implications/ Patient Teaching Applications: Support patient during uncontrollable outburst. Support patient during uncontrollable outburst. Discuss with the patient and family that the outburst are due to the disease Discuss with the patient and family that the outburst are due to the disease

process. process. Encourage patient to participate in group activity. Encourage patient to participate in group activity. Provide stimulation for the patient. Provide stimulation for the patient. Control stressful situations, if possible. Control stressful situations, if possible. Provide a safe environment. Provide a safe environment. Encourage patient to express feelings and frustrations related to disease process. Encourage patient to express feelings and frustrations related to disease process.

COMPARISON OF LEFT AND COMPARISON OF LEFT AND RIGHT HEMISPHERE STROKESRIGHT HEMISPHERE STROKES

LEFT HEMISPHERE LEFT HEMISPHERE  Paralysis or weakness on right side of the bodyParalysis or weakness on right side of the body Right visual field defectsRight visual field defects AphasiaAphasia Altered intellectual abilityAltered intellectual ability Slow, cautious behaviorSlow, cautious behavior RIGHT HEMISPHERERIGHT HEMISPHERE Paralysis or weakness on left side of the bodyParalysis or weakness on left side of the body Left visual field defectsLeft visual field defects Spatial-perceptual deficitsSpatial-perceptual deficits Increased distractibilityIncreased distractibility Impulsive behavior and poor judgementImpulsive behavior and poor judgement Lack of awareness of deficitsLack of awareness of deficits

ASSESSMENT:ASSESSMENT: Transient Ischemic Attack Transient Ischemic Attack

(TIA)(TIA) – is a neurologic – is a neurologic deficit lasting less than 24 deficit lasting less than 24 hours, with most hours, with most episodes resolving in less episodes resolving in less than 1 hour.than 1 hour.

sudden loss of motor, sudden loss of motor, sensory, or visual sensory, or visual function function

They occur when a blood They occur when a blood clot blocks a vessel for a clot blocks a vessel for a short period of time short period of time

may serve as a warning may serve as a warning of impending stroke of impending stroke

Courtesy of Intermountain Medical Imaging, Courtesy of Intermountain Medical Imaging, Boise, Idaho. Boise, Idaho.

Figure 1 shows an angiogram (a type of X-ray) Figure 1 shows an angiogram (a type of X-ray) of a normal neck artery (carotid artery) with of a normal neck artery (carotid artery) with smooth walls. Figure 2 shows a narrowed smooth walls. Figure 2 shows a narrowed carotid artery with ulcerated plaque (the surface carotid artery with ulcerated plaque (the surface of the plaque is irregular and broken) that is the of the plaque is irregular and broken) that is the source of clots. The clots travel to the brain and source of clots. The clots travel to the brain and cause TIA symptoms.cause TIA symptoms.

Angiogram of a transient ischemic attack (TIA)Angiogram of a transient ischemic attack (TIA)

MEDICAL MANAGEMENTMEDICAL MANAGEMENT:: GoalGoal preserve healthy brain tissue surrounding the preserve healthy brain tissue surrounding the

blockage. This can be accomplished by removing blockage. This can be accomplished by removing the blockage and restoring blood flow to the area, or the blockage and restoring blood flow to the area, or by protecting the surrounding tissue.by protecting the surrounding tissue.

warfarin sodiumwarfarin sodium – cardioembolitic stroke – cardioembolitic stroke aspirinaspirin – if warfarin is contraindicated – if warfarin is contraindicated platelet- inhibiting medicationplatelet- inhibiting medication – decrease the – decrease the

incidence of cerebral perfusion incidence of cerebral perfusion 3-hydroxy-2-methyl-glutaryl-coenzyme A 3-hydroxy-2-methyl-glutaryl-coenzyme A

reductase inhibitors-reductase inhibitors- to reduce coronary events to reduce coronary events and strokes and strokes

THROMBOLYTIC THERAPYTHROMBOLYTIC THERAPY – dissolving the blood – dissolving the blood clot that is blocking blood flow to the brainclot that is blocking blood flow to the brain

RECOMBINANT t-PARECOMBINANT t-PA- works by binding to fibrin - works by binding to fibrin and converting plasminogen to plasminand converting plasminogen to plasmin

Angiogram 3D reconstruction showing area of Angiogram 3D reconstruction showing area of intracranial arterial blockageintracranial arterial blockage

CONTRAINDICATIONS:CONTRAINDICATIONS: symptom onset greater than 3 hrs. before admission symptom onset greater than 3 hrs. before admission anticoagulated patient anticoagulated patient patient with any type of intracranial pathology patient with any type of intracranial pathology Criteria for t-PA administrationCriteria for t-PA administration 18 years or older 18 years or older clinical diagnosed ischemic stroke clinical diagnosed ischemic stroke time of onset of stroke known and is 3 hours or less time of onset of stroke known and is 3 hours or less systolic BP <185 mm Hg; diastolic < 110 mm Hg systolic BP <185 mm Hg; diastolic < 110 mm Hg not a minor stroke or rapidly resolving stroke not a minor stroke or rapidly resolving stroke no seizures at onset of stroke no seizures at onset of stroke not taking warfarin (COUMADIN) not taking warfarin (COUMADIN) prothrombin time <15 seconds or INR < 1.7 prothrombin time <15 seconds or INR < 1.7 not receiving heparin during the past 48 hours with elevated partial thromboplastin not receiving heparin during the past 48 hours with elevated partial thromboplastin

time time platelet count >100,000/mm3 platelet count >100,000/mm3 no prior intracranial hemorrhage, neoplasm, arteriovenosus malformation or no prior intracranial hemorrhage, neoplasm, arteriovenosus malformation or

aneurysm aneurysm no major surgical procedures within 14 days no major surgical procedures within 14 days no stroke, serious head injury or intracranial surgery within 3 months no stroke, serious head injury or intracranial surgery within 3 months no gastrointestinal or urinary bleeding within 21 days no gastrointestinal or urinary bleeding within 21 days

Dosage and administrationDosage and administration: dosage for t-PA is 0.9 : dosage for t-PA is 0.9 mg./kg., with a maximum dose of 90 mg. Ten percent of the mg./kg., with a maximum dose of 90 mg. Ten percent of the calculated dose is administered as an IV bolus over 1 calculated dose is administered as an IV bolus over 1 minute. The remaining dose (90%) is administered by IV minute. The remaining dose (90%) is administered by IV over 1 hour via an infusion pump.over 1 hour via an infusion pump.

Side effectSide effect: intracranial bleeding: intracranial bleeding Other treatmentOther treatment: anticoagulant administration (IV): anticoagulant administration (IV) Elevation of head of the bed to promote venous drainage Elevation of head of the bed to promote venous drainage

and to lower increased ICP.and to lower increased ICP. Intubation with an endotracheal tube to establish a patent Intubation with an endotracheal tube to establish a patent

airway, if necessaryairway, if necessary CAROTID ENDATERECTOMYCAROTID ENDATERECTOMY – removal of atherosclerotic – removal of atherosclerotic

plaque or thrombus from the carotid artery to prevent stroke plaque or thrombus from the carotid artery to prevent stroke in patients with occlusive disease of the extracranial in patients with occlusive disease of the extracranial cerebral arteries.cerebral arteries.

IndicationsIndications: TIA or mild stroke: TIA or mild stroke CAROTID STENTINGCAROTID STENTING – less invasive procedure that is – less invasive procedure that is

used for severe stenosisused for severe stenosis ComplicationComplication: stroke, cranial nerve injuries, infection or : stroke, cranial nerve injuries, infection or

hematomas and carotid artery disruptionhematomas and carotid artery disruption

NURSING INTERVENTIONSNURSING INTERVENTIONS::Improve mobility and preventing joint deformitiesImprove mobility and preventing joint deformities because flexor muscles are stronger than extensor muscles, a posterior splint is because flexor muscles are stronger than extensor muscles, a posterior splint is

applied at night to the affected extremity may prevent flexion and maintain applied at night to the affected extremity may prevent flexion and maintain correct positioning during sleep correct positioning during sleep

preventing shoulder adduction – a pillow is placed in the axilla when there is preventing shoulder adduction – a pillow is placed in the axilla when there is limited external rotation limited external rotation

the arm is placed in a neutral position, with distal joints positioned higher than the arm is placed in a neutral position, with distal joints positioned higher than the more proximal joints the more proximal joints

helps to prevent edema and resultant fibrosis helps to prevent edema and resultant fibrosis positioning the hand and fingers – volar resting splint can be used to support the positioning the hand and fingers – volar resting splint can be used to support the

wrist and hand in a functional position wrist and hand in a functional position changing position – should be changed every 2 hours changing position – should be changed every 2 hours to place patient in side-lying position pillow is placed between the legs before to place patient in side-lying position pillow is placed between the legs before

the patient is turned the patient is turned to promote venous return and prevent edema, the upper thigh should be acutely to promote venous return and prevent edema, the upper thigh should be acutely

flexed flexed if possible, the patient is placed in a prone position for 15-30 minutes several if possible, the patient is placed in a prone position for 15-30 minutes several

times a day times a day establishing an exercise program – to prevent venous stasis establishing an exercise program – to prevent venous stasis performed at least five times daily for 10 minutes at a time. performed at least five times daily for 10 minutes at a time. Preparing for ambulation – patient is ready to walk as soon as standing is Preparing for ambulation – patient is ready to walk as soon as standing is

achieved. achieved.

Preventing shoulder painPreventing shoulder pain the nurse should never lift the patient by the nurse should never lift the patient by

the flaccid shoulder or pull on the the flaccid shoulder or pull on the affected arm or shoulder affected arm or shoulder

range-of-motion exercise range-of-motion exercise antiseizure medication lamotrigine antiseizure medication lamotrigine

(Lamictal) (Lamictal)

Assistive devices to enhance self-care strokeAssistive devices to enhance self-care stroke eating devices – nonskid to stabilize plates eating devices – nonskid to stabilize plates plate guards to prevent food from being pushed off plate guards to prevent food from being pushed off

plate plate wide-grip utensils to accommodate a weak graspwide-grip utensils to accommodate a weak grasp bathing and grooming devices bathing and grooming devices - Long-handled bath sponge- Long-handled bath sponge grab bars, nonskid mats, hand-held shower heads grab bars, nonskid mats, hand-held shower heads electric razors with head at 90 degrees to handle electric razors with head at 90 degrees to handle shower and tub seats, stationary or on wheel shower and tub seats, stationary or on wheel toileting aids toileting aids raised toilet seat raised toilet seat grab bars next to toilet grab bars next to toilet dressing aids dressing aids Velcro closures Velcro closures elastic shoelaces elastic shoelaces long-handled shoe horn long-handled shoe horn mobility aids mobility aids canes, walkers, wheelchairs canes, walkers, wheelchairs transfer devices such as transfer boards and belts transfer devices such as transfer boards and belts

HEMORRHAGIC STROKEHEMORRHAGIC STROKE

15% to 20% of cerebrovascular disorders and are primarily caused by intracranial or 15% to 20% of cerebrovascular disorders and are primarily caused by intracranial or subarachnoid hemorrhage. subarachnoid hemorrhage.

caused by bleeding into the brain tissue, the ventricles or the subarachnoid space. caused by bleeding into the brain tissue, the ventricles or the subarachnoid space. primary intracerebral hemorrhage from a spontaneous rupture of small vessels primary intracerebral hemorrhage from a spontaneous rupture of small vessels

accounts for approximately 80% of hemorrhagic strokes and is caused chiefly by accounts for approximately 80% of hemorrhagic strokes and is caused chiefly by uncontrolled hypertension. uncontrolled hypertension.

secondary intracerebral hemorrhage is associated with arteriovenous secondary intracerebral hemorrhage is associated with arteriovenous malformations(AVMs),an intracranial aneurysms, intracranial neoplasms or certain malformations(AVMs),an intracranial aneurysms, intracranial neoplasms or certain medications(anticoagulants, amphetamines) medications(anticoagulants, amphetamines)

43% at 30 days-high mortality rate reported 43% at 30 days-high mortality rate reported

PATHOPHYSIOLOGYPATHOPHYSIOLOGY

symptoms are produced when a primary symptoms are produced when a primary hemorrhage, aneurysm, or AVM presses hemorrhage, aneurysm, or AVM presses on nearby cranial nerves or brain tissue on nearby cranial nerves or brain tissue or more dramatically when an aneurysm or more dramatically when an aneurysm or AVM ruptures, causing subarachnoid or AVM ruptures, causing subarachnoid hemorrhagehemorrhage

CLINICAL CLINICAL MANIFESTATIONSMANIFESTATIONS

severe headache- conscious severe headache- conscious patient most commonly patient most commonly reports reports

present with a wide variety of present with a wide variety of neurologic deficits, similar to neurologic deficits, similar to the patient with ischemic  the patient with ischemic 

Stroke. Stroke. comprehensive assessment comprehensive assessment

reveals the extent of the reveals the extent of the neurologic deficits neurologic deficits

many of the same motor, many of the same motor, sensory, cranial nerve, sensory, cranial nerve, cognitive and other functions cognitive and other functions that are disrupted after that are disrupted after ischemic stroke are also ischemic stroke are also altered after hemorrhagic altered after hemorrhagic stroke. stroke.

COMPLICATIONSCOMPLICATIONS

Based on assessment data, potential Based on assessment data, potential complications may develop include the ff,complications may develop include the ff,

vasospasm vasospasm seizures seizures hydrocephalus hydrocephalus rebleeding rebleeding hyponatremia hyponatremia

MEDICAL MANAGEMENTMEDICAL MANAGEMENT

GOALS GOALS allow the brain to recover from the initial result allow the brain to recover from the initial result

(bleeding)(bleeding) to prevent or minimize the risk for rebleedingto prevent or minimize the risk for rebleeding prevent or treat complications prevent or treat complications primarily supportive and consists of bed rest with primarily supportive and consists of bed rest with

sedation sedation management of vasospasms management of vasospasms surgical or medical treatment surgical or medical treatment Analgesics (codeine, acetaminophen) Analgesics (codeine, acetaminophen)    - for head and neck pain- for head and neck pain

NURSING INTERVENTIONSNURSING INTERVENTIONS

Optimizing Cerebral Tissue Perfusion Optimizing Cerebral Tissue Perfusion Relieving Sensory Deprivation and Relieving Sensory Deprivation and

Anxiety Anxiety Monitoring and Managing Potential Monitoring and Managing Potential

Complications Complications Promoting Home and Community Based Promoting Home and Community Based

Care Care

tHe EnD