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16 Cards in this Set

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WHAT IS THE DEFINITION OF INTRACEREBRAL HEMORRHAGIC BLEED
BLEEDING DIRECTLY INTO CEREBRAL TISSUE
INTRACEREBRAL HEMORRHAGIC BLEED CAUSES WHAT?
TIE

1. DESTROYS CEREBRAL TISSUE
2. CAUSES CEREBRAL EDEMA
3. INCREASES ICP
CAUSES OF INTRACEREBRAL HEMORRHAGIC BLEED
DANH SC

1. DRUG ABUSE
2. ANTICOAGULATION/THROMBOLYTIC THERAPY***
3. NOCOMPLIANCE W/ ANTIHYPERTENSIVE MED
4. HYPERTENSIVE RUPTURE OF CEREBRAL VESSEL
5. STRAINING
6. COAGULATION D/O (DIC)
PATHOPHYSIOLOGY OF INTRACEREBRAL HEMORRHAGIC BLEED
1. SMALL ARTERIAL VESSELS ARE DAMANGED FROM ATHERIOSCLEROSIS
2. BURST UNDER PRESSURE.
3. CREATE HEMATOMA IN SURROUNDING CEREBRAL TISSUE
4. INCREASE ICP D/T INCREASED CRANIAL PRESSURE
ASSESSMENT OF INTRACEREBRAL HEMORRHAGIC BLEED
- 50% EARLY LOC
- >50% SMOOTH PROGRESSION OF NEURO SX--SUDDEN ONSET WITH RAPID DETERIORATION, SEVERE H/A, N/V
- 33% OF MAX SX
- CRITICALLY ILL: UNCONSCIOUS REQUIRING VENTILATOR SUPPORT
- ELEVATED BP (250/150)
- INCREASED INTRACRANIAL PRESSURE
- DX WITH CT SCAN
- ANGIOGRAPHY FOR SURGICAL CANDIDATE WITH NO CLEAR ETIOLOGY OF BLEED
MEDICAL MANAGEMENT FOR INTRACEREBRAL HEMORRHAGIC BLEED
1. ABC
2. BP MANAGEMENT [MAP <130 W/ HX OF HTN][MAP <110 p SURGICAL TX]
3. KEEP CPP >70mmHg *****
4. MANNITOL
5. HYPERVENTILATION [paCO2 LOW TO NORM + HYPERO2 'EM] B/C DECREASE CO2 WHICH DECREASE ICP
6. NEUROMUSCULAR BLOCKAGE/SEDATION
7. MAINTAIN EUVOLEMIA
8. PCWP 5-12
9. KEEP BODY TEMP <38.5 [TYLENOL + BLANKET]
10. P. COMPRESSION DEVICE TO PREVENT DVT
11. PROPHYLACTIC ANTICONVULSANT THERAPY
12. SURGICAL EVACUATION IF CANDIDATE
CANDIDATE FOR SURGERY FOR INTRACEREBRAL HEMORRHAGIC BLEED
1. >3CM WITH NEURO DETERIORATION
2. HYDROCEPHALUS W/ BRAINSTEM COMPRESSION
3. YOUNG W/ MOD-LARGE LOBAR BLEED

- GLASGLOW <4 = NO SURG
NURSING MANAGEMENT OF INTRACEREBRAL HEMORRHAGIC BLEED
- FREQ ASSESSMENT
a. NEURO DETERIORATION
b. HEMODYNAMIC DETERIORATION [VS, PULSE OX]
c. SEIZURE ACTIVITY
- ADMINISTER/TITRATE MED
- MONITOR COMPLICATIONS
COMPLICATIONS OF INTRACEREBRAL HEMORRHAGIC BLEED
1. VASOSPASM + BLEEDING
2. INCREASE ICP
3. NONDOMINANT HEMISPHERE
4. DOMINANT HEMISPHERE
5. IMPAIRED SWALLOWING
S/S OF BLEEDING AND VASOSPASM OF INTRACEREBRAL HEMORRHAGIC BLEED
WIN, RN

- WORSENING H/D
- INCREASE ICP
- N/V
- RESPIRATORY CHANGES [CHEYNE-STOKES = SHALLOW + SLOW BREATH]
- NEW OR CHANGE IN NEURO DEFICIT
NURSING ACTION FOR BLEEDING AND VASOSPASM FOR INTRACEREBRAL HEMORRHAGIC BLEED
- PREVENT STRESS AND STRAINING
[STRESS]- BED REST, DARK + QUIET ROOM, ANALGESICS + SEDATIVE, NO LIMB RESTRAINTS***, HOB 35-45 DEGREE, BP CONTROL

[STRAINING]- STOOL SOFTNERS, AVOID VALSALVA MANEUVERS***

DVT PRECAUTIONS
FAMILY CAN VISIT
S/S OF INCREASE ICP FOR INTRACEREBRAL HEMORRHAGIC BLEED
- NO PERRL, CHANGE LOC, CRAP3 H -

A. CUSHING TRIAD*** [BRADYCARDIA, BRADYPNEA, INCREASE SBP]
B. REFLEXES DIMINISHED
C. ALTERED BREATHING [KUSSMAUL OR CHEYNE-STOKES]
D. POSTURING (DECEREBRATE - EXTENSIION, DECORTICATE - FLEXION); PROJECTIVE VOMITING, PAPILLEDEMA
E. H/A
S/S OF NONDOMINANT HEMISPHERE OF INTRACEREBRAL HEMORRHAGIC BLEED
VA2SE

1. VISUAL DEFICIT LIKE HEMIANOPSIA
2. AGNOSIA + APRAXIA [UNILATERAL NEGLECT= TYPE OF AGNOSIA; NO USE IN CERTAIN LIMB B/C O PARALYSIS]
3. SPATIAL ORIENTATION
4. EMOTIONAL LIABLITY
S/S OF DOMINANT HEMISPHERE OF INTRACEREBRAL HEMORRHAGIC BLEED
-REG-

1. RECEPTIVE APHASIA
2. EXPRESSIVE APHASIA
3. GLOBAL APHASIA
S/S OF IMPAIRED SWALLOWING (CN 9+10)
-D2AG-
1. DYSPHAGIA + DYSARTHRIA
2. ASPIRATION
3. GAG REFLEX GONE
NURSING DX OF INTRACEREBRAL HEMORRAGIC BLEEDING
1. INEFFECTIVE CEREBRAL TISSUE PERFUSION
2. UNILATERAL NEGLECT
3. IMPAIRED SWALLOWING
4. DISTURBED BODY IMAGE
5. RISK FOR ASPIRATION
6. IMPAIRED VERBAL COMMUNICATION
7. COMPROMISED FAMILY COPING