Intracerebral Hemorrhagic Bleed

Front 1

WHAT IS THE DEFINITION OF INTRACEREBRAL HEMORRHAGIC BLEED

Back 1

BLEEDING DIRECTLY INTO CEREBRAL TISSUE

Front 2

INTRACEREBRAL HEMORRHAGIC BLEED CAUSES WHAT?

Back 2

TIE

1. DESTROYS CEREBRAL TISSUE
2. CAUSES CEREBRAL EDEMA
3. INCREASES ICP

Front 3

CAUSES OF INTRACEREBRAL HEMORRHAGIC BLEED

Back 3

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)

Front 4

PATHOPHYSIOLOGY OF INTRACEREBRAL HEMORRHAGIC BLEED

Back 4

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

Front 5

ASSESSMENT OF INTRACEREBRAL HEMORRHAGIC BLEED

Back 5

- 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

Front 6

MEDICAL MANAGEMENT FOR INTRACEREBRAL HEMORRHAGIC BLEED

Back 6

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

Front 7

CANDIDATE FOR SURGERY FOR INTRACEREBRAL HEMORRHAGIC BLEED

Back 7

1. >3CM WITH NEURO DETERIORATION
2. HYDROCEPHALUS W/ BRAINSTEM COMPRESSION
3. YOUNG W/ MOD-LARGE LOBAR BLEED

- GLASGLOW <4 = NO SURG

Front 8

NURSING MANAGEMENT OF INTRACEREBRAL HEMORRHAGIC BLEED

Back 8

- FREQ ASSESSMENT
a. NEURO DETERIORATION
b. HEMODYNAMIC DETERIORATION [VS, PULSE OX]
c. SEIZURE ACTIVITY
- ADMINISTER/TITRATE MED
- MONITOR COMPLICATIONS

Front 9

COMPLICATIONS OF INTRACEREBRAL HEMORRHAGIC BLEED

Back 9

1. VASOSPASM + BLEEDING
2. INCREASE ICP
3. NONDOMINANT HEMISPHERE
4. DOMINANT HEMISPHERE
5. IMPAIRED SWALLOWING

Front 10

S/S OF BLEEDING AND VASOSPASM OF INTRACEREBRAL HEMORRHAGIC BLEED

Back 10

WIN, RN

- WORSENING H/D
- INCREASE ICP
- N/V
- RESPIRATORY CHANGES [CHEYNE-STOKES = SHALLOW + SLOW BREATH]
- NEW OR CHANGE IN NEURO DEFICIT

Front 11

NURSING ACTION FOR BLEEDING AND VASOSPASM FOR INTRACEREBRAL HEMORRHAGIC BLEED

Back 11

- 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

Front 12

S/S OF INCREASE ICP FOR INTRACEREBRAL HEMORRHAGIC BLEED

Back 12

- 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

Front 13

S/S OF NONDOMINANT HEMISPHERE OF INTRACEREBRAL HEMORRHAGIC BLEED

Back 13

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

Front 14

S/S OF DOMINANT HEMISPHERE OF INTRACEREBRAL HEMORRHAGIC BLEED

Back 14

-REG-

1. RECEPTIVE APHASIA
2. EXPRESSIVE APHASIA
3. GLOBAL APHASIA

Front 15

S/S OF IMPAIRED SWALLOWING (CN 9+10)

Back 15

-D2AG-
1. DYSPHAGIA + DYSARTHRIA
2. ASPIRATION
3. GAG REFLEX GONE

Front 16

NURSING DX OF INTRACEREBRAL HEMORRAGIC BLEEDING

Back 16

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