Question

System Disorder for intracerebral Hemorrhage

Alterations in Health (Diagnosis)

Pathophysiology Related to Client Problem

Health Promotion and Disease Prevention

Risk Factors

Expected Findings

SAFETY CONSIDERATIONS

Laboratory Tests

Diagnostic Procedures

Nursing Care

Medications

Client Education

Complications

Therapeutic Procedures

Interprofessional Care

Answer 1

  INTRACEREBRAL HEMORRHAGE.

Intracerebral hemorrhade occurs when a diseased blood vessel within the brain bursts , allowing blood to leak inside the brain.( the name means within the cerebrum or brain ). The sudden increase in pressure within the brain can cause damage to the brain cells surrounding the blood. If the amount of blood increases rapidly , the sudden buildup in pressure can lead to unconsciousness or death.

RISK FACTORS.

1. MODIFIABLE RISK FACTORS.

• Hypertension
• smoking
• Excessive alcohol consumption
• low triglycerides
• Anticoagulation
• Use of antiplatelet agent
• Drugs ( cocaine , heroin ,amphetamine )

2. NON MODIFIABLE RISK FACTORS.

• Old age
• Male sex
• Asian ethnicity
• Cerebral microbleeds

SYMPTOMS OF INTRACEREBRAL HEMORRHAGE

• Sudden weakness, tingling, or paralysis in face,arm,or leg, especially if it occur on only one side of body.
• sudden onset of severe headache
• Trouble swalloeing
• Nausea , vomitting.
• Loss of balance and coordination.
• Confusion , delirium
• Trouble with language skils
• Loss of consciousness , lethargy ,sleepiness.

PATHOPHYSIOLOGY.

The exact cause of brain damage following intracerebral hemorrhage is unknown.It is thought that ICH may result in brain injury by following mechanisms ;

** Neuronal ischemia folowing decreased blood flow to the area surrounding the clot.

** Overexpression of matrix metalloproteinases ( MMPs ) which may result in the breakdown of the blood brain barrier and edema.

LABORATOY TESTS

• Complete blood count
• Electrolytes
• Renal function tests
• Coagulation studies ( PT ,APTT , INR )
• Toxicology screen
• Blood glucose level

DIAGNOSIS

• Neurological examination
• Imaging tests includes CT scans
• MRI scans
• Angiogram
• Blood investigations

COMPLICATIONS

• Seizures
• Vision loss
• Problems with swllowing
• Impaired language skills
• Fatigue
• Difficulty with sensations or movements on one side of body
• pneumonia
• cognitive dysfunction
• depression fever.

PREVENTION

• Control the blood pressure
• lowering the cholesterol level
• lose excess weight
• limit alcohol and sto smoking
• eat a healthy diet
• get regular exercises
• control blood sugar levels.

MEDICATIONS

1. Anticonvulsants ( diazepam ,lorazepam )

2. Beta blockers ( labetalol)

3. Vasodilators ( hydralazine )

4. Calcium channel blockers (nicardipine )

5, Angiotensin converting enzyme inhibitors (enalapril , ramipril )

6. Diuretics ( hydrochlorothiazide ,diuril )

7. osmotic diuretics (mannitol)

8. Analgesics ( acetaminophen )

9.Hemostatics ( vitmin k1 )

10. Blood cmponents ( platelets ,fresh frozen plasma )

NURSING MANAGEMENT

• Asses the state of consciousness through the GCS scale ( Glasgow Coma Scale ) and promptly detect the appearance of new neurlogical signs .
• Monitor pupils frequently
• incase of psychomotor agitation ,reassure the patient and inform the doctor

BREATHING

• Ensure airway patency ,keep the head in a slightly raised position,monitor oxygen saturation in the blood.
• incaseof rspiratory depression ,position the guedel cannula ,ventillate the patient .

CARDIAC ACTIVITY

• Check heart rate and blood pressure frequently.
• position a venous catheter allowing solution infusion and intravenous therapy

ALTERATION OF THE HYDROELECTROLYTE BALANCE

• Ensure enteral or parenteral hydration
• monitor intake output hourly

HYGIENE

• Pratice total hygiene based on patient autonomy
• maintain oral hygine

MOBILISATION

• It is necessary to ensure all measures to prevent thrombophlebitis an pressure sores by means of timely interventions,
• change the position every 2 hourly
• use anti - bedsores (water ,air mattresses, pillows .)

SEIZURES

• Administer antoconvulsant drugs
• be ready to transfer the patient to ICU if necessary

PROCEDURES

• Medications delivered directly to the brain.
• removing the clot with a stent
• carotid endarterectomy
• angioplasty and stents
• surgical clipping

TREATEMENT TEAM MAY INCLUDE

• Neurologist
• Rehabilitation doctor
• dietitian
• physical therapist
• occupational therapist recreational therapist
• speech pathologist
• social worker
• psychologist