THIS IS CASE STUDY

1. BY : MARIAM FAHAD AL-HARBI / nusrat
Intracranial Haemorrhage
(non-traumatic )

2. Objective of the case study:
At the end of this presentation the listeners will be able to:
.
 Explain what is intracranial Haemorrhage.
 Discuss the anatomy & physiology of skull and brain .
 Enlist the sign and symptoms of intracranial Haemorrhage
 Identify method of diagnostic studies for intracranial Haemorrhage
 Discuss drug study for patient with intracranial Haemorrhage
 Explain the basic and appropriate nursing intervention , treatment, plan and
prognosis of intracranial Haemorrhage.

3. Outlines
1. Biographical Data
2. Physical Assessment Form
3. Anatomy & Physiology
4. Pathophysiology
5. Diagnostic Studies
6. Drug Study
7. Nursing Care Plan
8. Reference.

4. Biographical Data

5. PATIENT DATA :
Name of Patient: XXXXX MR:XXXXX
Gender: Male Nationality:
Age : 40 years old Marital Status: Married
DOA (Date of Admission): 20/10/2020
Medical Diagnosis: Intracranial Hemorrhage (non traumatic)
Reason for admission : Decrease Level of conscious
,sever Hypertension

6. PATIENT DATA :
History of present Illness:
General Appearance:
The patient was unconscious , disoriented .
Chief complain:
A 40 years old male patient who was found unresponsive on the
floor of his house by his relatives and was brought to emergency
department with decrease Level of conscious.

7. PATIENT DATA :
History of present Illness:
Vital signs:
• Blood pressure :230/110mmhg
• Heart rate:90bpm in sinus rhythm,
• temperature:37.6c
• Respiratory rate25bpm
• O2:94%
• cbs:149mg/dl
• Hight:170cm
• Weight:86kg

8. History of present Illness:
Family History:
Hypertension ,heart disease.
03
Immunization:
He received all vaccination when
he was child
None in Erfan hospital . .
04
Type of Diet:
Resource plus 4 cans+
water 800 ml ,with NGT
05
Past medical and Surgical History:
The relatives mentation that the patient
have sever headache since 3 weeks and his
take analgesic ,after that his fall down at the
house,
none surgical history.
01
Social history:
- Patient :M.H.R 40 years old ,
married ,he lives with his family
- He have 3 suns and 2 daughters.
- He is retired
- smoker
02

9. Physical Assessment (by body systems):

10. • Heart rate:90pbm sinus
rhythm
• Apical and radial pulse
regular
• Peripheral skin colour:
Abnormal
• Peripheral skin temp: warm
• Capillary refill: less tan 2sec
• BP : 230/110mmhg
Cardiovascular system:
Respiratory system
• Respiratory rate within normal limits
• Respiratory with efforts rhythm: regular
• Breath sound :clear upon auscultation
• RR:25/min
Endocrine system
-All glands on normal condition and
Functioning .
-No excess or deficiency hormones .

11.  Unconscious
 No Responsiveness to
verbal stimuli, touch and
painful stimuli
 GCS:5/15
 No moves all extremities
equally
Neurological system
• Patient with foley
catheter and diapers.
• Urine: yellow adequate
>0.5mls/kg/hr
• Within normal limits
Renal system
Musculoskeletal system
• Weakness in the muscle strength

12.  Abdomen: soft , no tender ,
non distended
 -The bowel sound active
and normal (8per minute).
Digestive system
• Dry skin
• Intact, no rashes or
other lesions.
Integumentary system
Reproductive system
-All organs are normal .

13. Anatomy & Physiology:

14. ANATOMY

15. Physiology:
Intracranial hemorrhage:
Intracranial haemorrhage (ICH) is a type of bleeding
that occurs inside the skull .
Disease process:
Haemorrhage that occur within the skull or brain generally
happen suddenly, from either external or internal causes. A
haemorrhage can rapidly cause brain damage and can be life-
threatening, Since the brain cannot store oxygen, it relies
upon a series of blood vessels to supply oxygen and nutrients.
When a haemorrhage occurs, oxygen may no longer be able to
reach brain tissue supplied by leaky or broken blood vessels.
Pooling of blood from an intracranial haemorrhage or cerebral
haemorrhage also puts pressure on the brain and deprives it
of oxygen . When a haemorrhage or stroke interrupts blood
flow around or inside the brain, depriving it of oxygen for
more than three or four minutes, the brain cells die. The
affected nerve cells and the related functions they control are
damaged as well.

16. Physiology:
The signs and symptoms:
• Sudden tingling, weakness, numbness, or paralysis of the
face, arm or leg, particularly on one side of the body
• Sudden, severe headache
• Difficulty with swallowing or vision
• Loss of balance or coordination
• Difficulty understanding, speaking (slurring nonsensical
speech), reading, or writing
• Change in level of consciousness or alertness, marked by
stupor, lethargy, sleepiness, or coma.
Risk Factors include:
• a family history of Intra cranial haemorrhage.
• heavy alcohol use.
• Hypertension.
• cigarette smoking.
• the use of certain drugs, including amphetamines, cocaine,
and MDMA (often called “ecstasy”).
• extreme physical exertion.

17. Physiology:
Intracranial haemorrhage has a number of causes,
including:
• Head trauma, such as that caused by a fall, car
accident, sports accident.
• Hypertensive (high blood pressure) damage to blood
vessel walls that causes the blood vessel to leak or
break.
• Ruptured cerebral aneurysm
• Smoking, excessive alcohol use, or use of illegal
drugs such as cocaine.

18. Diagnostic study:

19. Name of
Diagnostic Study
CT scan(brain)
Brain MRI
Normal Values
-
-
Results
-Large left parietal hematoma
5*7.4*3.6cm.
With compression of the mild line
shift to the right .
Minimal intraventricular
haemorrhage .
- Intracerebral hematoma with the
current examination
Implications
He was diagnosed with intra
cranial haemorrhage , High
blood pressure is the most
common causes of ICH.
Hematoma can result from any
injury to any type of blood vessel
, hematoma usually describe
bleeding which has more or less
clotted.

20. Name of
Diagnostic Study
Normal Values Results Implications
Hematology:
Hemoglobin:
Hematocrit:
Platelets count
Red blood cell count
White blood cell count
14.8-185gm/dl
42-52%
130-400*10(3)/mcl
4.70-6.10*10(6)/mcl
4.8-10.8*10(3)/mcl
15.2gm/dl
43%
326*10(3)/mcl
5.51L
7.7L
Normal
Normal
Normal
Normal
Normal
Anticoagulant:
INR:
1.1or below is considered
normal
1 Normal
(partial
thrombolastin time)PTT
25-35second 23second
Low ,can caused by blood
thinning medication this
patient he is take heparin

21. Drug study:

22. Drug Name Classification Indication Action Adverse
Reaction
Contraindication Nursing
Consideration
Generic
Name:
labetalol
hydrochlorid
Brand Name:
Trandate
Dosage:
10mg
Beta-Blockers,
Alpha Activity
Labetalol is used with
or without other
medications to treat
high blood pressure
(hypertension).
Lowering high blood
pressure helps prevent
strokes, heart attacks,
and kidney problems
Chemical effect :
used to treat high
blood
pressure. Labetalol
is in a class
of medications calle
d beta blockers.
Therapeutic effect:
It works by
relaxing blood
vessels and slowing
heart rate to
improve blood flow
and decrease blood
pressure.
fatigue,
weakness
blurred vision,
dry eyes
dizziness,
drowsiness,
insomnia
-People with overt
cardiac failure,
greater-than-first-
degree heart block,
severe bradycardia,
cardiogenic shock,
severe hypotension
-Anyone with a history
of obstructive airway
disease including
asthma, and those
with hypersensitivity
to the drug.
-Patients receiving labetalol IV
must be supine during and for
3 hr after administration.
-Vital signs should be
monitored every 5– 15 min
during and for several hours
after administration.
-Monitor intake and output
ratios and daily weight.
-Assess patient routinely for
evidence of fluid overload
(peripheral enema, dyspnea,
fatigue, weight gain, jugular
venous distention.
-Monitor patients receiving
beta blockers for signs of
overdose (bradycardia, severe
dizziness or fainting, severe
drowsiness, dyspnea,
bluish fingernails or palms,
seizures.

23. PATIENT MEDICATION

24. BRAND NAME GENERIC NAME DOSAGE FREQUENCY ROUTE DATE D/C ONGOING
Heparin
Adalat
Pentazole
Nimotop
Physiotens
Multiparin
Heparin
Nifedipine
Pantoprazole
Nimodipine
Moxonidine
Multiparin
5000units
90mg
40mg
60mg
0.4mg
5ml
TID
Daily
Daily
Q4
Daily
TID
SC
NGT
IV
NGT
NGT
SC
20/10
20/10
20/10
20/10
20/10
20/10
7days
7days
7days
7days
7days
1day

25. NURSING CARE PLANE

26. Assessment Nursing Diagnosis Planning Intervention Rational Evaluation
Subjective:
He have sever headache
since 3 weeks “as
verbalized by the
relative”
Objective:
Restlessness
Hypertension
Pale
Looks tired
Vital sign taken :
BP: 230/110mmhg left
Arm.
HR:90bpm in sinus
rhythm,
TEMP:37.6c
RR:25bpm
O2:94%
cbs:149mg/dl
Ineffective cerebral
tissue perfusion related
to brain bleeding.
After 8 hours of nursing
intervention the patient
will be able to display
decrease signs of
ineffective tissue
perfusion as evidence by
gradual improvement of
vital signs
Nursing Management(5):
1-closely monitor the vital
Sign.
2-monitor neurologic status
include:
Glasgow coma scale and
LOC.
3- elevate the head of the
bed 30 degrees .
4-establish iv line
5-Maintain bed rest, provide
quiet and relaxing
environment, restrict visitors
and activities. Cluster
nursing interventions and
provide rest periods
between care activities.
Limit duration of
procedures.
1-changes in the vital signs
may indicates changes
in patient status.
2-to detect changes
indicative of worsening or
improving
Condition
3-Reduces arterial pressure
by promoting venous
drainage and may improve
cerebral
Perfusion
4- to give any kind of
MEDICATION
5-Continuous stimulation or
activity can increase
intracranial pressure (ICP).
Absolute rest and quiet may
be needed to prevent re
bleeding in the case of
haemorrhage.
After 8 hours of nursing
intervention the patient
shall have displayed a
decreased sign of tissue
perfusion and gradual
improvement of vital
signs.
BP:180/100mmhg left
Arm.
HR:95bpm in sinus
rhythm,
TEMP:36.7c
RR:20bpm
O2:99%
cbs:120mg/dl

27. Medical:
interventions: administer medication as order by physician :
1-Anticoagulants: Heparin 5000 units - used to improve cerebral blood flow and prevent
further clotting when embolism and/or thrombosis is the problem.
2-tranexamic acid 500mg - Used with caution in hemorrhagic disorder to prevent lysis of formed
clots and subsequent re bleeding.
3-analgesic paracetamol 1gm - used to trait the pain
4-antihypertensive trandate infusion 12mg/hr
- Chronic hypertension requires cautious treatment because aggressive management increases
the risk of extension of tissue damage.
5- Follow up the CT scan after the test - the results of CT scan should be available to the doctor
within 24hours after the test.

28. HEALTH TEATCHING
1-Check your blood pressure as directed - High blood pressure
can increase your risk for a stroke , Follow your healthcare
provider's directions for controlling your blood pressure.
2-Eat a variety of healthy foods - To provide the body with all
important elements and vitamins.
3-Do not drink alcohol – Because it is cause of bleeding.
4-Exercise as directed- it can lower the blood pressure,
cholesterol, weight, and blood sugar levels.
5-Manage stress – it can raise blood pressure. Find new ways to
relax, such as deep breathing or listening to music.

29. QUISTIONS ?

30. References:
1. Cleveland Clinic. (2019). Cerebral & Intracerebral Hemorrhage | Cleveland Clinic.
[online] Available at: https://my.clevelandclinic.org/health/diseases/14480-
intracranial-hemorrhage-cerebral-hemorrhage-and-hemorrhagic-stroke
[Accessed 29 Nov. 2019].
2. Emedicine.medscape.com. (2019). Intracranial Hemorrhage Medication:
Antihypertensive agents, Osmotic diuretics, Antipyretics, analgesics,
Anticonvulsants, Antidotes, Antacids. [online] Available at:
https://emedicine.medscape.com/article/1163977-medication [Accessed 29
Nov. 2019].
3. Emedicine.medscape.com. (2019). Brain Imaging in Hypertensive Hemorrhage:
Practice Essentials, Computed Tomography, Magnetic Resonance Imaging.
[online] Available at: https://emedicine.medscape.com/article/338055-
overview [Accessed 29 Nov. 2019].