Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

subarachnoid hemorrhage


Published on

case study for nursing students

Published in: Health & Medicine
  • I have been a type 2 diabetic sufferer for years. Thirty days after following your prgram, I can report the following results... ▲▲▲
    Are you sure you want to  Yes  No
    Your message goes here
  • Follow the link, new dating source: ♥♥♥ ♥♥♥
    Are you sure you want to  Yes  No
    Your message goes here
  • Dating direct: ♥♥♥ ♥♥♥
    Are you sure you want to  Yes  No
    Your message goes here
  • I have found your program really helpful. It is so easy to understand. It makes far more sense than school teachers ever did. I desperately need a 'C' grade and with your package, I am bang on this pass rate. With a bit more revision, it will be a comfortable pass. Thanks Jeevan! ◆◆◆
    Are you sure you want to  Yes  No
    Your message goes here
  • Sharpen your mind with brain pill. learn more info.. ♥♥♥
    Are you sure you want to  Yes  No
    Your message goes here

subarachnoid hemorrhage

  1. 1. A Case Study Presentation on Subarachnoid Hemorrhage Presented by: Asma Alzahrani Asma Alshehri Nada Atallah Layla Ali Akam Rawan Almarwani Shrog Mfleh Alblwi Jawaher Alharbi Norah Ahmed Khlood alatwi
  2. 2. Why we choose this case ?
  3. 3. General Objectives: The primary concern of this Case Study Presentation is to further enhance the understanding of Subarachnoid Hemorrhage in congruence with the learned concepts of the Nursing students.
  4. 4. • Specific Objectives: This case presentation seeks to provide different information about the disease being considered with the ff. specific objectives: Give a brief introduction about Subarachnoid Hemorrhage together with the clinical manifestations. Present the clients demographic and health history. Present the abnormal results of the physical assessment and compare it to the normal. Present the different laboratory test and results done to the clients with its interpretation. 5. Discuss the normal Anatomy and Physiology of Central Nervous System. 6. Explain the Pathophysiology of Subarachnoid Hemorrhage. 7. Discuss the drug study. 8. Present a Nursing Care Plan. 9. Show a Discharge Planning that the client may use upon discharge to the hospital.
  5. 5. I. Introduction Statistics ( incidence and prevalence) II. Patient/Case Presentation a. Assessment b. Demographics c. Lifestyle d. Family history e. Medical History: III. Anatomy and Physiology IV. Medical Management l Interventions a. Medications b. Medical interventions c. Diagnostic and laboratory tests V. Nursing Interventions V. Conclusion & Recommendation VI. References Outline:
  6. 6. A subarachnoid hemorrhage is an uncommon type of stroke caused by bleeding on the surface of the brain. It is a very serious condition and can be fatal SAH : fourth most frequent cerebrovascular disorder- following athero-thrombosis, embolism and primary intra-cerebral hemorrhage. CAUSE: Excluding head trauma, the most common cause of SAH is rupture of vascular aneurysm. introduction:
  7. 7. Subarachnoid Hemorrhage: Bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space Definition:
  8. 8. •The doctors have confirmed that the main caused by the presence stretch in one of the main arteries feeding the brain, and that in 90% of cases as there are up to 5% of normal people are predisposed to occurrence of this expansion, and there are 10 people out of every 100 thousand people each year enter the stage It is called infiltration bloody phase, which precedes the bleeding or explosion, and the best treatment of these cases before entering into this phase where increasing the chances of successful surgical treatment to 99% if caught early. 10-12% die before receiving medical attention. Incidence and Prevalence
  9. 9. Many risk factors have been implicated in the pathogenesis of aneurysmal SAH. They include: arterial hypertension atherosclerosis alcohol use smoking race gender age analgesic use body mass index drug abuse oral contraceptive use size of unruptured aneurysm collagen vascular disease
  10. 10. and other genetic factors: a. the incidence of aneurysmal SAH increases with age reaching a peak in the sixth decade of life. b. sex: in adults, woman are affected more than men by a ratio of 3 : 2 c. aneurysmal SAH is rare in children and boys are affected more than girls by a ratio of 3 : 1 d. race: African-Americans are at a higher risk than white Americans e. the critical size of aneurysms determining the risk of rupture is reported to be between 5 and 7 mm . f. 11% of patients with either a ruptured or unruptured aneurysm had a family history of cerebrovascular disease(compared with 4% of matched controls)
  11. 11. Subarachnoid hemorrhage can be caused by: •Bleeding from (AVM) •Bleeding disorder •Bleeding from a •Head injury •Unknown cause (idiopathic) •Use of blood thinners Subarachnoid hemorrhage caused by injury is often seen in the elderly who have fallen and hit their head. Among the young, the most common injury leading to subarachnoid hemorrhage is motor vehicle crashes. Causes:
  12. 12. in other blood vessels An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel •Fibromuscular dysplasia (FMD) and other connective tissue disorders •High blood pressure •History of Polycystic kidney disease is a kidney disorder passed down through families in which many cysts form in the kidneys, causing them to become enlarged. •Smoking •A strong family history of aneurysms may also increase your risk. Risks Include:
  13. 13. Internal carotid artery Posterior communicating artery aneurysm
  14. 14. subarachnoid hemorrhage (SAH) is classified according to 5 grades, as follows • Grade I: Mild headache with or without meningeal irritation • Grade II: Severe headache and a nonfocal examination, with or without mydriasis • Grade III: Mild alteration in neurologic examination, including mental status • Grade IV: Obviously depressed level of consciousness or focal deficit • Grade V: Patient either posturing or comatose
  15. 15. The main symptom is a severe headache that starts suddenly (often called thunderclap headache). It is often worse near the back of the head. Many persons often describe it as the "worst headache ever" and unlike any other type of headache pain. The headache may start after a popping or snapping feeling in the head. Other symptoms: and alertness Eye discomfort in bright Mood and personality changes, including and irritability (especially Nausea and vomiting Symptoms:
  16. 16. Symptoms continuation… •Numbness in part of the body •Stiff neck
  17. 17. The goals of treatment are to: •Save life •Repair the cause of bleeding •Relieve symptoms •Prevent complications such as permanent brain damage (stroke) treatment
  18. 18. •How well a patient with subarachnoid hemorrhage does depends on a number of different factors, including: •Location and amount of bleeding •Complications •Older age and more severe symptoms can lead to a poorer outcome. •People can recover completely after treatment. But some people die even with treatment. Prognosis:
  19. 19. Possible Complications
  20. 20. PATHOPHYSIOLOGY Modifiable Risk Factors >HPN >Smoking >excessive intake of foods high in fats and cholesterol Non-modifiable Risk Factors> Advanced Age >Gender >Heredity Triggering Factors >Sudden extreme emotion Arterio venous malformation Cerebral aneurysm rupture Bleeding into the brain tissue and subarachnoid space
  21. 21. Blood Clots in the Subarachnoid Space Brain Compression Blood supply interruption Tissue Necrosis Neuronal Death Increase Intracranial Pressure T total Paralysis Regional Paralysis Epileptic Seizure : increase intraocular pressure= blindness Death Coma
  22. 22. Name: S.M Date of birth: December 14, 1984 Age: 31 years Gender: Female Marital status : Married Admission Date: 25/02/2015 Diagnosis: Subarachnoid hemorrhage Chief complaint: Headache, hypertension and projectile vomiting.
  23. 23. GENERAL APPEARANCE: alert of patient is reduce or low ,uncooperative
  24. 24. 1-skull 2-scalp 3-eyes 4-nose 5-throat 6-skin 7-neck region 8-lungs 12-upper and lower extremities 11-abdomen 10-breast 9-heart
  25. 25. AnalysisActual findingTechnique usedBody parts NormalThe skull is normocephalic and symmetrical to the body with prominences in frontal and occipital area ,symmetrical in all place. Inspection, palpation 1-Skull NormalWhite ,no mass, lumps, scar ,and lesions no area of tenderness is observed . Inspection2-Scalp
  26. 26. AnalysisActual findingTechnique usedBody parts Not normal indicates Low level of conscious Dilated pupils and no reaction to light , she have some discharges around the lacrimal area . Inspection3- Eyes NormalMidline symmetrical and patent , no discharge. Inspection4-Nose
  27. 27. AnalysisActual findingTechnique usedBody parts NormalOral cavity and pharynx normal. No inflammation, swelling, exudate, or lesions. Teeth and gingiva in good general condition. Inspection5- Throat Normalnormal color, texture and turgor with no lesions or eruptions. Generally uniform skin temperature. Inspection , palpation 6- Skin
  28. 28. AnalysisActual findingTechnique usedBody parts NormalSymmetrical and straight ,no palpable lumps, and supple, trachea is on midline of neck , and spaces are equal onboth sides. Inspection , palpation 7-Neck region NormalClear to auscultation and percussion without rhonchi, wheezing or diminished breath sounds. Auscultation , percussion 8-Lungs
  29. 29. AnalysisActual findingTechnique usedBody parts NormalNormal S1 and S2. No S3, S4 or murmurs. Rhythm is regular. There is no peripheral edema, cyanosis or pallor. Extremities are warm and well perfused. Auscultation9-Heart NormalNo tenderness, Masses, Nodules and discharge. Inspection , Palpation 10-Breast
  30. 30. AnalysisActual findingTechnique used Body parts NormalPositive bowel sounds. Soft, no distended, non tender. No guarding or rebound. No masses, uniform color ,rounded symmetrical Inspection , Auscultation, Percussion, Palpation 11-Abdomen NormalBoth feet reveals all toes to be normal in size and symmetry, normal range of motion, normal sensation with distal capillary filling of less than 2 seconds without tenderness, swelling, discoloration, nodules, both ankles, knees, legs, and hips reveals normal range of motion, normal sensation without tenderness, swelling, discoloration, crepitus, weakness or deformity. Inspection12-Upper and lower extremities
  31. 31. Normal Values:Result: 132-146mmol/L124(Sodium: (1 3.6-5.0mmol/L4.2Potassium : 98-107mmol/L92(Chloride:(2 22-29mmol/L25Enzymatic bicarbonate: Hyponatremia Hypochloremia 1 2
  32. 32. Normal Values:Result: 4.0-11.0 10^3/Ml14.51(WBC (1 3.8-4.8 10^6/Ml4.40RBC 12.0-16.0g/dl12.9Hemoglobin 36.0-45.0%37.5HCT 82.7-89.485.2MCV 31.5-34.5g/dl34.4MCHC leukocytosis 1
  33. 33. Normal Values:Result : 0.74-0.99mmol/L0.79Magnesium 0.81-1.58mmol/L1.01Phosphate 2.12-2.52mmol/L2.33Calcium Miscellaneous Chemistry
  34. 34. Normal Values:Result: 2.5-6.4mmol/L1.66Urea nitrogen 53-155mmol/L37Creatinine Renal Function Test
  35. 35. •Grade I or II SAH: •In patients with a suspected grade I or II subarachnoid hemorrhage (SAH), emergency department (ED) care essentially is limited to diagnosis and supportive therapy. •Early identification of sentinel headaches is key to reduced mortality and morbidity rates. Use sedation judiciously. •Secure intravenous access, and closely monitor the patient's neurologic status
  36. 36. • Grade III, IV, or V SAH: • In patients with a grade III, IV, or V subarachnoid hemorrhage (SAH) (ie, altered neurologic examination), ED care is more extensive. • Address the patient's airway, breathing, and circulatory status (ABCs). In addition, reliable neurologic examinations before and after initial treatment are critically important to optimizing management and to deciding on the appropriate neurosurgical intervention. • Intubation • Endotracheal (ET) intubation of obtunded patients protects them from aspiration caused by depressed airway protective reflexes. Also intubate to hyperventilate patients with signs of herniation. • Precautions • Avoid excessive or inadequate hyperventilation. Target the partial pressure of carbon dioxide (pCO2) at 30-35 mm Hg to reduce elevated ICP. Excessive hyperventilation may be harmful to areas of vasospasm. • Avoid excessive sedation. It makes serial neurologic exams more difficult and has been reported to increase ICP directly. However, avoid any increase in ICP due to excessive agitation from pain and discomfort.
  37. 37. •Neurosurgery to
  38. 38. •If no aneurysm is found, the person should be closely watched by a health care team and may need more imaging tests •Treatment for coma or decreased alertness includes: •Draining tube placed in the brain to relieve pressure •Life support •Methods to protect the airway •Special positioning
  39. 39. •A person who is conscious may need to be on strict bed rest. The person will be told to avoid activities that can increase pressure inside the head, including: •Bending over •Straining •Suddenly changing position
  40. 40. •Treatment may also include: •Medicines given through an IV line to control blood pressure •Nimodipine to prevent artery spasms •Painkillers and anti-anxiety medications to relieve headache and reduce pressure in the skull •Phenytoin or other medications to prevent or treat seizures •Stool softeners or laxatives to prevent straining during bowel movements
  41. 41. Adjunctive Therapies and Measures •Keep the patient's core body temperature at 37.2°C •Consider antiemetics for nausea or vomiting. •Elevate the head of the bed 30° to facilitate intracranial venous drainage. Emergent ventricular drainage by the neurosurgeon may be necessary. •Maintain the patient's serum glucose level at 80-120 mg/dL; use sliding or continuous infusion of insulin if necessary. •Fluids and hydration •Do not over hydrate patients because of the risks of hydrocephalus. •Patients with subarachnoid hemorrhage (SAH) may also have hyponatremia from cerebral salt wasting.
  42. 42. In our case : •Investigation : •CBC analysis •Urine analysis •Pt ,PTT •Diagnostic procedures : •ECG •CT brain •MRI • chest x ray
  43. 43. Special order : •Elevate the head of the bed 30° . •Normal saline 70ml hour •Regular soft diet •Keep oxygen saturation between 95 to 98 % .
  44. 44. DRUG STUDY
  45. 45. NURSING RESPONSIBILITIESSIDE EFFECTSINDICATIONS/ CONTRAINDICATION DOSAGE/ ROUTE/ FREQUENCY DRUG NAME Do not exceed 4gm/24hr. in adults Do not take for 10 days for pain in adults, or more than 3 days for fever in adults. Extended-Release tablets are not to be chewed. Monitor CBC, liver and renal functions. Assess for fecal occult blood and nephritis. Avoid using OTC drugs with Acetaminophen. Take with food or milk to minimize GI upset. Report N&V. cyanosis, shortness of breath and abdominal pain as these are signs of toxicity. Report paleness, weakness and heart beat skips Report abdominal pain, jaundice, dark urine, itchiness or clay-colored stools. Phenacetin may cause urine to become dark brown or wine-colored. Report pain that persists for more than 3-5 days Avoid alcohol. This drug is not for regular use with any form of liver disease. Minimal GI upset. Methemoglobinemia Hemolytic Anemia Neutropenia Thrombocytopenia Pancytopenia Leukopenia Urticaria CNS stimulation Hypoglycemic coma Jaundice Glissitis Drowsiness Liver Damage . -INDICATIONS Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances, bleeding diatheses CONTRAINDICATION Renal Insufficiency Anemia Special Concerns: Liver toxicity (hepatocyte necrosis) ROUTE IV DOSAGE 60mg FREQUENC Y Q6h GENERIC NAME: Paracetamol BRAND NAME Acetaminophen CLASSIFICATION Analgesics (nonopioid) - Muscle Relaxants -Anti- pyretic
  46. 46. NURSING RESPONSIBILITIESSIDE EFFECTSINDICATIONS/ CONTRAINDICATION DOSAGE/ ROUTE/ FREQUENCY DRUG NAME Assess patient for pain and limitation of movement; note type, location, and intensity prior to and at the peak following administration. Administer after meals or with food or an antacid to minimize gastric irritation. Instruct patient to take with a full glass of water and to remain in an upright position for 15-30 min after administration. Teach patient to report blurred vision, ringing of ears that may indicate toxicity. Advise patient to report change in urine pattern, edema, increased pain in joints, fever, blood in urine that may indicate nephrotoxicity Gastrointestinal - Abdominal discomfort, heartburn, abdominal cramps, nausea, vomiting and diarrhea. Central Nervous System - Headache, dizziness and drowsiness. Genitourinary - Blood in urine, decrease in urination and kidney failure. -INDICATIONS prescribed for painful Relieve pain after surgical intervention inflammatory conditions CONTRAINDIC ATION to patients with gastrointestinal bleeding, ulcer, severe kidney, liver disease, bleeding disorders, and hypersensitivity ROUTE IV DOSAGE 40MG FREQUENCY OD GENERIC NAME: Nimesulide BRAND NAME Nexen CLASSIFICATION Analgesic, antipyretic Non steroidal Anti- Inflammatory Agents NSAID
  47. 47. NURSING RESPONSIBILITIESSIDE EFFECTSINDICATIONS/ CONTRAINDICATION DOSAGE/ ROUTE/ FREQUENCY DRUG NAME Assess condition before therapy and reassess regularly thereafter to monitor drug’s effectiveness> Monitor pt for any adverse GI reactions,nausea,vomiting,diarrhea,> Assess for adverse reactions> for pt. with hepatic encephalopathy :regularly assess mental condition> monitor I & O> monitor for Inc.glucose level in diabetic pts Abdominal discomfort associated with Flatulence and intestinal cramps. Nausea,vomiting, diarrhea on prolonged use. -INDICATIONS Prevention and treatment of portal- systemic encephalopathy (PSE), including stages of hepatic precoma and coma CONTRAINDIC ATION to Patients who require a low galactose diet ROUTE Po DOSAGE 15 ML FREQUENCY OD GENERIC NAME: Lactulose BRAND NAME Cephulac CLASSIFICATION hyperosmotic laxative
  48. 48. Nursing managment
  49. 49. evaluationinterventionpalnningNursing diagnosisscientific explanation assessment Evaluate patient pain scale if it is reduced or not. -Assess for signs and symptoms of headache (statements of same, restlessness, irritability, grimacing, rubbing head, avoidance of bright lights and noises, reluctance to move) Rational:to assess whether the client felt the pain of acute or chronic -Assess patient's perception of the severity of the headache using a pain intensity rating scale. Rational:It is important to help patients express as factually as possible - Assess the patient's pain pattern (e.g. location, quality, onset, duration, precipitating factors, aggravating factors, alleviating factors). Rational:Different etiologic factors respond better to different therapies after 3hrs of nursing intervention the patient will reduce of pain as evidenced by: 1. verbalization of the same 2. relaxed facial expression and body positioning Acute pain related to stretching or compression of cerebral vessels and tissue associated with increased intracranial pressure leakage of blood from an aneurysm in the brain accumulation of blood between the arachnoid and pia mater elevation of the pressure in the cranium Subjective:I have a severe headache” as verbalized by patient Objective: Behavior: showing symptoms pain. Changes in the ability to perform daily activities. pain scale:5of 10 .
  50. 50. intervention -Assess the degree of making a false step in person from the patient, such as isolating themselves,Note the influence of pain such as: loss of interest in life, decreased activity, weight loss Position patient in semi fowler position. Rational:Pain that has been chronic and long-standing may have devastating emotional effects on the patient and these emotional complications may make effective treatment of the pain more difficult. -Encourage patient to rest in bed. Rational:to reduce the intensity of pain. -Provide quite and calm environment. -Teach relaxation and deep breathing techniques Rational:to reduce tension and create a feeling more comfortable. -Give the hot moist compress / dry on the head, neck, arms as needed. Rational:Hot moist compresses have a penetrating effect. The warmth rushes blood to the affected area to promote healing Massage the head / neck / arm if the patient can tolerate the touch. Rational:to decreases muscle tension and can promote comfort -Use the techniques of therapeutic touch, visualization, and stress reduction and relaxation techniques to another. Rational:Techniques used to bring about a state of physical and mental awareness and tranquility. The goal of these techniques is to reduce tensions, subsequently reducing pain. -Instruct the patient to use a positive statement "I am cured, I'm relaxing, I love this life“, Instruct the patient to be aware of the external-internal dialogue and say "stop" or "delay" if it comes up negative thoughts. Collaboration for providing analgesic as doctor order.. Rational:The use of a mental picture or an imagined event that involves use of the five senses to distract oneself from painful stimuli.
  51. 51. evaluati on interventionpalnningNursing diagnosis scientific explanation assessment After 2 hr Cerebral function improve d; neurolog ical deficits stabilized . Assess factors related to individual situation for decreased cerebral perfusion and potential for increased ICP. Rationale: Assessment will determine and influence the choice of interventions. Deterioration in neurological signs or failure to improve after initial insult may reflect decreased intracranial adaptive capacity requiring patient to be transferred to critical area for monitoring of ICP, other therapies. After 2 hr patient will able to Maintain improved level of consciousness, cognition, and sensory function. Ineffective Cerebral Tissue Perfusion related to hemorrhage the inadequacy of blood flow through the cerebral vasculature to maintain brain function Subjective: “Why am I here, what happened to me "as verbalized by patient Objective: -Altered level of consciousness; -Changes in sensory responses
  52. 52. intervention -Closely assess and monitor neurological status frequently and compare with baseline. Rationale: Assesses trends in level of consciousness (LOC) and potential for increased ICP and is useful in determining location, extent, and progression of damage. May also reveal presence of TIA, which may warn of impending thrombotic CVA. -Evaluate pupils, noting size, shape, equality, light reactivity. Rationale: Pupil reactions are regulated by the oculomotor (III) cranial nerve and are useful in determining whether the brain stem is intact. Pupil size and equality is determined -Document changes in vision: reports of blurred vision, alterations in visual field, depth perception. Rationale: Specific visual alterations reflect area of brain involved, indicate safety concerns, and influence choice of interventions. Assess higher functions, including speech, if patient is alert. Rationale: Changes in cognition and speech content are an indicator of location and degree of cerebral involvement and may indicate deterioration or increased ICP. -Position with head slightly elevated and in neutral position. Rationale: Reduces arterial pressure by promoting venous drainage and may improve cerebral perfusion. Maintain bedrest, provide quiet and relaxing environment, restrict visitors and activities. Cluster nursing interventions and provide rest periods between care activities. Limit duration of procedures. Rationale Continuous stimulation or activity can increase intracranial pressure (ICP). Absolute rest and quiet may be needed to prevent rebleeding in the case of hemorrhage Assess for nuchal rigidity, twitching, increased restlessness, irritability, onset of seizure activity Rationale: Indicative of meningeal irritation, especially in hemorrhage disorders. Seizures may reflect increased ICP or cerebral injury, requiring further evaluation and intervention. Administer supplemental oxygen as indicated. Rationale: Reduces hypoxemia. Hypoxemia can cause cerebral vasodilation and increase pressure or edema formation.
  53. 53. evaluatio n interventionPlanningNursing interventionassessment After 1 hour Patient was able acceptan ce of self in situation and awarenes s of own coping abilities Assess extent of altered perception and related degree of disability. Determine Functional Independence Measure score. Rationale: Determination of individual factors aids in developing plan of care/choice of interventions and discharge expectations. Determine outside stressors: family, work, future healthcare needs. Rationale: Helps identify specific needs, provides opportunity to offer information and begin problem- solving. Consideration of social factors, in addition to functional status, is important in determining appropriate discharge destination. After 1 hour Patient Verbalize acceptance of self in situation and Verbalize awareness of own coping abilities. Ineffective Coping related to vulnerability, cognitive perceptual changes. Subjective: Inability to make decisions Objective: Inability to cope/difficulty asking for help
  54. 54. evaluationinterventionplanningNursing interventionassessment Encourage patient to express feelings, including hostility or anger, denial , depression, sense of disconnectedness Rationale: Demonstrates acceptance of patient in recognizing and beginning to deal with these feelings. Identify previous methods of dealing with life problems. Determine presence of support systems. Rationale: Provides opportunity to use behaviors previously effective, build on past successes, and mobilize resources. Monitor for sleep disturbance, increased difficulty concentrating, statements of inability to cope, lethargy, withdrawal. Rationale: May indicate onset of depression, which may require further evaluation and intervention
  55. 55. evaluationinterventionplanningNursing interventionassessment . Refer for neuropsychological evaluation and/or counseling if indicated. Rationale: May facilitate adaptation to role changes that are necessary for a sense of feeling/being a productive person.
  56. 56. Discharge Plan • Activity  You will need to have someone with you for the next several days to watch for worsening of symptoms (see below) and to allow you to rest.  Start with light activity around the house for the first 3 days you are home.  Gradually increase your activity starting with short walks 1-2 times per day.  Avoid contact sports, skating, bike riding, or other such activities for 6 weeks. Encourage pt to do passive range of motion • Nutrition : Instruct the relative to feed pt on time with proper food low in Na Low in cholesterol low in fat and give citrus fruits ,moderate in fluid intake and increase fiber diet to improve health.  Ffollow the diet prescribed by the doctor.
  57. 57. Medications  Take your medications as prescribed and gradually decrease pain medications as your pain improves. Instruct pt and their relative to follow medication regimen Educate and instruct the patient and her family to monitor BP and PR before giving medication Follow-up Follow up with your primary care physician for all medical issues.
  58. 58. Call your doctor or return to the emergency room if you experience any of the following symptoms: . • Clear or bloody drainage from your nose or ears • Worsening headache • Changes in vision or differently sized pupils • Seizure activity or jerking / twitching of the face, arms, or legs • Sleepiness or difficulty waking up • Memory loss • Irritability • Nausea or vomiting that won’t stop • Confusion or difficulty talking • A fever above 100 degrees F • Arm, leg, or facial weakness • Difficulty walking, loss of balance, and dizziness • Stiff neck
  59. 59. • Subarachnoid hemorrhage (SAH) is a pathologic condition that exists when blood enters the subarachnoid space • The most common cause of SAH is trauma • The most common cause of spontaneous SAH is an aneurysmal bleed (65-80%) • •Sudden explosive headache may be the only symptom in a third of patients. •Of patients who present with a sudden explosive headache as the only symptoms, around 10% have SAH
  60. 60. References: • Naggara ON, White PM, Guilbert F, et al. Endovascular treatment of intracranial unruptured aneurysms: systematic review and meta-analysis of the literature on safety and efficacy. Radiology. 2010;256:887-897. • Reinhardt MR. Subarachnoid hemorrhoid. J Emerg Nurs. 2010;36:327-329. • Tateshima S, Duckwiler G. Vascular diseases of the nervous system: intracranial aneurysms and subarachnoid hemorrhage. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 51C. • Zivin J. Hemorrhagic cerebrovascular disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 415. • anatomy/blood-vessels-of-the-brain/
  61. 61. THANK YOU