Unit 1: Stroke: Hemorrhagic Flashcards
Hemorrhagic Stroke
bleeding into the brain
-blood is a irritant to the brain
3 Main subtypes of Hemorrhagic Stroke
- Nontraumatic Subarachnoid Hemorrhage (SAH)
- Intracerebral Hemorrhage (ICH)
- Intraventricular Hemorrhage (IVH)
Subarachnoid Hemorrhage
caused by a ruptured aneurysm (weakened blood vessel) and less commonly caused by an arteriovenous malformation (AVM; mass of arteries and veins that is not connected by a capillary network)
- sudden severe headache; “thunderclap” headache b/c intensity of the pain at onset
- neck stiffness and pain occur b/c of the irritation of the meninges, at base of skull, where pooling of blood occurs
- photosensitivity w/ meningeal irritation or inflammation
Aneurysm
weak, dilated vessel
Arteriovenous Malformation (AVM)
mass of arteries and veins that is not connected by a capillary network
Risk Factors for Subarachnoid Hemorrhage (SAH)
- hypertension
- smoking
- heavy alcohol use
- use of sympathetic nervous stimulants (cocaine)
- female gender
- hx of cerebrovascular disease
- postmenopausal state
How does a Cerebral Aneurysm Occur?
- as a result of an inherent weakness or gradually acquired weakness of the medial layer in a segment of a blood vessel; muscular layer that adds shape and tone to the vessel; a weakness in a segment of this layer causes an outpouching of the blood vessel through the outermost adventitial layer
- aneurysm ruptures in the thinnest walled portion of the aneurysm (dome)
Clinical Manifestations of Hemorrhagic Stroke
- similar to ischemic; motor deficit, visual field cuts
- severe headache
- early and sudden changes in LOC
Medical and Surgical Management
prevent and minimize complications such as aneurysm rebleeding and cerebral vasospasm (causes narrowing of blood vessel segments)
- Aneurysm clipping: aneurysms are secured by applying a titanium clip to the neck of the aneurysm or
- Aneurysm coiling: deploying platinum coils into the aneurysm during angiography; reduces blood flow to the aneurysm
- surgical evacuation of a hematoma below the tentorium b/c risk of brainstem compression
- intraventricular hemorrhage managed with CSF drainage
Complications of Hemorrhagic Stroke
- Subarachnoid Hemorrhage causes neurological and systemic complications; ischemic stroke, cerebral edema, pulmonary edema, myocardial ischemia/infarction, acute respiratory distress syndrome (ARDs)
- Vasospasm (causes change in consciousness, new focal (localized) motor weakness
- Hyponatremia
- Seizures (blood is irritant to brain)
Complications: Hyponatremia
may be caused by SIADH or by cerebral salt wasting syndrome (renal salt wasting syndrome)
Nursing Assessments
- Know the patients baseline for neurological status
- Serial neurological assessments; q 1-2 hours
- Vital Signs; q 1-2 hours or more when administering meds that alter BP
- ECG
- Serum Electrolytes
- Intake and Output
Nursing Assessments: Vital Signs
after hemorrhagic stroke, close monitoring of vital signs (BP) is necessary to prevent rebleeding or expansion of hematoma
- If BP lower than prescribed targets, there is risk of hypoperfusion
- If BP higher than prescribed targets, there is risk of increased ICP and rebleeding
Nursing Assessments: Electrocardiogram (ECG)
identification of rhythm disturbances (A-fib, ST segment, or T wave changes associated with MI) is essential in determining potential causes of stroke and intervening in complications of stroke
- after SAH, may experience myocardial stunning
- trending of 12-lead ECGs and cardiac enzymes allows identification of potential myocardial infarction and/or reversible myocardial stunning
Nursing Assessments: Electrolytes
-sodium: to identify disorders of salt and water imbalance resulting in hyponatremia, which places patients who have suffered a stroke at high risk for cerebral edema and neurological deterioration
