Journal of Brain & Neuroscience Research Category: Clinical Type: Opinion
Nursing Assistance to Patient with Cerebral Hemorrhage
- Ana Juana Tambasco1*
- 1 Department Of Neurosurgery, Registered Nurse, S. Luca Hospital, Vallo Della Lucania, Italy
*Corresponding Author:Ana Juana Tambasco
Department Of Neurosurgery, Registered Nurse, S. Luca Hospital, Vallo Della Lucania, Italy
Received Date: Dec 07, 2018 Accepted Date: Jan 26, 2019 Published Date: Feb 11, 2019
About 25% of strokes for elderly patients are due to acute cerebral hemorrhage. Consequently, treatments to improve prognosis should be identified.
We retrospectively analyzed the type of nursing assistance given to patients with cerebral hemorrhage admitted to us from 2016 to 2018.
We tried to identify arecommended clinical nursing pathway for patients with acute cerebral hemorrhage, improving the clinical effects and nursing satisfaction and reducing adverse reactions.
There is significant learner concern regarding education within the cerebral hemorrhage patients. Although there are educational guidelines and focused neurocritical care educational materials, these alone do not satisfy educational needs. This study demonstrates the need for educational changes, but it does not assess best strategies or curricular content.
State of consciousness
• Monitor pupils frequently (diameter and reactivity to light stimulus)
• In case of psychomotor agitation, reassure the patient and inform the doctor
• In case of respiratory depression, position the Guedel cannula, ventilate the patient with a mask and assist the resuscitator in endotracheal intubation maneuvers, if the respiratory autonomy fails
• Position a venous catheter allowing solution infusion and intravenous therapy. The correct dressing of the catheter insertion area will prevent infections
• Alteration of the hydroelectrolyte balance
• Guarantee the patient’s hydration via enteral or parenteral
• Keep a daily hydroelectrolyte balance, taking care to monitor hourly diuresis and detect any episodes of polyuria or oliguria
• Replace the bed linen avoiding sudden movements or rapid changes in position
• Take careful cleaning of the oral cavity even several times a day
• Assume correct postures with particular attention to any plegic limbs; the decubitus should be alternated with frequency and the permanence on the hemiplegic side must be shorter than that on the healthy side
• Use anti-bedsores (water, air mattresses, donuts, pillows)
• Passively mobilize the patient
• Position the patient in lateral decubitus
• Export any foreign bodies from the oropharynx and aspirate the secretions
• Position a nasogastric tube if the patient is not autonomous
• Administer anticonvulsant drugs, according to the prescription
• Evaluate the airway patency and monitor the parameters
• Be ready to transfer the patient to intensive care, where necessary
Patients with subarachnoid or cerebral hemorrhage are generally considered extremely “delicate” subjects. For such patients, after the acute phase, bed rest is imperative and all the stimuli that can provoke a pressure increase- both psychic (emotions) and physical (noises, trauma in the movements, enema dosage and energetic purgatives, protracted aspirations of tracheal secretions with stimulation of the reflex to cough)- are avoided.
The post-operative course of the patient provides a close control of the level of consciousness, the presence of headache or neck stiffness and the possible emergence of post-intervention neurological deficits. Intensive control of the blood pressure values is necessary to avoid ischemic complications due to vasospasm. We must not forget the possibility of the emergence of obstructive hydrocephalus. In addition, patients treated with endovascular procedure are often kept on anticoagulate with heparin for one week and on antiplatelet therapy for three months: they therefore require frequent coagulation checks, especially in the first postoperative week. Guidelines specific to neurocritical care disease states are available from the American Heart Association (AHA), NCS, American Academy of Neurology (AAN) and Congressof Neurological Surgeons, among others [7-10].
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Citation:Tambasco AJ (2019) Nursing Assistance to Patient with Cerebral Hemorrhage. J Brain Neursci 2: 006.
Copyright: © 2019 Ana Juana Tambasco, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.