I. Overview
Hypertensive cerebral hemorrhage is the most serious complication of hypertension, its incidence is related to the degree of elevated blood pressure, mostly seen in patients under the age of 50-60 years old, the prevalent sites are: shell pull hemorrhage accounts for about 40%, cerebellar and brainstem hemorrhage accounts for about 10%, cerebral bridge hemorrhage accounts for 10%, thalamic hemorrhage accounts for 10%, cerebral hemisphere cortex hemorrhage accounts for about 15%, intraventricular hemorrhage accounts for about 15%.
Clinical manifestations
These patients have a rapid onset and may or may not have precursor symptoms (headache, dizziness, numbness and discomfort of limbs, etc.) before the onset.
1.Headache, nausea and vomiting, neck stiffness.
2. Paralysis of the contralateral limb, hemiparesis, ataxia, loss of sensation.
3.Changes in consciousness, the milder ones are conscious, the more severe ones appear coma.
4. Nystagmus, double pupil narrowing or “pinpointing”.
Nursing diagnosis
1.Anxiety is related to (worry about disease prognosis, economic status, role change).
2. Ineffective airway clearance is associated with (impaired consciousness, diminished cough reflex).
3.Self-care deficits are related to (hemiplegia, impaired verbal communication, unconsciousness).
4.Changes in vital signs may be related to intracranial rebleeding.
5, Altered comfort is associated with hypothermia T>X.
6, Possibility of decreased effective circulating blood volume (i.e., BP below X mmHg) associated with resolution of black stool (blood in stool).
7, Hypertension (>XmmHg).
8, Lack of knowledge of (physical function, speech function) exercise.
9, Risk of impaired skin integrity associated with (impaired consciousness, limb hemiparesis, incontinence, poor nutritional status, diarrhea).
10. Potential complications: infection.
IV. Pre-operative care
1.According to the preoperative care routine of neurosurgery.
2. Absolute bed rest, keep quiet, avoid emotional excitement, prevent blood pressure from rising together with rebleeding.
3. Lie in a flat position with the head to one side and avoid substantial head turning.
4.For those who are agitated, appropriate restraint can be applied.
5.Keep the airway open, give oxygen 3 liters/minute inhalation.
6. Closely observe the changes of consciousness, pupils, BP, P and R. Report and deal with any abnormalities in time.
7.Prevent colds, avoid intense coughing and sneezing.
8.Give dietary guidance to prevent constipation and avoid forceful bowel movement.
9.Strengthen life care and psychological care.
V. Postoperative care
1.According to the postoperative care routine of neurosurgery.
2. Closely observe the changes of consciousness, pupil, BP, P, R and the condition of the posterior limbs, and observe the symptoms of vomiting blood and blood in stool.
3.Lie flat when not awake from general anesthesia, with head to the side, and elevate the head of the bed by 30° after awakening.
4.Keep the respiratory tract unobstructed, clear the respiratory secretions in time, and give oxygen inhalation.
5.Guidance on correct diet, fluid can be fed one day after surgery, and then gradually transition to general diet, strengthen the intake of nutrition, fiber and vitamin in the diet.
6.Postoperative unconsciousness according to coma care routine.
7.Strengthen basic care and prevent urinary tract infection and decubitus ulcers.
8.For those with language and body dysfunction, instruct and encourage individuals to perform functional exercises.
VI. Health guidance
1.Take regular blood pressure measurement and antihypertensive medication on time.
2.Take anti-epileptic drugs on time, and check liver function regularly.
3.People with debridement, pay attention to local protection, and cranial repair is feasible after six months.
4.Patients with hemiplegia and impaired consciousness should turn and pat their backs regularly, and those who are incontinent should pay attention to skin care and prevent bed sores.
5.For hemiplegic or aphasic patients, strengthen psychological care to build up confidence, cooperate with acupuncture and physiotherapy, and gradually carry out functional exercise according to the plan.
6.Regular review in outpatient clinic.