Abercrombie,_ Nursing spontaneous subarachnoid hem

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SAH Nursing

Key words: inferior vena spontaneous bleeding (non-traumatic) subarachnoid hemorrhage (SAH), Department of the brain surface or substance of the vascular lesions, rupture leaving blood to flow into subarachnoid space [1]. The most common disease for intracranial aneurysm, cerebral vascular malformations. Clinical manifestations of rapid-onset severe headache, nausea, vomiting, unconsciousness, and meningeal irritation. Patients often due to massive bleeding, rebleeding and vasospasm complicated with the death, do to stop bleeding of acute care or reduce recurrence, relieve spasm and improve the prognosis is very important. Our department since 2004 were treated 28 patients with spontaneous subarachnoid hemorrhage, through the Diet for patients with care, psychological counseling, close observation of changes in the condition and signs of life care, patients had no further bleeding, which have received satisfactory treatment effect of hospital, nursing experience reported as follows. 1 clinical data 2004 年 12 months to October 2006 were treated 28 cases of subarachnoid hemorrhage, were confirmed by CT diagnosis of the head, of which 19 males and 9 females, aged 28 to 61 years, mean age 48 years. Given to patients during hospitalization mannitol and furosemide to reduce intracranial pressure such as dehydration treatment, and given the role of the bleeding with antifibrinolytic drugs 6 - aminocaproic acid reduces rebleeding rate, intravenous nimodipine [2] Prevention of cerebral vasospasm after SAH occurred. 2 2.1 diet nursing care of patients with subarachnoid hemorrhage required absolute bed rest, intestinal creeping slowly, poor appetite, giving small meals often, providing high-calorie, high vitamin, high-quality protein, light, easy to digest and to inform patients eat food containing crude fiber vegetables, fruits (leeks, celery, bananas), and to ensure that nutrition, improve body resistance. Avoid spicy food, 1 ~ 2h after each meal a few minutes massaging the abdomen, can promote bowel movements,[link widoczny dla zalogowanych], helps digestion, maintain smooth stool. Avoid hard bowel movement, if necessary, give laxatives prescribed. Avoid too much meal, increased intra-abdominal pressure caused by increased intracranial pressure. While limiting the intake of water daily into the volume of 1500ml, so as not to aggravate cerebral edema. Conscious patient told his slow eating, head up 15 ° ~ 30 °, head to one side to prevent choking. Prescribed when necessary to give indwelling gastric tube. Daily water and electrolyte and heat to maintain the minimum requirement. 2.2 psychological care of patients with subarachnoid hemorrhage often irritability, mental excitement and other symptoms, psychological care can make a speedy recovery for the disease. Patiently explained to patients so that patients understand the disease etiology, clinical manifestations, diagnosis and treatment and reduce the control of the symptoms, to enable patients to maintain a relaxed and happy mood, establish their confidence to overcome the disease,[link widoczny dla zalogowanych], actively cooperate with the treatment and get enough rest. Illness observation 2.3.1 2.3 observation close observation of vital signs, records state of consciousness, pupil size, light reactions and vital signs. Consciousness, pupillary changes are important indicators to judge the disease, especially in patients with cerebral edema, should be observed 1 hour, pay attention to the orientation is correct, the pupil is so large, in order to detect cerebral hernia. When the disturbance of consciousness in patients with increased,[link widoczny dla zalogowanych], not easy to wake up, ranging from large on both sides of the pupil should be considered herniation occurred, promptly notify the physician for emergency treatment. To maintain stable blood pressure, vasoactive drugs to prevent blood pressure fluctuated, to minimize the moving, the relative concentration of treatment and care, reduce patient interference. 2.3.2 close observation of the symptoms of headache, the nature of the observed, intensity, duration, and distraction with relaxation techniques and other methods to keep quiet wards and reduce visits. Given prescribed analgesics, and the effect observed after treatment, if found severe headache, frequent vomiting and were sprayed,[link widoczny dla zalogowanych], meningeal irritation sign was promptly notify the doctors to give appropriate treatment. To detect and control the seizures occur, given prescribed antiepileptic drugs. Agitation or delirium, immediately find the cause and appropriate treatment, such as the addition of beds file,[link widoczny dla zalogowanych], given constraints with constraints, or compliance administration.

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