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Alyssa Justine E.


Saint Paul University Philippines-Tuguegarao


Jose R. Reyes Memorial Medical Center

The title of the study: Management of intracerebral hemorrhage, clearly defines what the
study is all about. Nursing care of patients with ICH is as critical as medical and surgical
treatments. Nursing responsibilities center on management of disease and prevention of
A brain hemorrhage is a type of stroke. It is caused by an artery in the brain bursting and
causing localized bleeding in the surrounding tissues. When blood from trauma irritates brain
tissues, it causes swelling. This is known as cerebral edema. The pooled blood collects into a
mass called a hematoma. These conditions increase pressure on nearby brain tissue and reduce
vital flow and kills brain cells. There are several factors and causes of brain hemorrhages. The
most common include head trauma, high blood pressure, aneurysm, blood vessel abnormalities,
amyloid angiopathy, blood or bleeding disorders, liver disease and brain tumors.
Patients afflicted with intracerebral hemorrhage experience potentially devastating
neurological sequelae. A patient may experience a sudden severe headache, seizures, weakness,
nausea or vomiting, loss of balance, and loss of consciousness. With these expected outcomes,
patients with intracerebral hemorrhage should be admitted to an intensive care unit for
experienced neurologic nursing care and close attention to vital signs, Gentle reduction in blood
pressure is recommended in individuals who present with elevated readings and in whom
hemorrhage is felt to be secondary to hypertension. For the vast majority of nontraumatic
intracerebral hemorrhages, the indications of surgery and use of intracranial pressure monitoring
devices remain unproven. Surgery is recommended for notable exceptions, such as for patients
with cerebellar hematoma ( 3 ml or larger ) and for patients with temporal lobe hematoma and
impending brain stem compression. In general, intracranial pressure monitoring device is
adviced to help guide treatment with hyperosmolar agents and hyperventilation when increased

ICP is suspected. For patients with smaller supratentorial hematomas who are alert or somnolent,
conservative treatment is optimal.
During our affiliation at Jose R. Reyes Memorial Medical Center, nursing care was
rendered to a patient with intracranial hemorrhage at the right basal ganglia. The patient was
admitted at the Surgical Intensive Care Unit after decompressive hemicraniectomy. In this
procedure a portion of the skull was relieve pressure on the brain. Following the procedure, a
nurse needs to assess the mental status and changes in the level of consciousness of the patient.
The patient should be place in a low fowlers position, which helps the drainage from the brain
and promote brain expansion. The patient should also be instructed to avoid extreme rotation of
the neck and hip flexion to prevent further increase in intracranial pressure. Maintaining a patent
airway is essential to prevent build-up of secretions leading to increase in partial pressure of
carbon dioxide and increase intracranial pressure. Osmotic diuretics and anticonvulsants are
administered as ordered to decrease cerebral edema and prevent seizure attacks.