SubarachnoiJ Hemorrhage A 54-ycar-old loan officer experienced the sudden onset of a severe headache while at work. She was taken to the emergency department of a local hospital where she described...

SubarachnoiJ Hemorrhage

A 54-ycar-old loan officer experienced the sudden onset of a severe headache while at work. She was taken to the emergency department of a local hospital where she described her headache as the "worst headache of my life." CT scan confirmed the diagnosis of SAH. Angiography revealed an aneurysm of the anterior communicating artery at the junction of the left anterior cerebral artery. The aneurysm was successfully coiled and the patient returned to the intensive care unit (ICU) following the procedure.

Describe nuning priorities of cue for this patient.

On the fifth day post-bleed, the nurse noted that this previously neurologically intact patient was difficult to arouse and once awake had right upper extremity weakness and difficulty speaking.

What actions should the nurse anticipate?

The patient was taken to radiology where a CT and computed tomography angiography (CTA) revealed normal postoperative changes and arterial narrowing, especially of the left middle cerebral artery. Her symptoms improved transiently with induced hypertension, but then recurred. Catheter angiography confirmed severe vasospasm of the left middle cerebral artery. Intra-arterial milrinone was infused with radiologic improvement in vasospasm. Postprocedure, she was able to speak (although confused) and move her right arm, against resistance, 4 out of 5 strength. Following several days in the ICU, she was transferred to the progressive care unit and then to acute care. Her neurologic examination continued to improve, and she was discharged home on post-bleed day 14 with outpatient speech therapy to address occasional word-finding difficulty and subtle cognitive deficits.