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DIFFERENTIAL DIAGNOSIS

SIGNS AND SYMPTOMS PATIENTS DIAGNOSIS DIAGNOSIS TO COMPARE DIAGNOSIS TO COMPARE

Headache Nausea and vomiting Elevated blood pressure Fever Dizziness Decrease LOC Periorbital edema Disrupted motor sensory Cranial nerve and cognitive dysfunction

Subarachnoid hemorrhage probably related to ruptured aneurysm

Cerebrovascular accident

Intracerebral hemorrhage

Discharge Planning
Medication
Instruct the client and family to take his medications on time prescribed by the doctor Educate client about the proper intake of the medication and importance of following the prescribed medications Encourage client to avoid strenuous activities or exercise Encourage the client to have passive range of motion exercises Encourage ambulation (with or without assistance) Instruct the client to take medication as follows: Captopril Simvastatin Educate client to take Paracetamol tab, 500mg when fever persist Instruct client to take a bath everyday and observe cleanliness on personal hygiene Encourage frequent oral hygiene; use soft bristle toothbrush Instruct the client to go back to the hospital for his follow up check up at OPD department Educate the importance of follow up check ups and responding to the doctors advise Instruct the client to decrease salt and fat consumption Educate client to eat nutritious food such as vegetables and fruits Encourage balance meal and food variety
Encourage client to take time on her own spiritual belief and ask for guidance and personal concerns Encourage use of cranes or assistance when ambulating if necessary to prevent fall and injury

Exercise

Treatment

Hygiene

OPD

Diet

Spiritual / Safety and Security

Precipitating Factors Over 50 y.o Female Hypertension

Predisposing Factors High sodium diet Second hand smoker

Increase Blood pressure

Increase peripheral resistance

Stress at apex of bifurcation (circle of Willis) administer captopril to lower BP

High velocity of blood flow transmit pulsatile forces

Increase pressure of moving blood

Formation of aneurysm

Ischemia

-headache -neck or back pain -dizziness

Turbulence and vibration from the pulsatile blood flow act on weakened wall

Increase size of aneurysm and decrease wall thickness

Overpowering of the structural components of the artery

(intra-aneurysmal pressure, aneurysm size, thinning of the vessel wall)

-disrupted motor sensory -cranial nerve and cognitive dysfunction -decrease LOC Blood leaks on the brain Ruptured aneurysm -fever -increase WBC

Injury on the brain tissue

Increase ICP

Accumulation of blood in the subarachnoid space

Brain disturbances

SUBARACHNOID HEMORRHAGE

Disruption of normal cerebral metabolism by direct exposure of the brain to blood Increase ICP and compression of structures from blood in the subarachnoid space Arterial vasospasm