Subarachnoid

Hemorrhage
related to
ruptured brain
anuerysm

What is Subarachnoid
Hemorrhage?

There is bleeding in the area around the brain when there

is a subarachnoid hemorrhage. The majority of the time, it
happens when an aneurysm on the surface of the brain
bursts and releases blood. The pressure on the brain then
increases as the blood accumulates inside the skull and
around the brain. Damage to brain cells, chronic problems,
and disabilities may result from this (“Subarachnoid
Hemorrgahe”, 2019).
Pathophysiology of the Disease
 Shelby is a 32-year-old concert pianist. Before her
performance this evening, she told a friend that she was

Case expecting what she called “the worst headache I’ve ever
had” and that she had taken two extra strength

Scenario
acetaminophen (Tylenol ES), but they “did not touch her
headache”. During her performance, she stopped playing,
reached up, grasped her head, and then fell unconscious.
When the paramedics arrived, she was intubated and an
IV was started with normal saline. On arrival at the
emergency department, she has a Glasgow Scale Score
of 3. Her husband reports a history of hypertension and
states she recently quit taking her medication because it
made her feel tired. She is trying to quit smoking; she has
cut down to a half pack of cigarettes per day, she drinks
alcohol only socially on weekends, and she has a remote
history of cocaine use. He says that she has complained
of worsening, intermittent headaches for the past few
weeks.
 ABCDE-ASSESSMENT
A-AIRWAY- GCS of 3 (intubated)

B- BREATHING- GCS of 3 (intubated)

CUES C-CIRCULATION-Brain hemorrhage/

(objective) Hypertension

D- DISABILITY- GCS of 3 (comatose)

 Ineffective Breathing Pattern r/t
neuromuscular impairment (head
trauma) as evidenced by GCS of 3.

NURSING Ineffective Cerebral Tissue Perfusion

related to brain injury as evidenced
by GCS of 3

DIAGNOSIS Decreased Cardiac Output r/t

increased vascular resistance as
evidenced by a health history of
hypertension

Deficient Knowledge r/t to

unfamiliarity as evidenced by misuse
of therapeutic management

Risk for activity intolerance as

evidenced by immobility
Ineffective NURSING INTERVENTIONS:

Breathing Assess and record respiratory

rate and depth at least every 4
hours.
Pattern r/t Assess ABG levels.
Assess for the use of accessory
neuromuscular muscle.
Suction secretions, as necessary.
impairment Observe the presence of sputum
for amount, color, consistency.
(head trauma) Place a patient with proper body
alignment for maximum breathing
as evidenced pattern.

by GCS of 3.
 NURSING INTERVENTIONS:
Ineffective Assess the patient’s neurologic and

Cerebral respiratory status (e.g., airway patency,

pattern).
Obtain BP measurements in both arms
Tissue and monitor the patient’s heart rate.
Slightly elevate the patient’s head using
Perfusion pillows to maintain a neutral position.
Ensure the patient’s environment is calm

related to and conducive to relaxation.

Appropriately regulate the number of
visitors, activities, and operations.
brain injury as Arrange each activity with consideration
to the patient’s rest schedule.

evidenced by Administer antihypertensives as

prescribed.
Review the patient’s CT scan with the
GCS of 3 medical team to determine the presence
or absence of SAH.
 Assess heart rate, blood

Decreased pressure and peripheral

pulses

Cardiac Output Monitor urine output. If the

patient is acutely ill, measure
r/t increased hourly urine output and note a
decrease in output
vascular Administer supplemental
oxygen as needed
resistance as Closely monitor fluid intake,

evidenced by a including IV lines. Maintain fluid

restriction if ordered

health history of Maintain adequate ventilation

and perfusion (placing the
hypertension client in Semi Fowler position
or Supine)
 Provide an atmosphere of
respect, openness, trust, and

Deficient
collaboration.
Include the patient in creating the

knowledge related
teaching plan, beginning with
establishing objectives and goals
for learning at the beginning of the
to the unfamiliarity session.
Support self-directed, self-
of treatment as designed learning.
Provide clear, thorough, and
evidenced by understandable explanations on
the patient’s therapeutic

misuse of management
Provide clear, thorough, and

therapeutic understandable explanations on

the patient’s therapeutic
management
management Encourage questions and note
progress of teaching and learning.
 Nursing Intervention

Risk for activity Assess the physical activity level and mobility of

intolerance as the patient.

Determine the patient’s level of activity

evidenced by intolerance.
Observe and monitor the patient’s sleep pattern

immobility and the amount of sleep achieved over the past

few days.
Assess the need for ambulation aids for ADLs.
Assess the patient’s baseline cardiopulmonary
status before initiating activity.
Establish guidelines and goals of activity with
both patients and SO.
Provide emotional support and positive attitude
regarding abilities
 CONCLUSION:
Why is Subarachnoid Hemorrhage an emergency?

Subarachnoid Hemorrhage(SAH) refers to bleeding beneath one of the

delicate layers that encase and safeguard your brain. This medical
condition is an emergency and required immediate treatment
(“Subarachnoid Hemorrhage”, n.a.). As this affects the brain of the patient,
other necessary bodily functions such as breathing and circulation may
be impaired. This, in addition with the bleeding, affects the perfusion of the
brain with sufficient blood–oxygen. If not treated immediately, this can
cause irreversible brain damage or even death if left untreated
(“Subarachnoid Hemorrhage”, 2022).