Nursing Care Plan for Hemorrhagic Stroke

Hemorrhagic strokes primarily involve bleeding inside or around the tissues of the brain.
Hemorrhagic stroke ideally occurs either when the vessel wall of blood within the brain bleeds or
rapture or when one that is outside it tends to leak into the surrounding tissues; which causes
them to substantially swell with fluids from the blood vessels. Patients sometimes suffer both
hemorrhages simultaneously. It is essential to note the fact that this kind of stroke normally
happens due to the fact that an artery supplying that particular part of the brain has been
weakened by a number of age-related changes in the lining cells.
Research has discovered the fact that a traumatic head injury may easily result in
hemorrhagic stroke. Hence, there stands a need for caregivers and medical practitioners to be in a
position to identify and further attend to patients suffering from a head injury for purposes of
ensuring they receive treatment with immediate effect. Hemorrhagic kind of stroke is one that
takes place when the blood from a given artery suddenly or unexpectedly begins to bleed into the
brain of a patient. The part of the patient’s body that is ideally controlled by the damaged area or
part of the brain cannot function properly . Immediate emergency care is needed by a patient
experiencing the symptoms of a stroke. Fewer brain cells are practically damaged when medical
treatment begins sooner.

Signs of a Stroke;
 Sudden confusion
 Sudden weakness or numbness of the arm, face, or leg, mostly on one side of the body
 Sudden trouble seeing in one or both eyes

 Sudden trouble speaking
 Sudden dizziness, coordination or loss of balance
 Sudden trouble walking
 Sudden severe headache with no known cause

Symptoms of Subarachnoid Hemorrhages and Intercranial Hemorrhages
 Changes in vision
 Sudden severe headache
 Weakness, inability to move or numbness in a leg or an arm
 Loss of coordination or balance
 Difficulty comprehending speech or loss of speech
 Seizure
 Vomiting and nausea
 Loss of alertness or confusion
 Loss of consciousness

Additional Symptoms;
 Sensitivity to light
 Paralysis of one side of the body
 Frequent fluctuations in breathing and the heart beat
 Stiffness in the neck or neck pain

 Difficulty swallowing
 Hand tremors
 Abdominal taste in the mouth

Causes and Risk Factors of Hemorrhagic Stroke;
This type of stroke is primarily caused by sudden bleeding inside the brain from a blood
vessel or in the surrounding spaces of the brain. This sudden bleeding may result from the
following;
 Cerebral aneurysm
 Head injuries
 Blood vessel abnormalities, including amyloid angiopathy or arteriovenous malformation
 High blood pressure
 Bleeding or blood disorders, such as sickle cell anemia
 Brain tumor
 Liver disease
 Drug abuse
The various uncommon causes of this kind of stroke further include radiation treatments or
inflamed blood vessels.

Diagnosis of Hemorrhagic Stroke

The diagnosis of this kind of stroke is substantially based on what can be described as a
thorough medical history as well as the physical exam. The medical practitioner may strongly
suspect and conclude on the fact that there is bleeding inside the patient’s skull based on the
symptoms. Imaging tests play a role in assisting to determine whether the stroke was as a result
of a clot or whether it was caused by bleeding inside the brain. Imaging tests include computed
tomography and magnetic resonance imaging scans. Lumbar puncture (spinal tap) or
electroencephalogram ought to be done for purposes of confirming the best diagnosis of a
hemorrhagic stroke (Pedrão, 2018).

Impaired Physical Mobility Diagnosis;
This type of nursing diagnosis is normally given to victims of cerebrovascular accident
who have practically suffered an impairment in physical mobility. It usually affects the patient’s
ability to dress themselves, move around, perform daily living tasks, and use their hands for self-
care activities such as toileting and feeding. Hence, these patients may need assistance with the
daily living tasks, including dressing and eating, among other activities, and they may further
experience an impaired ability to communicate self-care activities as well as needs, resulting in
difficulty in coping physically and emotionally (Carpenito-Moyet, 2006).
The actual intervention of the described condition includes restoring mobility when
possible, prevention of dependent disabilities, and preserving or maintaining the existing
mobility. Offering a safe environment, nutrition, exercises, and changing position are among the
essential special patient care needed by the client. The nursing care plan for the impaired kind of
physical mobility ought to include the following practices;

The medical practitioner should assist the client/patient to carry out muscle exercises
when allowed out of bed or as able. In doing so, the nurse must execute knee bends and
abdominal-tightening exercises; including stand on toes and hop on foot. The practice comes in
handy in ensuring that the patient gains enhanced sense of balance. It further contributes to the
strengthening of the compensatory parts of the body (Pedrão, 2018). The medical practitioner
also needs to consider presenting a safe environment for the patient. The bed must be in a down
position, bed rails should be up, and essential items close by. The measures play a significant
role in promoting a secure and safe environment. It also reduces the chances and risk for falls.
There is need to establish a good number of measures to ideally prevent thrombophlebitis
and skin breakdown from prolonged immobility;

 Utilize anti-embolic sequential or stocking compression devices if appropriate
 Dry, clean or moisturize skin as necessary
 Utilize pressure-relieving devices as indicated
 Stockings or sequential compression devices if appropriate
The listed measure will highly assist in the prevention of skin breakdown. Besides, the
devices utilized in the compression play the important role of promoting increased venous return
to achieve preventing possible thrombophlebitis or venous stasis in the legs. The medical
practitioner must execute active or passive assistive ROM exercises to all of the extremities. The
idea of exercise is ideal as it enhances the increased venous return, maintains muscle strength as
well as stamina, and prevents stiffness (Pedrão, 2018). It further avoids contracture deformation
that could build up as quick as possible and, hence, could hinder the usage of prosthesis.

The nurse ought to present various suggestions with reference to nutritional intake for
adequate metabolic requirements and energy resources. It is advisable to consider administering
the correct nutrition as it helps to keep and maintain sufficient levels of energy to the patient. The
client will need properly balanced and adequate intake of fats, carbohydrates, minerals, and
vitamins to provide energy resources. The nurse should also keep the limbs of the patient in
functional alignment with either one or more of the following; sandbags, pillows, prefabricated
splints, or wedges. The measure helps to avoid too much plantar tightness or flexion and
footdrop. The feet must be maintained in dorsiflexed position. Principles of progressive exercise
ought to be reinforced. They emphasize on the actual fact that joints are supposed to be exercised
to the actual point of pain, and not beyond. The mentioned pain practically occurs as a result of
muscle or joint injury (Carpenito-Moyet, 2006). If inappropriate movement is continued, further
damage is highly expected. The nurse ought to offer explanation about the progressive activity to
patient. The idea of providing small and attainable goals play the role of increasing the self-
confidence of the patient and reducing any frustration.

Unilateral Neglect Diagnosis;

Unilateral neglect ideally presents as some kind of a lack of awareness of one given side of the
body. It can also be described as a lack of response to stimuli on one side of the body. There is
need to note the fact that the left side neglect is frequently experienced and seen as compared to
the right side neglect. The patients of stroke have a tendency of acting oblivious to one side.
Examples of neglect may include the inability to see objects off to one side, eating food on only
one side of the plate, dressing or grooming only one side of the body, reading only one side of

the page, and being unaware of the affected limbs (In Schweizer et al, 2014). A stroke patient
with unilateral neglect will only draw half of an object when asked to draw one. In essence, the
mentioned symptoms of neglect tend to differ from one individual to another.
There are certain techniques that the medical practitioner can put in place to help improve
neglect. They can consider approaching the stroke patient from the side that has been affected
causing them to have to attend to this other side. Gently turn the patient’s head towards you if
they do not look at you. The nurse must also sit on the affected side as they go along interacting
with the stroke patient (Bogousslavsky et al, 2007). The care giver should touch the affected side
or even bring the non-affected hand of the patient over for purposes of touching the affected side.
This comes in handy in assisting make them practically aware of that side through touch. Also,
the medical practitioner may put objects on the side that has been affected with the intention of
making the patient search for them. Examples of these objects may include a glass of water, tv
remote, the phone, among other things. The nurse can further incorporate the limb that has been
affected into activities. A good example includes the medical practitioner practically guiding the
affected arm via an activity such as reaching an object, stroking the family pet, or wiping off a
table.
Clients with symptoms of a hemorrhagic stroke is advised to seek immediate and
emergency medical care. This is because prompt or immediate medical attention helps to prevent
more widespread damage to the brain and life-threatening complications. The treatment of this
type of stroke ideally depends on where it is located, what caused it, and the size of the
hemorrhage. The existing treatment options include neurosurgical procedures or interventional
radiology, such as coil embolization or clipping that may also be performed to stop or end the

bleeding and further reduce the pressure in the brain. The patient may be given medicine to
prevent seizures, reduce swelling, and reduce pain.

References

Bogousslavsky, J., Godefroy, O., & ebrary, Inc. (2007). The behavioral and cognitive neurology
of stroke. Cambridge: Cambridge University Press.
Carpenito-Moyet, L. J. (2006). Handbook of nursing diagnosis. Lippincott Williams & Wilkins.
In Schweizer, T. A., & In Macdonald, R. L. (2014). The Behavioral Consequences of Stroke.
Pedrão, T. G. G., Brunori, E. H. F. R., Santos, E. D. S., Bezerra, A., & Simonetti, S. H. (2018).
NURSING DIAGNOSES AND INTERVENTIONS FOR CARDIOLOGICAL
PATIENTS IN PALLIATIVE CARE. Journal of Nursing UFPE/Revista de Enfermagem
UFPE, 12(11).