Subdural hematoma is a severe condition that occurs when blood collects between the dura mater (the outer protective covering of the brain) and the brain’s surface.
This accumulation of blood can put pressure on the brain tissue, potentially leading to severe complications if not promptly diagnosed and treated.
The nursing diagnosis of subdural hematoma is critical to patient care. It plays a vital role in guiding appropriate interventions and improving patient outcomes.
Understanding Subdural Hematoma
A subdural hematoma forms when blood vessels, typically veins, rupture between the brain’s surface and its outer covering (the dura mater).
This bleeding can occur suddenly (acute subdural hematoma) or gradually over time (chronic subdural hematoma).
The condition is often associated with head trauma but can also occur spontaneously, especially in older adults or those with certain risk factors.
Causes (Related to)
Subdural hematomas can result from various factors, including:
- Head trauma (e.g., falls, motor vehicle accidents, sports injuries)
- Use of blood thinners or anticoagulants
- Advanced age (brain shrinkage increases susceptibility)
- Chronic alcohol abuse
- Repeated minor head injuries
- Cerebral aneurysm rupture
- Arteriovenous malformations
- Certain blood disorders
Signs and Symptoms (As evidenced by)
Patients with subdural hematomas may present with a range of signs and symptoms, depending on the size, location, and rate of bleeding.
Subjective: (Patient reports)
- Headache (often severe and persistent)
- Confusion or altered mental status
- Memory problems
- Dizziness or vertigo
- Nausea
- Vision changes (e.g., blurred or double vision)
Objective: (Nurse assesses)
- Altered level of consciousness
- Pupillary changes (e.g., unequal pupils, sluggish reaction to light)
- Weakness or paralysis on one side of the body
- Seizures
- Slurred speech
- Balance and coordination problems
- Changes in vital signs (e.g., increased blood pressure, irregular pulse)
- Vomiting (especially projectile)
- Respiratory pattern changes
Expected Outcomes
The primary goals of nursing care for patients with subdural hematoma include:
- Maintain optimal neurological function
- Prevent further neurological deterioration
- Manage intracranial pressure effectively
- Promote patient and family understanding of the condition and treatment plan
- Enhance recovery and rehabilitation
- Prevent complications
- Support emotional and psychological well-being
Nursing Assessment
A thorough nursing assessment is crucial for patients with subdural hematoma. Key areas of focus include:
- Neurological status:
• Assess the level of consciousness using the Glasgow Coma Scale
• Evaluate pupillary responses, motor function, and sensory function
• Monitor for changes in cognitive abilities and memory - Vital signs:
• Regular monitoring of blood pressure, heart rate, respiratory rate, and temperature
• Pay attention to signs of increased intracranial pressure (e.g., widening pulse pressure, bradycardia) - Pain assessment:
• Use appropriate pain scales to evaluate headache intensity and characteristics
• Assess for other sources of pain or discomfort - Functional status:
• Evaluate the patient’s ability to perform activities of daily living
• Assess for changes in balance, coordination, or gait - Psychological status:
• Screen for signs of anxiety, depression, or other mood disturbances
• Assess the patient’s and family’s understanding of the diagnosis and treatment plan - Skin integrity:
• Assess for pressure ulcers, especially in patients with limited mobility - Laboratory and diagnostic tests:
• Review results of imaging studies (CT scans, MRI)
• Monitor relevant blood tests (e.g., coagulation profile, complete blood count)
Nursing Interventions
Nursing interventions for patients with subdural hematoma are multifaceted and aim to address both physical and psychosocial needs:
- Neurological monitoring:
• Perform regular neurological checks and document findings
• Implement seizure precautions and management protocols - Intracranial pressure management:
• Elevate the head of the bed 30-45 degrees
• Maintain a quiet, calm environment
• Administer medications as prescribed (e.g., osmotic diuretics, anticonvulsants) - Pain management:
• Administer analgesics as ordered
• Implement non-pharmacological pain relief strategies (e.g., relaxation techniques, positioning) - Nutrition and hydration:
• Assist with feeding as needed
• Monitor fluid balance and provide oral care - Activity and mobility:
• Encourage mobility as tolerated
• Implement fall prevention strategies - Psychosocial support:
• Provide emotional support and education to the patient and family
• Facilitate referrals to support groups or counseling services - Medication management:
• Administer and monitor the effects of prescribed medications
• Educate patients and families about medication regimens and potential side effects - Perioperative care:
• Prepare patients for surgical interventions (if required)
• Provide post-operative monitoring and care - Rehabilitation coordination:
• Collaborate with physical, occupational, and speech therapists
• Assist in implementing therapy recommendations
Nursing Care Plans
The following nursing care plans address common issues faced by patients with subdural hematoma:
Care Plan 1: Risk for Increased Intracranial Pressure
Nursing Diagnosis: Risk for Increased Intracranial Pressure related to the presence of subdural hematoma as evidenced by altered level of consciousness and pupillary changes.
Related Factors:
- Presence of space-occupying lesion (subdural hematoma)
- Cerebral edema
- Altered cerebral blood flow
Nursing Interventions and Rationales:
- Monitor neurological status every 1-2 hours or as ordered.
Rationale: Early detection of neurological changes allows for prompt intervention. - Elevate the head of the bed 30-45 degrees.
Rationale: Promotes venous drainage and reduces intracranial pressure. - Maintain a quiet, calm environment with minimal stimulation.
Rationale: Reduces metabolic demands on the brain and helps control intracranial pressure. - Administer osmotic diuretics and other medications as prescribed.
Rationale: Helps reduce cerebral edema and intracranial pressure. - Monitor input and output closely.
Rationale: Ensures proper fluid balance and helps prevent overhydration, which can exacerbate increased intracranial pressure.
Desired Outcomes:
- The patient will maintain stable neurological status.
- The patient will demonstrate no signs of increasing intracranial pressure (e.g., deteriorating level of consciousness, pupillary changes, or worsening headaches).
- The patient will verbalize understanding of measures to reduce intracranial pressure.
Care Plan 2: Acute Pain
Nursing Diagnosis: Acute Pain related to increased intracranial pressure secondary to subdural hematoma as evidenced by patient reports of headache intensity 8/10 and facial grimacing.
Related Factors:
- Increased intracranial pressure
- Inflammation of brain tissues
- Stretching of the meninges
Nursing Interventions and Rationales:
- Assess pain characteristics, intensity, and aggravating/relieving factors regularly.
Rationale: Provides a baseline for evaluating the effectiveness of pain management strategies. - Administer prescribed analgesics and monitor their effectiveness.
Rationale: Pharmacological management is often necessary for adequate pain control in subdural hematoma patients. - Implement non-pharmacological pain relief measures (e.g., relaxation techniques, quiet environment).
Rationale: Complementary methods can enhance pain relief and reduce reliance on medications. - Position the patient comfortably, avoiding neck flexion.
Rationale: Proper positioning can alleviate pain and prevent increases in intracranial pressure. - Educate the patient and family about pain management strategies and the importance of reporting pain.
Rationale: Empowers the patient and family to participate in pain management actively.
Desired Outcomes:
- The patient will report pain intensity as 3/10 or less.
- The patient will demonstrate the use of non-pharmacological pain relief techniques.
- The patient will verbalize satisfaction with a pain management plan.
Care Plan 3: Impaired Physical Mobility
Nursing Diagnosis: Impaired Physical Mobility related to neurological deficits secondary to subdural hematoma as evidenced by weakness on one side of the body and difficulty with balance.
Related Factors:
- Hemiparesis or hemiplegia
- Altered perception or balance
- Pain or discomfort
- Cognitive impairment
Nursing Interventions and Rationales:
- Assess the patient’s level of mobility, strength, and balance regularly.
Rationale: Provides a baseline for monitoring changes and planning interventions. - Implement fall prevention measures (e.g., bed alarms, non-slip footwear, clear pathways).
Rationale: Reduces risk of injury from falls due to mobility impairments. - Assist with range of motion exercises and encourage active movement as tolerated.
Rationale: Helps maintain joint flexibility and muscle strength and prevents complications of immobility. - Collaborate with physical and occupational therapists to develop and implement a mobility plan.
Rationale: A multidisciplinary approach ensures comprehensive and targeted mobility interventions. - Educate the patient and family on safe mobility techniques and using assistive devices.
Rationale: Promotes independence and mobility safety.
Desired Outcomes:
- The patient will demonstrate improved or maintained level of mobility.
- The patient will participate in the prescribed physical therapy regimen.
- The patient will remain free from falls or injuries related to mobility impairments.
Care Plan 4: Risk for Ineffective Cerebral Tissue Perfusion
Nursing Diagnosis: Risk for Ineffective Cerebral Tissue Perfusion related to increased intracranial pressure secondary to subdural hematoma.
Related Factors:
- Increased intracranial pressure
- Cerebral edema
- Altered cerebral blood flow
- Potential for cerebral vasospasm
Nursing Interventions and Rationales:
- Monitor vital signs, especially blood pressure, closely.
Rationale: Changes in blood pressure can affect cerebral perfusion pressure. - Assess neurological status frequently, including level of consciousness and pupillary reactions.
Rationale: Early detection of changes in neurological status can indicate alterations in cerebral perfusion. - Administer medications as prescribed to maintain adequate cerebral perfusion pressure.
Rationale: Certain medications can help optimize cerebral blood flow and reduce intracranial pressure. - Maintain head of bed elevation at 30-45 degrees unless contraindicated.
Rationale: Proper positioning can help optimize cerebral blood flow and reduce intracranial pressure. - Monitor oxygen saturation and provide oxygen therapy as ordered.
Rationale: Ensuring adequate oxygenation is crucial for cerebral tissue perfusion.
Desired Outcomes:
- The patient will maintain stable vital signs and neurological status.
- The patient will demonstrate no signs of deteriorating cerebral perfusion (e.g., decreased level of consciousness, new focal deficits).
- The patient will maintain adequate oxygenation levels (SpO2 > 95%).
Care Plan 5: Anxiety
Nursing Diagnosis: Anxiety related to uncertain prognosis and impact of subdural hematoma diagnosis as evidenced by expressed worry, restlessness, and increased blood pressure.
Related Factors:
- Life-threatening illness
- Changes in health status and functional abilities
- Fear of long-term disability
- Unfamiliar hospital environment
Nursing Interventions and Rationales:
- Assess the patient’s level of anxiety and identify specific concerns.
Rationale: Provides insight into the patient’s emotional state and guides interventions. - Provide clear, honest information about the diagnosis, treatment plan, and prognosis.
Rationale: Reduces fear of the unknown and helps the patient feel more in control. - Teach relaxation techniques such as deep breathing and guided imagery.
Rationale: Provides coping mechanisms to manage anxiety symptoms. - Encourage expression of feelings and concerns.
Rationale: Validates the patient’s emotions and provides an opportunity for support. - Facilitate referrals to support groups or counseling services as appropriate.
Rationale: Provides additional resources for emotional support and coping strategies.
Desired Outcomes:
- The patient will report decreased levels of anxiety.
- The patient will demonstrate the use of effective coping strategies.
- The patient will verbalize feelings of increased control over their situation.
References
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