Hemorrhagic Stroke: NCLEX Priorities
Hemorrhagic stroke: BP control, no anticoagulation, ICP management.
Hemorrhagic stroke is bleeding into brain tissue or subarachnoid space. Different management than ischemic.
Causes
Hypertensive (most common). Aneurysm (SAH). AVM. Anticoagulation.
BP control
Aggressive BP control, target SBP <140-160. Nicardipine, labetalol IV.
No anticoagulation, no thrombolytics
Reverse anticoagulation immediately, vitamin K + FFP/PCC for warfarin, andexanet for DOACs, protamine for heparin.
ICP management
Elevate HOB 30°. Avoid Valsalva. Maintain CO2 35-40. Hyperosmolar therapy (mannitol, hypertonic saline) for elevated ICP.
SAH specifics
'Worst headache of my life', classic. Nimodipine to prevent vasospasm. Surgical clipping or coiling of aneurysm.
Frequently asked
Mannitol vs hypertonic saline?
Both osmotic. Mannitol diuretic effect; hypertonic saline avoids in hyponatremia.
Why nimodipine in SAH?
Reduces vasospasm and secondary ischemia. 21-day course.
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