[Verified Answer]: A 45 y/o female patient with PMH…

A 45 y/o female patient with PMH significant for cigarette smoking and hypertension presents to the ED with the abrupt onset of “The worst headache of my life!”. The severe left-sided headache is associated with severe photophobia, nausea, and vomiting. She presents to the ED with the following VS: BP 160/90, HR 100, RR 26, Temp 98.6. 1.) What initial diagnostics would be appropriate? STAT CT/ CTA head reveals a large subarachnoid hemorrhage, with evidence of an actively bleeding aneurysm of the anterior communicating artery (ACA). The neurosurgery team is en-route, and plans are made for emergent ventriculostomy placement at the bedside, followed by emergent cerebral angiography and coiling of the aneurysm. As the team prepares a STAT dose of Mannitol, Hypertonic saline infusion, and Nicardipine infusion per the orders of the neurosurgery team, the patient is noted to have progressively declining mentation, in addition to decreasing heart rate (Sinus bradycardia 50s), increased blood pressure (180/100), and shallow, gasping respirations. The nurse promptly relays these findings to the responsible clinicians. 2.) What is the role of Mannitol, Hypertonic saline, and Nicardipine in the management of this patient’s condition? 3.) Is the patient displaying any signs-symptoms concerning for increased ICP? What interventions should the nurse prepare/ advocate for? The patient was emergently intubated for airway protection and an EVD was placed emergently at the bedside for CSF/ blood drainage and monitoring of ICP. 30ml of bloody CSF was drained immediately, with subsequent decrease in the patient’s ICP from 35 to 25. The patient was taken emergently to the neuro IR suite for embolization of her ruptured ACA aneurysm, and returns to the ICU for post-operative management. HR BP on return to the ICU is 135/80, with ICP 15. 4.) Please discuss the management of the patient post cerebral angiography/ intervention. What is this patient’s CPP? 5.) What are important considerations for the RN when managing the patient with an EVD? Over the next two days, periodic interruption of sedation reveals improving mental status, and the patient was successfully liberated from mechanical ventilation on POD #2. She remains on a nicardipine infusion with goal SBP < 140 and hypertonic saline to maintain serum Na+ 145-150. 6.) The patient is prescribed oral Nimodipine Q4H and undergoes daily trans-cranial doppler ultrasound for a period of 21 days post-op in order to prevent/ monitor for what complication of aneurysmal SAH?