Info

Medication or Drug Class

Dosage

Description

Rationale

Calcium channel blockers

Corticosteroids

Varies with drugs such as nimodipine, verapamil

Varies with drugs such as methylprednisolone, hydrocortisone

Inhibits calcium entry across cell membranes in vascular smooth muscles

Inhibits inflammatory processes such as edema and capillary dilation

Prevent vasospasm and hypertension

Reduce swelling

Other Medications: Antihypertensives may be prescribed for patients with high blood pressure. Antiepileptics are administered for treatment and prevention of seizures. Sedatives may be prescribed to promote rest and relaxation, and aminocaproic acid, a fibrinolytic inhibitor, may be given to minimize the risk of rebleeding by delaying blood clot lysis. The patient may receive colloids such as albumin or plasmanate to decrease blood viscosity and expand the intravascular volume.

Independent

The environment should be as quiet as possible, with minimal physiological and psychological stress. Maintain the patient on bedrest. Limit visitors to immediate family and significant others. Apply thigh-high elastic stockings and intermittent external compression boots. Discourage and control any measure that initiates Valsalva's maneuver, such as coughing, straining at stool, pushing up in bed with the elbows, turning with the mouth closed. Assist with hygienic care as necessary. If the patient has a facial weakness, assist her or him during meals.

Preoperatively, provide teaching and emotional support for the patient and family. Position the patient to maintain a patent airway by elevating the head of the bed 30 to 45 degrees to promote pulmonary drainage and limit upper airway obstruction. Suction the patient's mouth and, if needed, the nasopharynx and trachea. Before suctioning, oxygenate the patient well, and to minimize ICP increases, limit suctioning to 20 to 30 seconds at a time. If the patient has facial nerve palsy, apply artificial tears to both eyes. Take appropriate measures to prevent skin breakdown from immobility. Postoperatively, promote venous drainage by elevating the head of the bed 20 to 30 degrees. Emotional support of the patient and family is also important. The patient may be dealing with a neurological deficit, such as paralysis on one side of the body or loss of speech. If the patient cannot speak, establish a simple means of communication such as using a slate to write messages or using cards. Encourage the patient to verbalize fears of dependency and of becoming a burden.

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