Subarachnoid Hemorrhage: Comprehensive Nursing Care and Management Strategies

Subarachnoid hemorrhage (SAH) is a critical neurological emergency that requires immediate and meticulous nursing care to prevent complications and support patient recovery. The primary goal in the early stages is to stabilize the patient and minimize factors that could trigger rebleeding or worsen outcomes.

Immediate Patient Stabilization and Environmental Control

Upon diagnosis, patients must be placed on strict bed rest with minimal physical activity. It's essential to maintain a calm, quiet environment free from loud noises, bright lights, and unnecessary disturbances. Stress and emotional agitation can elevate blood pressure, increasing the risk of rebleeding. Therefore, ensuring psychological comfort through supportive communication and minimizing visitor traffic is crucial.

Blood Pressure Monitoring and Medication Management

Continuous monitoring of blood pressure is vital in SAH management. Hypertension significantly increases the risk of secondary bleeding, so antihypertensive medications should be administered as prescribed to maintain stable, controlled levels. Nurses play a key role in timely medication delivery and vigilant tracking of hemodynamic parameters to avoid sudden fluctuations.

Pain Management and Symptom Relief

Severe headache is one of the hallmark symptoms of subarachnoid hemorrhage. To alleviate discomfort, analgesic therapy should be initiated promptly. Non-opioid options such as diclofenac sodium sustained-release capsules are often used for effective pain control with fewer side effects. However, all pain relief strategies must be carefully coordinated with the medical team to avoid masking neurological changes.

Neurological Assessment and Early Detection of Deterioration

Ongoing neurological observation is a cornerstone of SAH care. Nurses should regularly assess the patient's level of consciousness using standardized tools like the Glasgow Coma Scale (GCS). Special attention must be paid to pupillary response—any sign of pupil dilation or sluggish reaction may indicate increased intracranial pressure or brain herniation.

If there's a decline in consciousness or abnormal pupillary findings, an urgent non-contrast CT scan should be arranged to evaluate for hematoma expansion or new bleeding. Rapid imaging and intervention can be life-saving in these scenarios.

Preventing Complications in Comatose Patients

For patients who remain unconscious, proactive measures are necessary to prevent common hospital-acquired complications. One of the most important interventions is turning and back tapping every two hours. This not only helps prevent pressure ulcers but also promotes lung expansion and mucus clearance, reducing the risk of pneumonia.

Nutritional Support and Feeding Protocols

Many SAH patients are unable to swallow safely due to altered mental status or neurological impairment. In such cases, enteral nutrition via nasogastric (NG) tube should be initiated according to protocol. Regular assessment of gastric residuals and proper head-of-bed elevation during feeding help reduce the risk of aspiration and gastrointestinal intolerance.

In addition, multidisciplinary collaboration with dietitians, speech therapists, and neurologists ensures optimal nutritional planning and timely transition to oral intake when appropriate.

Conclusion: A Multidimensional Approach to Recovery

Effective nursing care for subarachnoid hemorrhage goes beyond basic monitoring—it involves a comprehensive, proactive strategy aimed at stabilizing vital signs, managing symptoms, preventing secondary injury, and supporting long-term recovery. With consistent surveillance, skilled interventions, and a patient-centered approach, healthcare providers can significantly improve outcomes for individuals facing this life-threatening condition.