The nurse is assisting with planning care for a client who has a subarachnoid hemorrhage (SAH). Which of the following relates to a high mortality rate for a client who has an SAH?
A.
Poor functional ability
B.
Rebleeding of the injury
C.
Decreased cerebrospinal fluid
D.
Use of nimodipine
The Correct Answer and Explanation is:
The correct answer is B. Rebleeding of the injury.
Explanation:
A subarachnoid hemorrhage (SAH) is a type of stroke where there is bleeding in the subarachnoid space, the area between the brain and the tissues that cover the brain. This space is filled with cerebrospinal fluid (CSF) that cushions the brain. SAH often results from the rupture of an aneurysm or head trauma, and it is a medical emergency with a significant risk of mortality.
Among the listed options, rebleeding of the injury is the most critical factor related to high mortality in SAH cases. Here’s why:
- Rebleeding:
- Rebleeding refers to the recurrence of hemorrhage after the initial bleed, usually from the same source such as an aneurysm. It is one of the most feared complications of SAH and significantly increases the risk of death and long-term disability. Rebleeding can happen within the first 24 hours, with the highest risk occurring within the first few days after the initial bleed.
- When rebleeding occurs, the sudden increase in intracranial pressure can lead to brain damage, coma, or death. The mortality rate for rebleeding can be as high as 70%. Preventive measures include early surgical intervention, such as clipping or coiling the aneurysm to reduce the risk of rebleeding.
- Poor functional ability (option A):
- While poor functional status might indicate a worse prognosis in the long run, it is not directly related to an increased immediate mortality rate like rebleeding.
- Decreased cerebrospinal fluid (option C):
- Decreased CSF does not typically relate to high mortality. In fact, increased intracranial pressure due to a buildup of CSF (hydrocephalus) can be more concerning in SAH.
- Use of nimodipine (option D):
- Nimodipine is a calcium channel blocker used to prevent vasospasm, a common complication of SAH. Vasospasm can cause delayed ischemia, which can lead to brain damage. However, nimodipine is used to reduce complications and is associated with improved outcomes, rather than an increased mortality rate.
In summary, rebleeding remains the most significant immediate threat in patients with SAH, and managing this risk is crucial to improving survival rates.