Health-Related Quality-of-Life Outcomes: Comparing Patients With Aneurysmal and Nonaneurysmal Subarachnoid Hemorrhage.

Subarachnoid hemorrhage (SAH) is divided into two major types (aneurysmal [ASAH] and nonaneurysmal [NASAH]) because, in approximately 15% of the patients who experience SAH, no source of hemorrhage can be identified. Anecdotal evidence and contradictory research suggest that patients with NASAH experience some of the same health-related quality of life (HRQOL) issues as patients with ASAH. This quantitative survey design study compared 1-3 years after hemorrhage the HRQOL in patients who had experienced an NASAH with those who had experienced an ASAH. This is the first U.S. study to specifically investigate HRQOL in NASAH and the second to compare HRQOL outcomes between patients with ASAH and NASAH. These study results corroborate those of the first-that the two groups are much more similar than different. It confirms that the impact on employment for both hemorrhage groups is significant, and it also finds an even greater inability to return to work for the patients with NASAH. Physical symptom complaints were more common in the group with NASAH, whereas the group with ASAH experienced more emotional symptoms. Both groups had low levels of posttraumatic stress disorder (PTSD), with those levels not differing significantly between groups. However, PTSD and social support were shown to impact HRQOL for both groups. The authors recommend that clinicians assess all patients with SAH for PTSD and institute treatment early. This may include offering psychological services or social work early in the hospital course. Further research and policy changes are needed to assist in interventions that improve vocational reintegration after SAH. Patients with NASAH should no longer be described as having experienced a "benign hemorrhage." They have had a life-changing hemorrhage that may forever change their lives and impact their HRQOL.

[Standardized impartial assessment of pain in unconscious patients with the Zurich Observation Pain Assessment on a neurosurgical intensive care unit - a case report]. / Die standardisierte Fremdeinschätzung von Schmerzen bei bewusstseinsbeeinträchtigten Patienten mit dem Zurich Observation Pain Assessment (ZOPA©) auf einer neurochirurgischen Intensivstation - Eine Fallstudie.

BACKGROUND: International studies show that the majority of patients undergoing treatment in ICUs report moderate to strong levels of pain. It has been established that undetected or insufficiently treated pain can cause severe physical and emotional distress. Therefore, early and effective pain assessment is a primary treatment goal of intensive care, which is a challenge with patients having cognitive impairment. AIM: This article shows how using the Zurich Observation Pain Assessment (ZOPA(©)) as part of a standardized assessment can close this gap. METHOD: An interpretive single case study evaluates the use of ZOPA(©) in nursing practice and its influence on pain management. RESULTS: The study case involved an intensive care patient with a severe subarachnoid haemorrhage for whom a total of 126 single ZOPA(©) assessments were analyzed. A total of 19 assessments showed behavioral characteristics indicative of pain. Immediate interventions to alleviate pain were taken in three quarters of these assessments. The study ICU has used ZOPA(©) for the past five years. This unit has a standard medication procedure, so nurses can administer analgesics on an "as needed" basis and take their responsibility in implementing pain management. CONCLUSION: This study supports the finding that ZOPA(©) can contribute to early and effective detection of pain in cognitively impaired patients, resulting in improved pain treatment.

Recovery and quality of life in patients with ruptured cerebral aneurysms.

PURPOSE: Subarachnoid hemorrhage (SAH) secondary to ruptured cerebral aneurysm is a common and frequently devastating condition with a high mortality and morbidity among survivors. The purpose of this study was to conduct a long-term follow-up of SAH patients, assess the changes in functional outcomes, describe quality of life (QOL), and determine its predictors 3.6 years after the hemorrhage. DESIGN: The study design is an exploratory, descriptive correlational design. METHODS: Results were collected from a sample of 113 SAH survivors treated in our institution over a 2-year period (January 2006 until December 2007). We collected data on early and long-term functional outcomes and compared the differences. The health-related QOL was measured using the Polish version of The Short Form - 36 Health Survey Questionnaire (SF-36v2). Multivariable logistic regression was derived to define independent predictors of the QOL. FINDINGS: The mean follow-up time was 3.6 years. Sixty-six percent of patients had improvement in functional outcomes and among previously employed people 56% returned to work. QOL deteriorated in 24% of patients with the most affected dimension of Physical Role. Factors that predict good QOL are male gender, younger age, good economic/professional status, lack of physical handicaps, rehabilitation in a professional center, subjective improvement in health status, and absence of headaches or physical decline. CONCLUSIONS AND CLINICAL RELEVANCE: Recovery process in SAH patients is dynamic and progresses over time. Since physical handicaps and low economic status significantly reduce the quality of life, an effort should be made to provide intensive rehabilitation and to encourage SAH survivors to return to work.

Management for the case of twice ruptured anterior communicating artery aneurysm: from nursing perspective.

The anterior communicating artery (ACoA) is the most common site of cerebral aneurysms, accounting for as much as 36% of aneurysms. Microsurgical clipping and coil embolization are treatment modalities for ruptured and nonruptured cerebral aneurysms. Compared with surgical clipping, coil embolization has a relatively lower mortality and incidence of cognitive impairment in patients. However, successful management of the patient with twice ruptured ACoA aneurysm is facing critical challenges.This article has described a case of twice ruptured aneurysm with the first rupture occurring when the patient was admitted and the second rupture occurring during coil embolization. Perioperative nursing assessment, monitoring, intervention, patient teaching, and the nurse's role are discussed from a nursing perspective.

The complexity of caring for patients with ruptured cerebral aneurysm: case studies.

Ruptured intracerebral aneurysm causes instantaneous neurologic chaos and is associated with high morbidity ad mortality. The event initiates a cascade of physiologic and structural changes that manifest themselves in a variety of clinical symptoms. The critical care team of nurses, physicians, and therapists must rapidly identify the cause; understand the pathology; and use advanced assessment techniques, medications, and interventions to stabilize the patient and to counter the horrendous effects of the injury. Interventions that include endovascular aneurysm coiling and cerebral angioplasty are providing new options for isolating the aneurysm and countering the effects of vasospasm. Through an integrated team approach, recovery from ruptured aneurysm will be maximized.

Arteriovenous malformation in the pregnant patient: a case study.

Subarachnoid hemorrhage (SAH) due to ruptured arteriovenous malformation (AVM) or aneurysm accounts for 4.4% of all maternal deaths. It is the third most common nonobstetric cause of maternal death. Significant differences, such as timing of the initial bleed and rebleeding, exist between aneurysmal and AVM related SAH. Increased risk of AVM related SAH appears to correlate with the augmented cardiac output of pregnancy, as well as with other coagulation, hemodynamic and endocrinological changes. These changes usually occur between 20 weeks gestation and 6 weeks postpartum. All suspicious neurological signs and symptoms in the gravid patient should be thoroughly evaluated. Although the nursing care of the pregnant patient with an AVM is similar to that of nonpregnant patients, there are specific clinical observations that are relevant to these patients.