Year of Publication

2020

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Debra Hampton

Clinical Mentor

Dr. Justin Fraser

Committee Member

Dr. Lacey Buckler

Committee Member

Dr. Karen Butler

Abstract

Abstract

Backgro

Abstract

Background: Subarachnoid hemorrhage (SAH) patients experience significant headaches that can last weeks to years. The treatment for these headaches has not been effective in successful alleviation of pain. Understanding the present standard of care will help guide future medication modalities for these patients.

Conceptual Framework: The Neuman Systems Model was utilized as a framework in this study.

Methodology: A retrospective review of the electronic records of patients who experienced a subarachnoid hemorrhage (SAH) at an academic health system in the southcentral part of the United States was done to evaluate patient demographics and comorbidities. Variables included Hunt-Hess (HH) scores, intracranial pressures, aneurysm coiling, and patient-reported pain scores over the first ten days of hospital admission.

Results: A total of 203 patient electronic medical records were evaluated for this study. Maximum daily pain score was statistically significant on admission day 5, with

Abstract

Background: Subarachnoid hemorrhage (SAH) patients experience significant headaches that can last weeks to years. The treatment for these headaches has not been effective in successful alleviation of pain. Understanding the present standard of care will help guide future medication modalities for these patients.

Conceptual Framework: The Neuman Systems Model was utilized as a framework in this study.

Methodology: A retrospective review of the electronic records of patients who experienced a subarachnoid hemorrhage (SAH) at an academic health system in the southcentral part of the United States was done to evaluate patient demographics and comorbidities. Variables included Hunt-Hess (HH) scores, intracranial pressures, aneurysm coiling, and patient-reported pain scores over the first ten days of hospital admission.

Results: A total of 203 patient electronic medical records were evaluated for this study. Maximum daily pain score was statistically significant on admission day 5, with a mean for Hunt-Hess I 5.47, Hunt-Hess II 7.0, and Hunt-Hess III 7.07. Acetaminophen administration (in milligrams) was 729.59 for HH I, 679.93for HH II, and 338.82for HH III on day one of admission. Admission day 10 was also statistically significant with HH I receiving (in milligrams) 437.75, HH II receiving 718.42, and HH III receiving 912.76. Morphine equivalent dosing for day one admissions were HH I 2.69, HH II 5.52, and 0.86 (p=.009).

Discussion: Those patients who presented to the hospital with a SAH with a HH I or HH II had similar intensity headache, but received more acetaminophen than HH III. On admission day 5, HH I experienced less headache than HH II or HH III.

Conclusion: Of the patients in the study, all HH classifications presented with similar headache. Patients with a HH I or HH II received more acetaminophen and opioids than HH III on admission day I. Those with a HH II and HH III had greater headache on admission day five than HH I, and received more acetaminophen.

a mean for Hunt-Hess I 5.47, Hunt-Hess II 7.0, and Hunt-Hess III 7.07. Acetaminophen administration (in milligrams) was 729.59 for HH I, 679.93for HH II, and 338.82for HH III on day one of admission. Admission day 10 was also statistically significant with HH I receiving (in milligrams) 437.75, HH II receiving 718.42, and HH III receiving 912.76. Morphine equivalent dosing for day one admConclusionissions were HH I 2.69, HH II 5.52, and 0.86 (p=.009).

Discussion: Those patients who presented to the hospital with a SAH with a HH I orConclusion II had similar intensity headache, but received more acetaminophen than HH III. On admission day 5, HH I experienced less headache than HH II or HH III.

Conclusion: Of the patients in the study, all HH classifications presented with similar headache. Patients with a HH I or HH II received more acetaminophen and opioids than HH III on admission day I. Those with a HH II and HH III had greater headache on admission day five than HH I, and received more acetaminophen.

und: Subarachnoid hemorrhage (SAH) patients experience significant headaches that can last weeks to years. The treatment for these headaches has not been effective in successful alleviation of pain. Understanding the present standard of care will help guide future medication modalities for these patients.

Conceptual Framework: The Neuman Systems Model was utilized as a framework in this study.

Methodology: A retrospective review of the electronic records of patients who experienced a subarachnoid hemorrhage (SAH) at an academic health system in the southcentral part of the United States was done to evaluate patient demographics and comorbidities. Variables included Hunt-Hess (HH) scores, intracranial pressures, aneurysm coiling, and patient-reported pain scores over the first ten days of hospital admission.

Results: A total of 203 patient electronic medical records were evaluated for this study. Maximum daily pain score was statistically significant on admission day 5, with a mean for Hunt-Hess I 5.47, Hunt-Hess II 7.0, and Hunt-Hess III 7.07. Acetaminophen administration (in milligrams) was 729.59 for HH I, 679.93for HH II, and 338.82for HH III on day one of admission. Admission day 10 was also statistically significant with HH I receiving (in milligrams) 437.75, HH II receiving 718.42, and HH III receiving 912.76. Morphine equivalent dosing for day one admissions were HH I 2.69, HH II 5.52, and 0.86 (p=.009).

Discussion: Those patients who presented to the hospital with a SAH with a HH I or HH II had similar intensity headache, but received more acetaminophen than HH III. On admission day 5, HH I experienced less headache than HH II or HH III.

Conclusion: Of the patients in the study, all HH classifications presented with similar headache. Patients with a HH I or HH II received more acetaminophen and opioids than HH III on admission day I. Those with a HH II and HH III had greater headache on admission day five than HH I, and received more acetaminophen.

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