NURSING DIAGNOSIS Objective: Impaired verbal communication S/P Hemicraniecto related to cerebral impairment my to GCS 13 secondary intracerebral (E3V4M6)

6) Speaks with hemorrhage in R basal ganglia difficulty Slurring Difficulty in forming words or sentences Difficulty in expressing thoughts verbally Difficulty in comprehendin g or maintaining usual communicatio n pattern Difficulty in use of facial and body expressions Use of nonverbal cues

ASSESSMENT

SCIENTIFIC PLANNING INTERVENTION RATIONALE Intracerebral After 7 hours of Independent hemorrhage is focal nursing interventions Provide an bleeding from a blood the patient will: atmosphere vessel in the brain Indicate an of acceptance and parenchyma. The cause understanding privacy through is usually hypertension. of the speaking slowly and Blood from an communicatio in a normal tone, intracerebral n problem not forcing the hemorrhage client to Establish accumulates as a mass communicate. method of that can dissect communicatio through and compress n in which adjacent brain tissues, needs are causing neuronal expressed dysfunction. Large Use resources hematomas increase appropriately intracranial pressure. Pressure from Taught techniques supratentorial to improve hematomas and the speech by accompanying edema initially asking may questions that cause transtentorial client can brain herniation, answer with a compressing the yes or no. brainstem and often causing secondary hemorrhages in the midbrain and pons. If the hemorrhage ruptures into the ventricular system,

RATIONALE

EVALUATION After 7 hours of nursing interventions the patient has: Indicated an understanding of the communication problem Established method of communication in which needs are expressed Used resources appropriately

Impaired ability to communicate spontaneously is frustrating and embarrassing. Nursing actions should focus on decreasing the tension and conveying an understanding of how difficult the situation must be for the client. Deliberate actions can be taken to improve speech. As the clients speech improves, his confidence will increase and she will make more attempts at speaking.

blood may cause acute hydrocephalus. Cerebellar hematomas that are > 3 cm in diameter may cause midline shift or herniation. Herniation, midbrain or pons hemorrhage, intraventricular hemorrhage, acute hydrocephalus, or dissection into the brainstem can impair consciousness and cause coma and death.

Used strategies to improve the clients comprehension by using touch and behavior to communicate calmness and adding other non verbal methods of communicatio n such as pointing or using flash cards for basic needs; using pantomime; or using paper and pen. Involved the significant others in the plan of care

Improving the clients comprehension can help to decrease frustration and increase trust. Clients with aphasia can correctly interpret tone of voice

Enhances participation and commitment to plan.