Subarachnoid Hemorrhage Screening Clinical Problem - Essay Example

Subarachnoid Hemorrhage Screening Clinical Problem Introduction The investigator seeks to illustrate how management subarachnoid hemorrhage (SAH) posses a major threat to asymptomatic patients and those already infected with hypertension based on its screening and particularly, cerebral angiography screening (Bederson & AANS Publications Committee,1997, p. 78). Evidence points out that, those persons with strong familial inheritable connective tissue disorders are highly susceptive to SAH as well as those binge drinkers and sympathomimetic substances abusers. It is also noted that adult’s females are highly exposed to search diseases than males whereas boys are much exposed than girls. On a general perspective, SAH infections are attached to all individuals. Its results from blood surges into subarachnoid space sandwiched between pial and arachnoid membrane. With regard to clinical view, Subarachnoid Hemorrhage has head trauma as the commonest disorder. It is attached spontaneous hemorrhage occurring as a result of arteriovenous malfunction and ruptured cerebral aneurysm. Management practices such as intubation and hyperventilation are encouraged as they increase ICP characteristics in patients. Angiotensin-converting enzyme inhibitors, calcium channel inhibitors, hydralazine, Loop diuretic and osmotic agent is best management practices employed to control Subarachnoid Hemorrhage effects. Subarachnoid Hemorrhage is also characterized by increased arteriole mean pressure going beyond 130 mm Hg and Antihypertensive agents are used as counteractive mechanism during such scenarios. Patient is also advice to stay ways from ICP-elevations factors such as nitrates (DeMello, 2009, p. 123). The purpose of this paper is to introduce an evidence-based change project that focuses on identification of proper mechanisms and approaches to be applied in Angiography Screening with respect to SAH asymptotic patients so as to weed out the associated risks and outcomes (cerebral vasospasm, hydrocephalus development, and re-bleeding) that leads to increased morbidity and mortality rates. Background Subarachnoid Hemorrhage has presented various daunting challenges and health threats to individuals across the board regardless of age, race as well as sex. Serious neurologic outcomes such as hydrocephalus developments, re-bleeding and cerebral vasospasm are projected as major risks associated with this deadly disease. Sympathomimetic agents have acted as pressor agent’s presents breeding environments for growth of these diseases with respect to escalating rates of intracranial hemorrhage. Following these shocking and hazardous scenarios associated with Subarachnoid Hemorrhage, screening and diagnosis have been identified as its counteractive measures in regard to Subarachnoid Hemorrhage treatment and management (Wildman, 2009, p. 155). Missed incidences scenarios have increasingly become inevitable following its diagnosis and screening. Surprisingly, Angiogram Screening poses a major threat to asymptomatic patients resulting into increased morbidity and mobility to such patients. Existence of a range of Subarachnoid Hemorrhage predisposition factors such as hypertensions, inheritable connective tissue disorders, binge drinking, abuse of sympathomimetic substances and smoking amplifies the inability to manage Subarachnoid Hemorrhage by clinicians. It is very severe as over 40% of untreated patients die within the first one month of its contraction while 10% of reported cases of patients die before reaching hospitals. Following the major threats associated with angiography screening benchmarked against its associated pros and cons with respect to intracranial aneurysms determination, Magnetic Resonance (MR) and CT angiography have consequently been identified as best management approaches. Such innovations have been informed by reduced chances of missed incidences as well as quality imaging culminating into higher intracranial aneurysms detection rates. Furthermore, reduced consumption of alcohol, cocaine, methamphetamine as well as smoking rates reduction are been suggested as best proactive and preventive ways to curb Subarachnoid Hemorrhage. Significance of the problem Patient’s safety remains erected as the primary role of clinicians. Actions undertaken by health providers should remain focused on patient’s high degree of care and safety. Patients’ best of interest should always remain the policy of a health provision facility so as to ensure diseases are weeded out at earlier stages and that minimal risks associated with clinicians actions such as diagnosis and screening (Weir, 1998, p. 165). The identified problem is thus of great significance as it is noted that angiogram screening with respected to aneurysm detection has frequently led to health risks to asymptomatic patients culminating into increased morbidity and mortality rates. Weeding out this threat to patients’ life will translates to increased patients’ care and reduced loss of lives to the community. It is upon these premises that, an intensive research and development program needs to be done based on increased funding and grants diverted to clinicians in order to establish better ways of screening by focusing on the elimination of such angiogram screening shortcomings as well as using alternatives such as CT and Magnetic Resonance screening that are projected to reduce chances of missed incidences as well elimination of threats to asymptomatic patients. Despite the higher costs associated with application of Magnetic Resonance and CT screening as well as increased research to weed out risks to asymptomatic patients based on the use of angiogram screening, patients stands to benefits more from such development based on reduced possibility of missed incidences. PICO questions and Components Concept of Evidence based Practice The concept was coined in 1992 in medicine practice (EBM) and has subsequently been incorporated to various faculties including nursing. “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values”(David, 2000, p.1) defines It is embedded on the notion that practical decisions are to be quantitative-research-evidence based arrived at based on strictly and narrowly outlined criterion (Shemitt, 2011, p. 145). Rational and health promotional practical decisions are thus arrived at leading to better care provision resulting from incorporation best promising evidence properly integrated health professionals skills and other resources taking keen interest on the target group preferences, values, status and features within the context of enabling environment. Meaning of PICO acronym PICO acronym presents a researcher with a framework to remember salient concepts that have mandatorily be identified during the research question formulation as well as the remembering which key concepts to act as search engines in retrieving the most relevant article projected to answer the stated research questions making investigator to develop a confidence he has identified published existing reports. P- Population; with a topic of interest, I-Intervention; treatment, procedures, therapies, develop, implement, C-Comparison; interventions, procedures, therapies, tests, placebo, treatment and O-Outcome; results based on intervention. Presenting a question For all the asymptomatic patients does the application of Magnetic Resonance and CT screening mechanisms in detection of aneurysms rather than Cerebral Angiogram Screening culminate into reduced probability of missed incidence and risks associated with Subarachnoid Hemorrhage? Description to PICO Elements Population In this context, the population entailed all asymptomatic patients that were being screened for Subarachnoid Hemorrhage regardless of age, races, sex, gender or region. Intervention This was framed in a manner to instill expansive knowledge amongst clinicians handling angiogram screening on asymptomatic patients in order to apply alternatives such as application of Magnetic Resonance or CT Screenings in detecting aneurysms. This aimed at reducing cases of missed incidence during screening and reduction of cases of morbidity and mortality rates associated with cerebral angiogram screening. Comparison Increased risks of Subarachnoid Hemorrhage based on the untreated asymptomatic diseases. Outcome Increase application of Magnetic Resonance and CT screenings in aneurysms detections. In addition, there was increase in reasonable care related knowledge during angiogram screening executed on asymptomatic patients. Reduce possibilities of occurrence of missed incidence following extensive use of MR and CT in aneurysms screening detections. Conclusion Subarachnoid Hemorrhage Screening poses greater threats to asymptomatic patients. The use of cerebral angiogram screening not only escalates morbidity and mortality rates amongst asymptomatic patients but also leads to chances of missed incidences. Evidenced based practices have thus help clinicians in making rational practical decisions when screening such delicate patients (Hütter, 2000, p. 187). This has culminated into a shift from aneurysms detection based on cerebral angiogram screening to application of Magnetic Resonance and CT in such screening. This is projected to reduce cases of morbidity and mortality associated with cerebral angiogram bottlenecks. Reduction of cases of missed incidences has also been recorded following the shift. Asymptomatic patients can thus be screened and treated without being harmed. Clinicians on the other hand have become confident in handling such patients which culminates in to increased patients’ care. Reference Bederson, J. B., & AANS Publications Committee. (1997). Subarachnoid hemorrhage: Pathophysiology and management. Park Ridge, Ill: American Association of Neurological Surgeons. David Sackett (2000). Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edition. Churchill Livingstone, Edinburgh. DeMello, W. (2009). Renin angiotensin system. London: Sage. Hütter, B. O. (2000). Neuropsychological Sequelae of Subarachnoid Hemorrhage and its Treatment. Wien: Springer. Shemitt, I. (2011). Evidence based practice and decisions. London: Routledge. Weir, B. (1998). Subarachnoid hemorrhage: Causes and cures. New York: Oxford University Press. Wildman, R. (2009). Advanced human nutrition. New Jersey: Pearson. Read More