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Adult Subdural Hematoma Nursing Guide

This clinical guide provides a quick reference for understanding subdural hematoma, emphasizing nursing considerations using the nursing process. 

Content reviewed by Ann Dietrich, MD, FAAP, FACEP. 

Overview of Adult Subdural Hematoma

ICD-10 Code for Subdural Hematoma: I62.00 

Etiology and Epidemiology 

A subdural hematoma is a type of bleed with an abnormal collection of blood under the dura mater, within the skull but outside the brain tissue (Stat Pearls, 2023). The meninges, comprising the pia mater (inner layer), arachnoid (middle layer), and dura mater (outer layer), protect the brain from injury (Kondamudi & Pierre, 2021). A subdural hematoma occurs when a blood vessel tears, causing blood to leak into the subdural space below the dura mater. 

Types of Subdural Hematomas: 

  • Acute: Occurs within minutes to hours post-trauma and is the most dangerous. 
  • Subacute: Develops within days to weeks after trauma. 
  • Chronic: More common in individuals > 65 years. Bleeding occurs slowly and may take weeks to months to become symptomatic after the initial trauma. 

Causes of Subdural Hematomas

  • Head injury or trauma (e.g., car crashes, falls) 
  • Falling and head impact 
  • Sports and a head injury 
  • Assault or physical abuse 

High-Risk Groups

  • Older adults (As you get older the brain shrinks, creating extra space and stretching blood vessels, making it more likely for bleeds to occur with trauma) 
  • Athletes  
  • Individuals on blood thinners (Bleeding does not stop as easily making longer and more severe bleeding likely) 
  • Hemophiliacs (Predisposed to longer and more severe bleeding because of clotting abnormalities) 
  • Alcoholics 

Prevalence

  • Up to 25% of individuals experiencing head trauma develop subdural hematomas (Cleveland Clinic, 2024). 

Diagnosis 

Diagnosis involves a thorough physical and neurological examination, including the patient's history of head injury, medications, chronic conditions, and lifestyle habits. Neurological assessments may involve: 

  • Blood pressure checks 
  • Balance and strength tests 
  • Vision tests 

Subdural Hematoma Symptoms

  • Immediate or gradual onset 
  • The more severe bleeding the more severe the symptoms 
  • Altered mental status, seizures, weakness on one side of the body, headache, memory loss, personality changes, and confusion, especially in older adults 

Imaging Tests

Management 

Treatment depends on the hematoma's size and associated symptoms and may include: 

  • For large or severe bleeds 
  • Intubation and airway control 
  • Immediate surgery which may include a craniotomy or Burr Hole 
  • For small bleeds 
  • Observation of symptoms 
  • Monitoring vital signs 
  • Bed rest 
  • Vitamin K therapy 
  • Medications to reduce swelling and pressure 
  • Surgical interventions (craniotomy or burr hole) 

Adult Subdural Hematoma Nursing Care Plan

Nursing Considerations 

Assessment 

  • Persistent headache 
  • Confusion 
  • Drowsiness 
  • Altered level of consciousness 
  • Nausea and vomiting 
  • Slurred speech 
  • Vision changes 
  • Dizziness, loss of balance 
  • Weakness on one side 
  • Irritability 
  • Problems with walking 
  • Memory loss, personality changes, and confusion 

Nursing Diagnoses/Risk For 

  • Ineffective Cerebral Tissue Perfusion: Related to hemorrhage, evidenced by altered level of consciousness, memory loss, slurred speech, vision changes. 
  • Impaired Verbal Communication: Related to neuromuscular impairment, evidenced by slurred speech, confusion, altered level of consciousness. 
  • Acute Pain: Related to trauma or headache, evidenced by verbalization of pain, facial expression, irritability, anxiety, restlessness. 

Interventions 

  • Observe and monitor neurological status. 
  • Evaluate the Glasgow Coma score. 
  • Monitor vital signs. 
  • Implement seizure precautions. 
  • Maintain bed rest. 
  • Provide a quiet environment. 
  • Use simple yes/no questions. 
  • Provide communication alternatives. 
  • Monitor pain levels. 
  • Administer analgesic medication for pain as ordered. 
  • Prepare the individual and family for surgery if needed. 

Expected Outcomes 

  • Improved level of consciousness 
  • Decrease or absorption of subdural hematoma 
  • Improved vision 
  • Improved strength, balance, and mobility 
  • Decreased pain 
  • Improved tissue perfusion 

Individual/Caregiver Education 

  • Educate on the condition, treatment, and expected outcomes. 
  • Prevention strategies such as head protection and fall protection. 
  • Wound care if surgery is performed. 
  • Adherence to medication regimen. 
  • When to notify the healthcare provider: persistent headaches, increased confusion, seizure activity, signs of wound infection, visual disturbances. 
  • Follow-up recommendations with healthcare providers. 

FAQs

Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2024

References

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