University of Rochester Medicine
F.F. Thompson Hospital ICU Stroke Education
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Thompson ICU stroke response

Bundled Care for Intracerebral Hemorrhage

This activity is for ICU nurses caring for patients with confirmed or suspected intracerebral hemorrhage at a community hospital. You will read the article first, then practice how the article’s bundle concepts translate into bedside nursing awareness, escalation, and local-protocol follow-through.

Read the article first Use Thompson-approved protocols Practice ICU escalation
1

Read the Article First

The questions and bundle concepts in this activity come from the assigned article. Keep Thompson policy in front of you when applying any of this to patient care.

Thompson practice comes first. This module uses the article to build shared awareness, but it does not replace Thompson-approved stroke, ICU, medication, transfer, or provider-order protocols.
Start with this short introduction, then read the article on AACN. If the LMS blocks embedded YouTube, open the video directly: YouTube introduction.
Assigned reading: Bundled Care Interventions for the Management of Intracerebral Hemorrhage Open Article

Article access for this review

Use the AACN article page for this public review. The article can be read without signing in; AACN membership is only needed to claim CE credit. In the final MyPath/LMS version, the article can be embedded at this point in the activity.

Open AACN Article

2

Why This Bundle Matters in Our ICU

Spontaneous intracerebral hemorrhage is high-risk, time-sensitive, and easy to undertreat when the team waits for one step to finish before beginning the next.

Learning objectives

  1. Identify bundled-care interventions for patients experiencing spontaneous intracerebral hemorrhage.
  2. Apply practical nursing actions for early blood pressure management and neurologic monitoring.
  3. Match common anticoagulants with appropriate reversal or hemostatic strategies.
  4. Explain how dysphagia screening, venous thromboembolism prevention, and neurosurgical escalation fit into a complete intracerebral hemorrhage response.

Community ICU frame

Thompson is a community acute-care hospital serving the Finger Lakes region with a small ICU footprint compared with a tertiary center. The bedside work is practical: stabilize well, use local protocols, and escalate early when a patient may need resources beyond what should stay here.

This is not about memorizing every medication dose. It is about recognizing what needs to happen now, what can happen in parallel, and what should never be delayed.

Likely ICU patient

Older adult from home or a long-term-care setting, often with hypertension, atrial fibrillation, anticoagulant exposure, fall risk, or sudden neurologic change.

What nurses own

Neurologic trends, blood pressure vigilance, nothing-by-mouth status before swallow screening, medication history, timely escalation, and closed-loop communication.

When to push

If the patient is worsening, the clock is drifting, reversal is unclear, or transfer/escalation may be needed, speak up through the Thompson chain of command.

Local-policy anchor: The answers here reflect the article’s discussion of bundled care. At the bedside, follow Thompson-approved protocols and provider orders. If you are unsure how the article connects to Thompson policy, contact Alice Taylor, Stroke Coordinator.

Need the source material?

The introduction video is embedded in the first section, and the article opens on AACN for this review. If an embed is blocked in your browser or LMS, use these links instead.

Open Video Open Article
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Warm-Up: What Belongs in the Bundle?

Select the actions that are part of the article’s bundled-care response. Local policy and provider orders guide the exact bedside steps.

4

Timeline Challenge

Match each care element to the time goal emphasized in the article.

Door-to-CT ScanRapid imaging after arrival
Target Blood Pressure GoalReach ordered systolic blood pressure goal after treatment begins
Anticoagulation ReversalAdminister after intracerebral hemorrhage is confirmed by radiology
Venous Thromboembolism PreventionPneumatic compression devices after diagnosis
Dysphagia ScreenScreen before fluids, nutrition, or medications by mouth
5

ICU Case Simulation: First 90 Minutes

Work through a Thompson-style community ICU admission. Your job is to keep parallel tasks moving and advocate when the bundle stalls.

ICU admission from the Emergency Department

Emergency medical services pre-notified for sudden right-sided weakness, vomiting, headache, and declining speech. CT scan confirms spontaneous intracerebral hemorrhage. The patient is coming to the ICU for close monitoring while the team determines whether care can safely continue locally or requires higher-level neurologic escalation.

Age82
Blood pressure192/104
AnticoagulantApixaban
Neurologic statusGlasgow Coma Scale 12, pupils equal
Scenario rule: Choose the nursing action that best supports ICU care. Actual medication, transfer, and swallow-screen decisions still follow orders and approved workflows.

Clinical monitor

Systolic blood pressure192/104
Minutes since CT scan0
Airway/swallowNothing by mouth
Neurologic statusGlasgow Coma Scale 12
AnticoagulationApixaban
Bundle0/5
Round 1 of 5 Arrival priorities

CT scan confirms intracerebral hemorrhage. The patient arrives hypertensive and on apixaban.

Choose the next action

Use the monitor, handoff details, and team resources to choose the best next move. If a choice does not fit the patient data, feedback will nudge you and you can choose again.
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Reversal Match

Use the recognition clues below, then match the anticoagulation exposure to the reversal or hemostatic strategy highlighted in the article.

This is meant to build recognition, not test dosing. For actual orders, use pharmacy, providers, and local resources.

Recognition clues

  • Heparin family: think protamine.
  • Warfarin: replace clotting factors now and give vitamin K for sustained reversal.
  • Dabigatran: has a specific antidote.
  • Infusion anticoagulants: stopping the infusion matters because there is no specific antidote.
  • Factor Xa inhibitors: apixaban, rivaroxaban, and edoxaban group together.

Bedside move

Do not wait until every detail is memorized. Identify the likely medication class, verify the medication history, and close the loop with the provider and pharmacy early.

Unfractionated or low-molecular-weight heparin
Warfarin
Dabigatran
Argatroban or bivalirudin
Apixaban, rivaroxaban, or edoxaban
7

Knowledge Check

Answer five quick questions. A passing score is 80% overall.

8

Wrap-Up: Build the Bundle Board

Sort each bedside move into the objective it supports. This is a quick way to pull the whole activity back together.

For this public review link, nothing is sent to an LMS. In the MyPath/LMS version, completion and score will be recorded.

What the board should show

The article’s bundle is not one task. It is a coordinated set of bedside priorities: limit expansion, reverse when indicated, protect swallowing and airway safety, prevent complications, and keep escalation visible.

How to play

Match each bedside move to the objective it supports. Use the same recognition pattern you practiced in the case.

Titrate ordered blood pressure medications and watch for overshoot.
Verify anticoagulant history and close the loop with provider/pharmacy.
Repeat focused neurologic checks and report a change quickly.
Keep the patient nothing by mouth until dysphagia screening is complete.
Apply pneumatic compression when cleared.
Clarify neurology, neurosurgery, or transfer planning early.