Critical Care Stroke Education Intracerebral Hemorrhage Bundle
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Critical care stroke response

Bundled Care for Intracerebral Hemorrhage

This activity is for critical care nurses caring for patients with confirmed or suspected intracerebral hemorrhage. 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 local approved protocols Practice ICU escalation
Activity content is adapted from Rodriguez et al., “Bundled Care Interventions for the Management of Intracerebral Hemorrhage: A Review,” published in Critical Care Nurse in 2026. View citation.
1

Read the Article First

The questions and bundle concepts in this activity come from the assigned article. Use your organization’s approved protocols and provider orders when applying any of this to patient care.

Primary source: Rodriguez S, Gilbert B, Qualls K, Cooper M, Deyoung C, Walston T. Critical Care Nurse. 2026;46(2):9-17.

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

Article access

Use the AACN article page for this activity. The article can be read without signing in; AACN membership is only needed to claim CE credit.

Open AACN Article

Correction note for Table 2: Table 2 in the article incorrectly shows bivalirudin as reversed with Kcentra. The article text correctly states that bivalirudin should be stopped and that there is no specific reversal agent. This activity uses the corrected interpretation: argatroban or bivalirudin = stop the infusion, no specific reversal agent. Follow local protocols, pharmacy guidance, and provider orders for actual care.

How this activity uses the article

The bundle elements, timeline targets, anticoagulation reversal recognition, and nursing priorities in this activity are educational adaptations of the Rodriguez et al. review. Case details are fictional and are included to help nurses practice recognition and escalation.

Full citation: Rodriguez S, Gilbert B, Qualls K, Cooper M, Deyoung C, Walston T. Bundled Care Interventions for the Management of Intracerebral Hemorrhage: A Review. Critical Care Nurse. 2026;46(2):9-17. doi:10.4037/ccn2026556.

2

Why This Bundle Matters in Critical Care

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.

Source note: This overview summarizes the rationale and nursing role described by Rodriguez et al. (2026).

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

Many nurses first manage intracerebral hemorrhage in a community or regional hospital, not a neurocritical care center. The bedside work is practical: stabilize well, use local protocols, and escalate early when the patient may need resources beyond what can safely be provided locally.

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 your local chain of command.

Local-policy anchor: The answers here reflect the article’s discussion of bundled care. At the bedside, follow your organization’s approved protocols, medication guidance, transfer pathways, and provider orders.

Need the source material?

The introduction video is embedded in the first section, and the article opens on AACN. If an embedded resource is blocked in your browser, use these links instead.

Open Video Open Article
3

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.

Source note: Bundle items are adapted from the care priorities reviewed by Rodriguez et al. (2026).

4

Timeline Challenge

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

Source note: Time goals are drawn from the article’s discussion of rapid imaging, blood pressure management, reversal, dysphagia screening, and venous thromboembolism prevention.

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 community ICU admission. Your job is to keep parallel tasks moving and advocate when the bundle stalls.

Source note: This is a fictional case built from the nursing priorities and bundled-care concepts in Rodriguez et al. (2026).

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.
6

Reversal Match

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

Source note: Reversal recognition is summarized from the article. Follow local pharmacy guidance, protocols, and provider orders for actual therapy.

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

How to think through it

  • Start by sorting each medication into its anticoagulant class.
  • Ask whether the medication is taken by mouth or running as an infusion.
  • Factor Xa name cue: apixaban, rivaroxaban, and edoxaban are the "-xaban" family.
  • Then choose the strategy type: specific antidote, factor replacement, vitamin K support, infusion stop, or heparin reversal.
  • Use the correction note from the reading section if a table entry conflicts with the article text.

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.

Source note: Questions are based on Rodriguez et al. (2026) and the AACN CE objectives for the article.

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.

Source note: The board summarizes article-derived nursing priorities into bedside recognition categories.

This final board is a self-check. Do not enter patient identifiers or protected health information anywhere in this activity.

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.

Reference

Rodriguez S, Gilbert B, Qualls K, Cooper M, Deyoung C, Walston T. Bundled Care Interventions for the Management of Intracerebral Hemorrhage: A Review. Critical Care Nurse. 2026;46(2):9-17. doi:10.4037/ccn2026556. PMID: 41916567.

This learning activity is an educational adaptation of the article and is not a substitute for organizational policy, provider orders, or specialty consultation.