An Intracranial Aneurysm is a dilation of the walls of a cerebral artery that develops as a result of weakness in the arterial wall.

Learn the nursing interventions and management for patients with intracranial aneurysm. Its cause is unknown, but it may be due to atherosclerosis, a congenital defect of the vessel walls, hypertensive vascular disease, head trauma, or advancing age. Most commonly affected are the internal carotid, anterior or posterior cerebral, anterior or posterior communicating, and middle cerebral arteries. Symptoms are produced when the aneurysm presses on nearby cranial nerves or brain tissue or ruptures, causing subarachnoid hemorrhage. Prognosis depends on the age and neurologic condition of the patient, associated diseases, and the extent and location of the aneurysm.

Clinical Manifestations

Contents [hide] 1 Clinical Manifestations 2 Assessment and Diagnostic Methods 3 Medical Management 4 Nursing Process 5 Assessment 6 Nursing Diagnoses 7 Planning and Goals 8 Nursing Interventions o 8.1 Improving Cerebral Tissue Perfusion o 8.2 Relieving Sensory Deprivation o 8.3 Monitoring and Managing Potential Complications o 8.4 Teaching Patients Self Care o 8.5 Continuing Care 9 Evaluation o 9.1 Expected Patient Outcomes

Neurologic decits (similar to those of ischemic stroke) Rupture of the aneurysm causes sudden, unusually severe headache; often, loss of consciousness for a variable period; pain and rigidity of the back of the neck and spine; and visual disturbances (visual loss, diplopia, ptosis). Tinnitus, dizziness, and hemiparesis may also occur. If the aneurysm leaks blood and forms a clot, patient may show little neurologic decit or may have severe bleeding, resulting in cerebral damage followed rapidly by coma and death.

The four types of aneurysms (A) saccular, (B) dissecting, (C) mycotic, and (D) pseudoaneurysm.

Assessment and Diagnostic Methods

CT scan or MRI, cerebral angiography, and lumbar puncture are diagnostic procedures used to conrm an aneurysm.

Medical Management
Allow the brain to recover from the initial insult (bleeding).

Prevent or minimize the risk of rebleeding. Prevent or treat other complications: rebleeding, cerebral vasospasm, acute hydrocephalus, and seizures. Provide bed rest with sedation to prevent agitation and stress. Manage vasospasm with calcium channel blockers, such as nimodipine (Nimotop). Endovascular techniques may also be used. Administer supplemental oxygen and maintain the hemoglobin and hematocrit at acceptable levels to assist in maintaining tissue oxygenation. Institute surgical treatment (arterial bypass) or medical treatment to prevent rebleeding. Manage increased intracranial pressure (ICP) by draining the CSF via ventricular catheter drainage. Administer mannitol to reduce ICP, and monitor for signs of dehydration and rebound elevation of ICP. Administer antibrinolytic agents to delay or prevent dissolution of the clot if surgery is delayed or contraindicated. Manage systemic hypertension with antihypertensive therapy, arterial hemodynamic monitoring, and stool softeners to prevent straining and elevation of blood pressure.

Nursing Process
Follow the nursing process below for patients with Intracranial Aneurysms

Assessment
Perform a complete neurologic assessment: level of consciousness, pupillary reaction (sluggishness), motor and sensory function, cranial nerve decits (extraocular eye movements, facial droop, ptosis), speech difculties, visual disturbance or headache, and nuchal rigidity or other neurologic decits. Document and report neurologic assessment ndings, and reassess and report any changes in patients condition. Detect subtle changes, especially altered levels of consciousness (earliest signs of deterioration include mild drowsiness and slight slurring of speech). Diagnosis

Nursing Diagnoses
Ineffective tissue perfusion (cerebral) related to bleeding or vasospasm Disturbed sensory perception due to the restrictions of aneurysm precautions Anxiety due to illness or restrictions of aneurysm precautions Collaborative Problems/Potential Complications Vasospasm Seizures Hydrocephalus Aneurysm rebleeding Hyponatremia

Planning and Goals

Patient goals include improved cerebral tissue perfusion, relief of sensory and perceptual deprivation, relief of anxiety, and absence of complications.

Nursing Interventions
Improving Cerebral Tissue Perfusion
Monitor closely for neurologic deterioration, and maintain a neurologic ow record. Check blood pressure, pulse, level of consciousness, pupillary responses, and motor function hourly; monitor respiratory status and report changes immediately. Implement aneurysm precautions (immediate and absolute bed rest in a quiet, nonstressful setting; restrict visitors, except for family). Elevate the head of bed 15 to 30 degrees or as ordered. Avoid any activity that suddenly increases blood pressure or obstructs venous return (eg, Valsalva maneuver, straining), instruct patient to exhale during voiding or defecation to decrease strain, eliminate caffeine, administer all personal care, and minimize external stimuli. Apply antiembolism stockings or sequential compression devices. Observe legs for signs and symptoms of deep vein thrombosis tenderness, redness, swelling, warmth, and edema. Keep sensory stimulation to a minimum. Explain restrictions to help reduce patients sense of isolation. Relieving Anxiety Inform patient of plan of care. Provide support and appropriate reassurance to patient and family. Assess for and immediately report signs of possible vasospasm, which may occur several days after surgery or on the initiation of treatment (intensied headaches, decreased level of responsiveness, or evidence of aphasia or partial paralysis). Also administer calcium channel blockers or uid volume expanders as prescribed. Maintain seizure precautions. Also maintain airway and prevent injury if a seizure occurs. Administer antiseizure medications as prescribed (phenytoin [Dilantin] is medication of choice). Monitor for onset of symptoms of hydrocephalus, which may be acute (rst 24 hours after hemorrhage), subacute (days later), or delayed (several weeks later). Report symptoms immediately: acute hydrocephalus is characterized by sudden stupor or coma; subacute or delayed is characterized by gradual onset of drowsiness, behavioral changes, and ataxic gait. Monitor for and report symptoms of aneurysm rebleeding. Rebleeding occurs most often in the rst 2 weeks. Symptoms include sudden severe headache, nausea, vomiting, decreased level of consciousness, and neurologic decit. Administer medications as ordered. Hyponatremia: monitor laboratory data often because hyponatremia (serum sodium level under 135 mEq/L) affects up to 30% of patients. Report low levels persisting for 24 hours, as syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral salt wasting syndrome (kidneys cannot conserve sodium) may develop.

Relieving Sensory Deprivation

Monitoring and Managing Potential Complications

Teaching Patients Self Care

Provide patient and family with information to promote cooperation with the care and required activity restrictions and prepare them for patients return home. Identify the causes of intracranial hemorrhage, its possible consequences, and the medical or surgical treatments that are implemented. Discuss the importance of interventions taken to prevent and detect complications (eg, aneurysm precautions, close monitoring of patient). As indicated, facilitate transfer to a rehabilitation unit or center. Urge patient and family to follow recommendations to prevent further complications and to schedule and keep followup appointments. Refer for home care if warranted, and encourage health promotion and screening practices.

Continuing Care

Evaluation
Expected Patient Outcomes
Demonstrates intact neurologic status and normal vital signs and respiratory patterns Demonstrates normal sensory perceptions Exhibits reduced anxiety level Is free of complications