LWBK397-A_001-084.

qxd 8/27/09 9:31 PM Page 58 Aptara

58 Aneurysm, Intracranial
A
• If the aneurysm leaks blood and forms a clot, patient may show
little neurologic deficit or may have severe bleeding, resulting
in cerebral damage followed rapidly by coma and death.
Assessment and Diagnostic Methods
CT scan or MRI, cerebral angiography, and lumbar puncture
are diagnostic procedures used to confirm 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 hemo-
globin and hematocrit at acceptable levels to assist in main-
taining 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 antifibrinolytic agents to delay or prevent disso-
lution of the clot if surgery is delayed or contraindicated.
• Manage systemic hypertension with antihypertensive ther-
apy, arterial hemodynamic monitoring, and stool softeners
to prevent straining and elevation of blood pressure.

NURSING PROCESS
THE PATIENT WITH AN INTRACRANIAL
ANEURYSM
Assessment
• Perform a complete neurologic assessment: level of con-
sciousness, pupillary reaction (sluggishness), motor and