Brain Aneurysm

Diagnostic
Findings

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The following tests help establish a
diagnosis, which usually follows
aneurysmal rupture:
Angiography
Lumbar puncture
Computed tomography scanning
Magnetic resonance imaging and magnetic
resonance angiography
Treatment

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When surgical correction poses too much risk
(in very elderly patients and those with heart,
lung, or other serious diseases), when the
aneurysm is in particularly dangerous location,
or when vasospasm necessitates a delay in
surgery, the patient may receive conservative
treatment, including:

Bed rest in a quiet, darkened room (may last for 4 to

6 weeks) if immediate surgery isnt possible
Avoidance of coffee, avoid stimulants in the diet
Provide pain control as needed
Antihypertensive if needed
Phenytoin or other anticonvulsant
Corticosteroids to reduce meningeal
irritation
Phenobarbital or another sedative to relax
the patient
Nimodipine, a calcium channel blocker, to
decrease cerebral vessel vasospasm
Prevent any activities that initiate valsalva
maneuver (straining at stool, coughing)
 Surgical
Management

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To reduce the risk of vasospasm, rebleeding,
and cerebral infarction, the physician may
attempt to repair the aneurysm

The goal of surgery is to

prevent bleeding in an unruptured
aneurysm or further bleeding in an
already ruptured aneurysm.
Craniotomy. Surgical evacuation is
most frequently accomplished via a
craniotomy.
 Endovascular coiling. Goal is to seal
off aneurysm and stop further blood
from entering the aneurysm and
prevents risk for rupture and rebleeding

Usually, surgical repair (by surgical clipping &

ligating)
After surgical repair, the patients condition
depends on the extent of damage from the
initial bleeding and the degree of success in
treating the resulting complications.
 Surgery cant improve the patients
neurologic condition unless it removes
a hematoma or reduces the
compression effect.
 Nursing
Management

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During initial treatment after
hemorrhage:
Maintain a patent airway because the patient may
need supplementary oxygen.
Position the patient to promote pulmonary drainage
and prevent upper airway obstruction.
Suction the airway as needed to remove secretions
and to prevent hypoxia and vasodilation from
carbon dioxide accumulation. Suction in less than 15
seconds to avoid increased ICP.
Provide frequent nose and mouth care as tolerated
If surgery is delayed:
Impose aneurysm precautions to minimize the risk of
rebleeding and to avoid increased ICP. Such
precautions include bed rest in a dark, quiet room
(with head of the bed flat or elevated less than 30
degrees as ordered); limited visitors; avoidance of such
stimulants as coffee; avoidance of Valsalva's maneuver
and other strenuous activity; and restricted fluid
intake.
If surgery is delayed:
Watch for these danger signs of an enlarging
aneurysm, rebleeding, intracranial clot, vasospasm,
increases ICP or other complications:
decreased LOC,
unilateral enlarged pupil,
onset or worsening of hemiparesis or motor deficit, increased
blood pressure,
slowed pulse rate
worsening or sudden onset of a headache,
renewed or persistent vomiting,
For preoperative and postoperative
interventions and conservative
treatment:
Provide emotional support to the patient and her
family. To minimize stress, encourage the patient to
use relaxation techniques.
Turn the patient often. Encourage deep breathing
and leg movement. Assist with active range-of-
motion (ROM) exercises; if the patient is paralyzed,
perform passive ROM exercises.
For preoperative and postoperative
interventions and conservative
treatment:
Monitor arterial blood gas levels, LOC, and vital signs
often, and accurately measure intake and output.
Avoid taking temperature rectally because vagus
nerve stimulation may cause cardiac arrest.
Give fluids as ordered, and monitor I.V. infusions.
Maintain fluid volume to decrease risk of
vasospasm.
For preoperative and postoperative
interventions and conservative
treatment:
If the patient can eat, provide a high-fiber diet
(including such foods as bran, salads, and fruit) to
prevent straining during defecation, which can
increase ICP. Obtain an order for a stool softener or
a mild laxative, and administer it as ordered.
Implement a bowel elimination program based on
previous habits
For preoperative and postoperative
interventions and conservative
treatment:
If appropriate, perform postoperative craniotomy
care:
Inspect the patients head dressing for bleeding and
CSF drainage; position the patient so that the neck is
in a straight line to prevent interference with cerebral
drainage by neck flexion; monitor ICP as ordered; and
maintain adequate respiratory function and brain
oxygenation using supplementary oxygen and
mechanical ventilation as ordered.
For preoperative and postoperative
interventions and conservative
treatment:
Teach the patient and family about the condition.
Encourage her family to adopt a realistic attitude,
but don't discourage hope. Answer questions
honestly.
Explain all tests, neurologic examinations,
treatments, and procedures to the patient and
family
For preoperative and postoperative
interventions and conservative
treatment:
If surgery is to be performed, provide preoperative
teaching if the patients condition permits. Be sure
the patient, if possible, and family understand the
surgery and its possible complications. Reinforce the
physicians explanations as necessary.
For preoperative and postoperative
interventions and conservative
treatment:
If surgery is to be performed, provide preoperative
teaching if the patients condition permits. Be sure
the patient, if possible, and family understand the
surgery and its possible complications. Reinforce the
physicians explanations as necessary.
For preoperative and postoperative
interventions and conservative
treatment:
Before discharge, make a referral to a home health
care nurse or a rehabilitation center when
necessary.
Teach family members to recognize and
immediately report signs of rebleeding, such as
headache, nausea, vomiting, and changes in LOC
(irritability, restlessness).
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