Cerebral aneurysm is a fatal disease, cerebral aneurysm nursing care should be managed well. Cerebral aneurysm occurs local dilataton in cerebral artery that is caused by arterial wall weakening. Most of patient with subarachnoid hemorrhage come to death immediately.
Cerebral aneurysm is a local dilataton in cerebral artery. It might be caused by arterial wall weakening. The cerebral aneurysm is like berry or it called sirculer aneurysm. Cerebral aneurysm appears in Willis circle, it is an anastomosis that forms mayor cerebral artery in brain basis.
Cerebral aneurysm often becomes rupture and subarachnoid hemorrhage will occurred. Most of patient with subarachnoid hemorrhage will face death immediately.
- Congenital deformity combination and degenerative progress
- Congenital deformity like weaken artery wall
- Degenerative proses like hypertension and atherosclerosis.
Sign and Symptoms
- Bleeding in cerebral tissue and the symptoms makes hemiparesis, dysphagia, and visual defect
- Bleeding that make nuchal rigidity, pain especially in back and leg, fever, anxious, irritability, blurry vision.
- Complication that may occur are high intracranial pressure, recurrent of bleeding, vasospasm, acute hydrocephalus which is caused by cerebral fluid accumulation in cerebral cavity because of blood blocked the cerebral fluid flow or adhesion, pulmonary emboli as an effects of deep vein thrombosis or aneurysm treatment.
- Cerebral aneurysm has some signals that we should aware of:
- Consciousness level decrease
- Unilateral pupil dilatation
- Hemiparesis attack or motoric deficits
- High blood pressure
- Slow and weak pulse
- Severe headache
- Nuchal rigidity
- Excessive vomits
- Intermittent signs like agitation, weakness of lower extremity, language deficit, intracranial pressure increase.
- If the aneurysm closes with carotid arhtery, diplopia, ptosis, pupil dilatation, and cannot move the eye ball
- Rupture of aneurysm can cause severe headache, vomit and nausea, and lele of consciousness changes like coma.
Cerebral Aneurysm Degree
The cerebral aneurysm degreee is depend on location and bleeding. The patient with aneurysm rupture can be devided into 5 degrees:
Diagnostic examination is one of the most important part of cerebral aneurysm nursing care. In a diagnosis examination, doctors may prescribe and perform treatment which is as a collaboration. Some of the diagnosis examination are as follows:
- Computed tomography (CT) scan shows subarachnoid or ventricular bleeding
- Magnetic resonance imaging or magnetic resonant angiography can identify cerebral aneurysm as flow void or with computer reconstruction in cerebral vessels.
- Cerebral angiography ensures aneurysm location and identifies the vessels condition
- Lumbar puncture for blood in cerebral fluid identification while CT scan result in normal condition. But, this lumbar puncture should not be done if there is intracranial pressure changes.
- First aids of cerebral aneurysm are oxygenation and ventilation
- Amelioration by surgery to tied up aneurysm with muscle. Surgery is an emergency treatment that still need patient’s inform consent after first bleeding
- If the bleeding correction is risky, aneurysm location in risky locations, or vasospasm condition that needs to delay surgery. The treatment for these circumstances are:
- Bed rest with therapeutic environment
- Avoid coffee and other stimulant and aspirin
- Codein prescription or other analgesic is needed to reduce the headache or pain
- Avoid constipation, suppository will be needed to help patient’s defecation
- Anti-hypertension or hydralazine if patient has hypertension signs
- Nimodipine, Calsium blocker to reduce vasospasm of cerebral vessels
- Reduce the edema with corticosteroid
- Phenytoin or anti-convulsion
- Aminocaproic like fibrinolysis inhibitor to minimize recurrent bleeding
Cerebral Aneurysm Nursing Care
In cerebral aneurysm nursing care, the nursing care is challenging. It is because the cerebral aneurysm need immediate treatment to prevent mortality. So nurses role here to prevent the patient’s condition worse. Some of the cerebral aneurysm nursing care will be explained as follows:
- Early nursing care for hemorrhage are open the airway because the patient will need more oxygen. Regulate the patient’s position to help pulmonary drainage and reduce obstruction of airway. If the patient used intubation , pre-oxygenation with 100% oxygen before sucking the secret in patient’s airway will prevent hypoxia and vasodilatation caused by carbon dioxide accumulation
- Do every prevention that is needed to minimize bleeding and intracranial pressure changes. Those preventions are bed rest with quiete and dark environment (make sure the bed position is about 30 degree high), limit the guest for patient, avoid caffeine in the menu, avoid other stimulant and physical activity, include limit the fluid intake. Inform the patient and family about those prevention.
- Change the patient’s position if there are no intracranial pressure changes. Ask the patient to do deep breath and range of motion, if patient has a paralysis, do ROM routinely.
- Monitor analysis blood gas result, LOC, and vital signs. Accurately measure the balance of intake and output. Do not measure the temperature in rectal, because it will stimulate the heart attacks
- Give right fluid and monitor the infusion to prevent intracranial changes
- Aware of dysphagia symptoms like hard to swallow, hiccup, cough, secretion in respiratory system, slow in swallowing process, and cranial nerves dysfunction (V,VII,IX,X, or XII)
- Evaluate the patient’s speaking ability and recommend maximal protection during eating like regulate the position, food consistency, and the swallowing strategy. If patient has high risk of aspiration, then use nasogastric to provide nutrition
- If patient can eat well, give high bulk diet to prevent constipation and intracranial pressure changes. Give patient mild laxative; do not increase the fluid to prevent constipation. Do special program for patient. If patient is prescribed steroid, check the blood in patient’s feces.
- If patient has cranial nerve III (eyelid cannot be closed), V (sensation), or VII (for tears secretion), give the patient artificial tear secretion or ophthalmic ointment to prevent cornea damage. Occlusive eye protection from steel can be given
- Use anti-embolism trouser to prevent DVT (Deep Vein Thrombosis)
- If patient difficult to speak, make a simple alternative communication like using cards, boards, or something like that. Try to speak about the topic that does not make the patient feel frustrating. Suggest the family to speak with normal rhythm even the patient cannot respond well.
- Give patient an emotional support and involve the family in nursing care.
- Before patient is permitted to go home, suggest the patient to see nurse or rehabilitation center, and teach the family to understand the recurrent bleeding that may occurs after.