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Cerebral Aneurysm & Subarachnoid Hemorrhage

Cerebral Aneurysm & Subarachnoid Hemorrhage. Rita C arey- N ita. Cerebral Aneurysm . Cerebral aneurysm is a weakness in the wall of a cerebral artery Can be cogenital —trauma—result of disease When ruptured a subrarachnoid hemorrhage results

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Cerebral Aneurysm & Subarachnoid Hemorrhage

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  1. Cerebral Aneurysm & Subarachnoid Hemorrhage Rita Carey-Nita

  2. Cerebral Aneurysm Cerebral aneurysm is a weakness in the wall of a cerebral artery • Can be cogenital—trauma—result of disease • When ruptured a subrarachnoid hemorrhage results • Person is unsymptomatic with unruptured aneurysm unless large • Often affect young healthy individuals Pathophysiology • Can affect any cerebral artery but 80% occur in the circle of Willis in an area of bifurcation • Turbulence is believed to create the outpouching of the cogenitally weak artery Rupture occurs at any given time • During strenuous activity or sexual activity or when quiet & inactive

  3. Subarachnoid Hemorrhage Subarachnoid hemorrhage is the collection of blood beneath the arachnoid mater following an aneurysm rupture • Other causes include head trauma & rupture of AV malformation • Presence of blood outside vessel irritates the brain tissue leading to vasospasm

  4. Signs & Symptoms • Small hemorrhage • Mild headache • Vomiting • Disorientation • Rupture of aneurysm • Sudden severe headache • Hold head • Crying • Photophobia • Decrease in LOC as increase in ICP • Seizure • Nuchal rigidity • Enlarged pupil • Abnormal gaze • Motor dysfunction

  5. Diagnostic tests • CT scan • Identifies presence & location • Cerebral angiogram • More precise

  6. Therapeutic Interventions • ICU • Arterial line & Central venous pressure • For careful monitor of BP • Parameters SBP between 120-160mmHg • Vasoactive medication Surgical treatment • Craniotomy to expose aneurysm • If neck may clamp • If no neck wrap with sterile plastic or muslin • May clamp artery on either side removing that portion from circulation Nonsurgical treatment • If inoperable insertion of metallic coil or fibrin with the intent of occluding the aneurysm without rupturing

  7. Complication Rebleeding • Rerupture before treatment has high morbidity & mortality Hydrocephalus • Blood enter the ventricular system affecting the circulation and reabsorption of CSF • May treat with external ventricular drain • 25% require ventriculoperitoneal shunt Vasospasm • Narrowing of blood vessel diameter causing ischemia

  8. Assess neurological status • Any decrease in LOC • Irritability—restlessness—dizziness—syncope—visual changes—pupillary changes—aphasia • Paralysis—parethesias—seizures • Assess respiratory status • Lung sounds • Oxygen saturation • Airway • Cough • Respirations • Dyspnea • Assess for dysphagia • Assess for skin integrity

  9. Review the care plan on pages 1119-1123 Take note of Nursing Diagnoses and Implementations

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