Cerebral Aneurysm

Cerebral Aneurysm Nursing Diagnosis Interventions and Care Plans

Cerebral Aneurysm NCLEX Review Care Plans

Nursing Study Guide on Cerebral Aneurysm

Cerebral aneurysm, also called as brain aneurysm, is a bulge located on a weakened area of a blood vessel in the brain, which causes an abnormal ballooning.

The weakness of the arterial wall can often trigger an aneurysm to leak or rupture.

This can lead to hemorrhagic stroke or bleeding into the brain. It often arises in the space between the brain and its surrounding tissues resulting in a condition known as subarachnoid hemorrhage.

In most occasions, brain aneurysms don’t rupture and those who have this condition can be asymptomatic.

Detection of brain aneurysm is often due to diagnostics of another suspected disorder.

Signs and Symptoms of Cerebral Aneurysm

Unruptured brain aneurysm usually does not present symptoms, but if enlarged, it can press on nerves and brain tissues which can cause symptoms such as:

  • Pain localized above and behind on one eye
  • Dilatation of pupils
  • Blurred or double vision
  • Unilateral facial numbness or weakness

If an aneurysm is only leaking insignificant amount of blood or sentinel bleed.

It may cause a sudden and severe headache. Once the aneurysm ruptures, the expected symptoms are:

  • Sudden severe headache, often described as “the worst headache” the patient has experienced
  • Confusion
  • Nausea and vomiting
  • Blurred or double vision
  • Light sensitivity
  • Drooping of eyelids
  • Seizure
  • Loss of or change in consciousness

Causes and Risk Factors of Cerebral Aneurysm

Cerebral aneurysms discreetly develop on individuals who have weakened blood vessels.

Although the cause of cerebral aneurysm is still unknown, many experts believe that it can develop because of a genetic condition.

This weakness can result in the wear and tear of the blood vessel, leading to the development of a bulge or a balloon in the affected area which may leak or rupture resulting in cerebral bleeding.

A wide range of factors can predispose an individual into developing this condition. These can be present at the time of birth, or it can develop over time.

Conditions present at birth that present a high risk of developing cerebral aneurysm:

  • Family history of brain aneurysm- strong familial history involving first degree
  • relatives
  • Cerebral Arteriovenous Malformation- abnormal connection between arteries and veins
  • disrupting blood flow
  • Coarctation of the Aorta- a genetic condition which result in abnormal narrowing of
  • the aorta
  • Polycystic Kidney Disease- causes elevated blood pressure due to cysts in the kidneys
  • Inherited connective tissue disorders such as Ehlers-Danlos Syndrome

Other risk factors include:

  • Older age – more common in adults than children
  • Gender – women are more high risk compared to men
  • Hypertension
  • Cigarette smoking
  • Excessive Alcohol consumption
  • Drug use particularly cocaine
  • Infection- certain blood infection such as mycotic aneurysm
  • Severe head trauma

Complications of Cerebral Aneurysm

  1. Cell and Tissue Death. The bleeding from a ruptured cerebral aneurysm usually lasts for a few seconds, but it can result in a significant damage that may lead to the death of its surrounding cells.
  2. Hypoxemia. Cerebral aneurysm may also increase intracranial pressure that can disrupt the brain’s oxygen supply. The patient may experience loss of consciousness. This can lead to death.
  3. Other Cerebral disorders. Other complications may develop, such as narrowing or vasospasm of blood vessels in the brain, obstruction in the circulation of cerebrospinal fluid which can result in hydrocephalus, and depletion of sodium levels in the blood (hyponatremia) which can cause the brain to swell. A ruptured aneurysm also increases the likelihood of bleeding again, which can inflict permanent damage to the brain.

Diagnosis of Cerebral Aneurysm

When presenting symptoms are indicative of ruptured aneurysm, the following diagnostic tests will be performed to determine the presence of aneurysm:

  • Computerized Tomography (CT) Scan of the brain
  • Cerebrospinal fluid (CSF) Analysis
  • Magnetic Resonance Imaging (MRI)
  • Cerebral Angiogram or Cerebral Arteriogram- a more invasive procedure that
  • provides a detailed image of the arteries and aneurysm

Treatment of Cerebral Aneurysm

There are newer treatments for cerebral aneurysm, such as flow diverters that are being used for larger aneurysms.

However, there are two generally known surgical intervention for cerebral aneurysm.

Both of which can cause a potential risk for bleeding or loss of blood flow to the brain.

1.Surgical Clipping. This procedure is an open surgery that includes the removal of a portion of a skull to locate the aneurysm. Then, the neurosurgeon places a tiny metal clip on the neck of the aneurysm to impede its blood flow.

2.Endovascular Coiling. This is a safer and less invasive approach to seal an aneurysm. The surgeon inserts a catheter into the groin, carefully threading it to the aneurysm.

A soft platinum wire is then inserted and coiled inside the aneurysm to disrupt blood flow. It may increase the risk of repeating the procedure due to rebleeding. It can also be used in managing an unruptured cerebral aneurysm.

Aside from surgical management, medical management focused on alleviating symptoms and preventing complications is also used, this includes:

1. Medications to alleviate symptoms such as pain relievers for headache, calcium channel blockers to prevent vasospasm of the blood vessels, and anti-seizure drugs

2. Stroke prevention through the use of intravenous vasopressor to increase the blood pressure and angioplasty, a minimally invasive procedure to dilate narrow blood vessels

3. Ventriculoperitoneal shunting, a procedure used to treat hydrocephalus

4. Physical, Occupational and Speech Therapy

5. Lifestyle modification such as eating a healthy diet, exercising regularly, smoking cessation and avoiding prohibited drugs

Nursing Care Plans for Cerebral Aneurysm

Nursing Care Plan 1

Nursing Diagnosis: Ineffective Tissue Perfusion (Cerebral) related to increased intracranial pressure (ICP) secondary to cerebral aneurysm as evidenced by drowsiness, hallucinations, irritability, and memory problems

          Desired Outcome: The patient will maintain cerebral tissue perfusion as evidenced by increased level of consciousness (i.e. awake and alert) and will have an oriented with persons, places, and things.

InterventionsRationales
Assess the patient’s vital signs and neurological status at least every 4 hours, or more frequently if there is a change in them.To assist in creating an accurate diagnosis and monitor effectiveness of medical and surgical treatment for cerebral aneurysm.
Observe the patient for any signs and symptoms of increased ICP, such as sudden headache, vomiting, and decreased alertness.To facilitate early detection and management of increased ICP.
Increased ICP can be life-threatening as it may lead to brain damage, stroke, or coma.
Prepare the patient for the surgery as instructed by the surgeon.To remove the cerebral aneurysm, which is the underlying cause of the patient’s increased ICP.
Administer osmotic diuretics (e.g. Mannitol) as prescribed.To promote blood flow to the brain and to reduce cerebral edema.
Elevate the head of the bed at 30 degrees.To promote venous drainage from the patient’s head to the rest of the body in order to decrease ICP.

Nursing Care Plan 2

Nursing Diagnosis: Acute Pain related to pressure of enlarged aneurysm into the nerves, as evidenced by pain score of 10 out of 10 located above the eye, guarding sign on the head, restlessness, and irritability

Desired Outcome: The patient will report a pain score of 0 out of 10.

InterventionsRationales
Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10 and describe the pain he/she is experiencing.To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective.
Administer analgesics/ pain medications as prescribed.To provide pain relief to the patient.
Ask the patient to re-rate his/her acute pain 30 minutes to an hour after administering the analgesic.To assess the effectiveness of treatment.
Provide more analgesics at recommended/prescribed intervals.To promote pain relief and patient comfort without the risk of overdose.
Reposition the patient in his/her comfortable/preferred position. Encourage pursed lip breathing and deep breathing exercises.To promote optimal patient comfort and reduce anxiety/ restlessness.
Refer the patient to a pain specialist as required.To enable to patient to receive more information and specialized care in pain management if needed.

Nursing Care Plan 3

Nursing Diagnosis: Disturbed Sensory Perception related to pressure of enlarged aneurysm into the nerves, GCS 14, as evidenced by pain score of 10 out of 10 located above the eye, blurry vision, memory problems, and intermittent confusion

Desired Outcome: The patient will regain usual level of consciousness and perceptual functioning with GCS score of 15.  

InterventionsRationales
1. Assess the patient’s vital signs and sensory awareness, and monitor GCS.To create a baseline set of observations for the patient. The Glasgow Coma Scale is the gold standard for neurological assessment of a person’s level of consciousness.
2. Agree a simple method of communication with the patient, such as placing the call bell within reach, and using the phone to inform the healthcare workers of his/her needs and wants.To maintain proper communication between the patient and the healthcare team and ensure that needs are met and safety is maintained.
3. Remove any extraneous stimuli (such as very bright lighting or loud noises). Speak calmly and use short sentences when communicating. Leave the light on.To reduce stress levels and confusion.
Re-orient the patient to people, places, time, and important info about his/her current treatment.To eliminate confusion and gradually assist the patient to his/her normal level of consciousness.
Reposition the patient in his/her comfortable/preferred position. Encourage pursed lip breathing and deep breathing exercises.To promote optimal patient comfort and reduce anxiety/ restlessness.

Other nursing diagnoses:

  • Fatigue
  • Impaired Thought Processes
  • Activity Intolerance

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures. 

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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