Cerebral Aneurysm Nursing Diagnosis & Care Plan

A cerebral aneurysm, also known as an intracranial or brain aneurysm, is a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood.

This bulge can put pressure on a nerve or surrounding brain tissue, and it may leak or rupture, causing bleeding into the brain (hemorrhagic stroke).

Causes (Related to)

Cerebral aneurysms can result from various factors that affect the integrity of the blood vessel walls. Common causes include:

• Congenital defects in arterial walls
• Hypertension
• Atherosclerosis
• Trauma to the head
• Smoking
• Excessive alcohol consumption
• Drug abuse, particularly cocaine
• Genetic disorders (e.g., polycystic kidney disease, Ehlers-Danlos syndrome)
• Family history of aneurysms
• Age (more common in adults 30-60 years old)
• Gender (more common in women)

Signs and Symptoms (As evidenced by)

The signs and symptoms of a cerebral aneurysm can vary depending on whether it has ruptured or not. Patients may present with the following:

Subjective: (Patient reports)

• Severe headache (often described as the “worst headache of my life”)
• Nausea and vomiting
• Neck pain or stiffness
• Sensitivity to light (photophobia)
• Blurred or double vision
• Confusion
• Loss of consciousness

Objective: (Nurse assesses)

• Altered level of consciousness
• Seizures
• Weakness or paralysis on one side of the body
• Dilated pupils
• Drooping eyelid (ptosis)
• Speech difficulties
• Balance problems
• Increased blood pressure
• Fever
• Abnormal eye movements
• Cranial nerve deficits

Expected Outcomes

The following are common nursing care planning goals and expected outcomes for patients with cerebral aneurysms:

• The patient will maintain a stable neurological status
• The patient will demonstrate an improved level of consciousness
• The patient will report decreased pain and headache intensity
• The patient will maintain adequate cerebral perfusion
• The patient will show no signs of increased intracranial pressure
• The patient will demonstrate improved mobility and functional status
• The patient will verbalize understanding of the condition and treatment plan
• The patient will adhere to the prescribed medication regimen
• Patient and family will demonstrate coping skills and emotional stability

Nursing Assessment

1. Perform frequent neurological assessments
   Monitor the patient’s level of consciousness, pupillary reactions, motor strength, and sensory function. Use the Glasgow Coma Scale (GCS) to assess and document changes in neurological status.
2. Assess vital signs
   Monitor blood pressure, heart rate, respiratory rate, and temperature. Sudden changes in vital signs may indicate complications or deterioration in the patient’s condition.
3. Evaluate pain levels
   Assess the patient’s pain using a standardized pain scale. Note the characteristics, location, and intensity of the headache or other pain reported by the patient.
4. Monitor for signs of increased intracranial pressure (ICP)
   Look for signs such as decreased level of consciousness, pupillary changes, projectile vomiting, and Cushing’s triad (increased systolic blood pressure, widened pulse pressure, and bradycardia).
5. Assess for symptoms of vasospasm.
   Monitor for new onset of neurological deficits, which may indicate cerebral vasospasm, a common complication of aneurysmal subarachnoid hemorrhage.
6. Evaluate cognitive function
   Assess the patient’s orientation, memory, and ability to follow commands. Note any changes in speech or language comprehension.
7. Assess mobility and functional status.
   Evaluate the patient’s ability to perform activities of daily living and any limitations in mobility or strength.
8. Monitor fluid and electrolyte balance.
   Assess for signs of dehydration or fluid overload. Monitor serum electrolyte levels, particularly sodium, as hyponatremia is common in patients with subarachnoid hemorrhage.
9. Assess for psychological distress.
   Evaluate the patient and family for signs of anxiety, depression, or difficulty coping with the diagnosis and treatment.

Nursing Interventions

1. Maintain neurological monitoring
   Perform regular neurological checks as per hospital protocol. Report any significant changes in the patient’s neurological status to the healthcare provider immediately.
2. Manage pain and headache.
   Administer prescribed analgesics and monitor their effectiveness. Implement non-pharmacological pain management techniques such as positioning and relaxation techniques.
3. Promote adequate cerebral perfusion.
   Maintain the patient’s head in a neutral position, with the head of the bed elevated 30-45 degrees. Avoid activities that may increase intracranial pressure, such as straining or Valsalva maneuver.
4. Implement seizure precautions
   Ensure a safe environment for the patient. Have seizure management medications readily available as ordered.
5. Administer medications as prescribed.
   This may include antihypertensives, anticonvulsants, calcium channel blockers (for vasospasm prevention), and osmotic diuretics (for ICP management).
6. Monitor and manage fluid and electrolyte balance.
   Administer intravenous fluids as ordered. Monitor intake and output. Report significant imbalances to the healthcare provider.
7. Provide emotional support and education.
   Provide emotional support to the patient and family. Educate them about the condition, treatment options, and expected outcomes.
8. Implement fall prevention measures.
   Assess the patient’s fall risk and implement appropriate fall prevention strategies.
9. Assist with mobility and activities of daily living
   Encourage early mobilization as appropriate. Assist the patient with activities of daily living as needed, promoting independence when possible.
10. Prepare for and assist with procedures.
    Prepare the patient for diagnostic tests or interventions such as angiography or surgical procedures. Provide post-procedure care and monitoring.

Nursing Care Plans

Care Plan #1

Nursing Diagnosis Statement: Risk for Ineffective Cerebral Tissue Perfusion related to cerebral aneurysm and potential for vasospasm.

Related factors/causes:

• Presence of cerebral aneurysm
• Risk of aneurysm rupture
• Potential for cerebral vasospasm

Nursing Interventions and Rationales:

1. Perform neurological assessments every 1-2 hours or as per hospital protocol.
   Rationale: Frequent monitoring allows for early detection of changes in neurological status that may indicate decreased cerebral perfusion.
2. Maintain head of bed elevation at 30-45 degrees unless contraindicated.
   Rationale: This position helps to promote venous drainage and reduce intracranial pressure, optimizing cerebral blood flow.
3. Administer prescribed medications (e.g., nimodipine) as ordered.
   Rationale: Calcium channel blockers like nimodipine can help prevent and treat cerebral vasospasm.
4. Monitor and maintain systolic blood pressure within the prescribed range.
   Rationale: Proper blood pressure management is crucial for maintaining adequate cerebral perfusion without increasing the risk of aneurysm rupture.
5. Educate the patient and family about the signs and symptoms of decreased cerebral perfusion to report immediately.
   Rationale: Early recognition and reporting of symptoms can lead to prompt intervention and improved outcomes.

Desired Outcomes:

• The patient will maintain a stable neurological status as evidenced by consistent Glasgow Coma Scale scores.
• The patient will demonstrate adequate cerebral perfusion as evidenced by the absence of new neurological deficits.
• The patient will verbalize understanding of the importance of reporting changes in neurological status promptly.

Care Plan #2

Nursing Diagnosis Statement: Acute Pain related to cerebral aneurysm and increased intracranial pressure as evidenced by the patient’s report of severe headache and facial grimacing.

Related factors/causes:

• Cerebral aneurysm
• Increased intracranial pressure
• Meningeal irritation from subarachnoid hemorrhage

Nursing Interventions and Rationales:

1. Assess pain characteristics, intensity, and location using a standardized pain scale every 2-4 hours and as needed.
   Rationale: Regular pain assessment helps evaluate the effectiveness of pain management strategies and detect changes in the patient’s condition.
2. Administer analgesics as prescribed and evaluate their effectiveness.
   Rationale: Proper pain management is crucial for patient comfort and can help prevent increased intracranial pressure associated with severe pain.
3. Implement non-pharmacological pain relief measures such as providing a quiet environment, minimizing stimuli, and using relaxation techniques.
   Rationale: These interventions can complement pharmacological pain management and help reduce the patient’s pain perception.
4. Monitor for signs of increased intracranial pressure (e.g., decreased level of consciousness, pupillary changes) during pain episodes.
   Rationale: Severe pain can potentially increase intracranial pressure, worsening the patient’s condition.
5. Educate the patient and family about pain management strategies and the importance of reporting uncontrolled pain.
   Rationale: Patient and family education promotes active participation in pain management and ensures timely intervention for uncontrolled pain.

Desired Outcomes:

• Within 2 hours of intervention, the patient will report pain intensity at a level of 3 or less on a 0-10 scale.
• The patient will demonstrate the use of non-pharmacological pain relief techniques.
• The patient will maintain stable neurological status during pain management interventions.

Care Plan #3

Nursing Diagnosis Statement: Risk for Impaired Physical Mobility related to neurological deficits secondary to cerebral aneurysm.

Related factors/causes:

• Weakness or paralysis associated with aneurysm location
• Cognitive impairment
• Fear of falling or exertion
• Post-operative restrictions

Nursing Interventions and Rationales:

1. Assess the patient’s level of mobility and strength every shift.
   Rationale: Regular assessment helps track progress and identify areas requiring intervention.
2. Implement a progressive mobility plan in collaboration with physical therapy.
   Rationale: Early and progressive mobilization can help prevent complications associated with immobility and promote functional recovery.
3. Assist the patient with a range of motion exercises as tolerated.
   Rationale: These exercises help maintain joint flexibility and prevent muscle atrophy.
4. Educate the patient and family about safe mobility techniques and using assistive devices if necessary.
   Rationale: Proper education promotes safe mobility and reduces the risk of falls or injury.
5. Encourage the patient to participate in self-care activities, assisting as needed.
   Rationale: Promoting independence in activities of daily living can improve the patient’s confidence and functional status.

Desired Outcomes:

• The patient will demonstrate improved mobility and strength as evidenced by increased participation in daily activities.
• The patient will verbalize understanding of safe mobility techniques and use assistive devices correctly when needed.
• The patient will not experience falls or injuries related to mobility.

Care Plan #4

Nursing Diagnosis Statement: Anxiety related to diagnosis of cerebral aneurysm and uncertain prognosis as evidenced by expressed worry and restlessness.

Related factors/causes:

• Life-threatening condition
• Uncertainty about treatment outcomes
• Fear of disability or death
• Disruption in lifestyle and family roles

Nursing Interventions and Rationales:

1. Assess the patient’s level of anxiety and coping mechanisms regularly.
   Rationale: Regular assessment helps identify the patient’s emotional needs and evaluate the effectiveness of interventions.
2. Provide concise information about the patient’s condition, treatment plan, and prognosis.
   Rationale: Accurate information can help reduce anxiety associated with uncertainty and misconceptions.
3. Teach relaxation techniques such as deep breathing exercises and guided imagery.
   Rationale: These techniques can help reduce anxiety and promote a sense of control.
4. Encourage the patient to express feelings and concerns and provide active listening.
   Rationale: Emotional support and validation of feelings can help reduce anxiety and improve coping.
5. With the patient’s consent, family members should be involved in care and decision-making as appropriate.
   Rationale: Family support can provide comfort and reduce anxiety for the patient.

Desired Outcomes:

• The patient will report decreased anxiety levels as measured on a standardized anxiety scale within 48 hours.
• The patient will demonstrate the use of at least one relaxation technique to manage anxiety.
• The patient and family will verbalize understanding of the condition and treatment plan.

Care Plan #5

Nursing Diagnosis Statement: Risk for Ineffective Family Coping related to sudden onset of life-threatening condition and changes in family dynamics.

Related factors/causes:

• Sudden and severe nature of cerebral aneurysm diagnosis
• Uncertainty about the patient’s prognosis and potential for long-term disability
• Financial concerns related to treatment and potential long-term care needs
• Role changes within the family unit

Nursing Interventions and Rationales:

1. Assess the family’s understanding of the patient’s condition and their coping mechanisms.
   Rationale: Understanding the family’s perspective helps provide targeted support and education.
2. Provide clear, honest information about the patient’s condition, treatment, and prognosis.
   Rationale: Accurate information helps the family make informed decisions and reduces anxiety associated with uncertainty.
3. Encourage family participation in care activities as appropriate.
   Rationale: Involvement in care can help family members feel helpful and maintain a sense of connection with the patient.
4. Refer the family to support services such as social work, chaplaincy, or support groups.
   Rationale: Professional support services can provide additional resources and coping strategies for the family.
5. Teach stress management techniques and encourage self-care among family members.
   Rationale: Helping family members manage their stress improves their ability to support the patient and each other.

Desired Outcomes:

• Family members will verbalize understanding of the patient’s condition and treatment plan.
• The family will demonstrate positive coping strategies and stress management techniques.
• The family will report feeling supported and involved in the patient’s care.

References

1. American Association of Neurological Surgeons. (2023). Cerebral Aneurysm. Retrieved from https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Cerebral-Aneurysm
2. Boogaarts, H. D., et al. (2014). Aneurysmal Subarachnoid Hemorrhage: Long-Term Outcomes and Management. Journal of Neurosurgery, 121(2), 405-412.
3. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care. F.A. Davis Company.
4. Greenberg, M. S. (2019). Handbook of Neurosurgery (9th ed.). Thieme.
5. Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th ed.). Wolters Kluwer.
6. National Institute of Neurological Disorders and Stroke. (2023). Cerebral Aneurysms Fact Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Cerebral-Aneurysms-Fact-Sheet
7. Thompson, B. G., et al. (2015). Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 46(8), 2368-2400.
8. World Federation of Neurosurgical Societies. (2021). WFNS Grading System for Subarachnoid Hemorrhage. Retrieved from https://www.wfns.org/WFNSGrading