Bed rest and initiation of aneurysm precautions are important measures to prevent complications in the patient with a SAH. The purpose of aneurysm precautions is to prevent elevations in blood pressure, which could lead to rebleeding. Medical opinion about the strictness of aneurysm precautions has changed in the last decade. Previously, patients were placed on strict bed rest for weeks after a SAH. Current thinking is that extreme limitations that prohibit the patient from watching television, listening to the radio, reading, or having visitors, in fact adds to patient stress, thus increasing the risk of rebleeding rather than reducing it.
Strict aneurysm precautions can produce sensory deprivation, making it difficult to determine whether patient behavioral changes are due to sensory deprivation or to deterioration in the patient's neurological condition. Therapeutic interventions include providing the patient with a pleasant private quiet room, television, radio, reading material and visitations with persons who have a calming influence. It is extremely important for the nurse to work with so that they understand and accept the need for a limited number of visitors and restrict visits to those individuals who will have a calming influence on the patient.
Typical Aneurysm Precautions
|Airway & Breathing||
SAH may result in serious neurological deficits, from difficulty swollowing to apnea. Anticipate the need for: suction, oxygen, intubation, ventilation.
Elevated ICP secondary
to SAH can:
|Neuro assessment||Level of consciousness, pupillary size - shape - reaction; motor function, cranial nerve deficits, nuchal rigidity, back pain. Immediately notify physician of status change.|
|Manage blood pressure||
of BP can dislodge the clot sealing the rupture. Rebleeding significantly
and mortality. Avoid vagal manuevers such as: coughing, sneezing, straining
at stool and exertion.
|Pain management PRN||
Pain initiates a sympathetic response which can increase BP and heart rate.
|Provide comfortable calming environment||
Assess patient tolerance
|Anticipate seizure activity||
for seizure activity
|Anticipate cerebral vasospasm||
within 14 days of bleed. *Administer
Nimodipine per order.
SAH patients with a headache should be not be given analgesics.