Aneurysm precautions

Aneurysm Precautions

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.
Circulation	Elevated ICP secondary to SAH can: decrease cerebral perfusion cause bradycardia Elevate the head 30 - 60 degrees for venous return Monitor BP, Arterial, CVP Monitor ICP
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	Abrupt elevation of BP can dislodge the clot sealing the rupture. Rebleeding significantly increases morbidity and mortality. Avoid vagal manuevers such as: coughing, sneezing, straining at stool and exertion. Monitor BP Assist with position change Avoid rectal temperatures Sedation as ordered *Stool softeners
Pain management PRN	Pain initiates a sympathetic response which can increase BP and heart rate.
Provide comfortable calming environment	Assess patient tolerance of stimulation Explain importance of reducing tension Remove telephone Limit visitors Control lighting (photophobia)
Anticipate seizure activity	Monitor patient for seizure activity Explain importance of reporting symptoms Administer anticonvulsants per orders *Initiate seizure precautions
Anticipate cerebral vasospasm	Highest frequency within 14 days of bleed. Administer Nimodipine per order. Initiate Hyperdynamic orders
Review manufacturer's literature on Clazosentan, a novel endothelin A receptor antagonist, currently being studied for its ability to reduce cerebral vasospasm. http://www.actelion.com/uninet/www/www_main_p.nsf/Content/Development+Clazosentan

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SAH patients with a headache should be not be given analgesics.