Preoperative Nursing Care for a Patient with Cerebral Artery Aneurysm Rupture

1. Preoperative Nursing Care for a Patient with Cerebral Artery Aneurysm Rupture Ljubov Kinner North Estonian Medical Centre Foundation, Estonia Mentor: Eha Hõrrak, MA Tallinn Health Care College, Estonia

2. The aim of the current presentation is to describe the preoperative nursing care for a patient with cerebral artery aneurysm rupture. • The aim of the literature review was focused on the fact that cerebral aneurysm occurs 3% to 5% of the general population.

3. Statistics • The cause of subarachnoid haemorrhage is a rupture of an intracranial aneurysm in 75-80% of the cases. • Spontaneous subarachnoid haemorrhage causes immediate death in about 12-15% of the cases (Hedlund et al. 2007: 404). • The incidence of aneurysmal rupture is more common in women than in men by a ratio of 3:2 and increases with aging (Yamamoto et al. 2005:174).

4. Statistics • In the North Estonian Medical Centre Foundation in neurosurgery unit 60 subarachnoid haemorrhage cases and 5 unruptured aneurysm cases were recorded in 2008. • In 2009, 65 subarachnoid haemorrhage cases and 11 unruptured aneurysm cases were recorded.

5. An intracranial aneurysm is defined as abnormal saccular outpouching or dilatation of intracranial artery. If the aneurysm bleeds, it is classified as a ruptured intracranial aneurysm, also known as a subarachnoid haemorrhage.

6. Nursing problems of a preoperative patient with ruptured cerebral artery aneurysm • headaches, low back pain, stiff neck, nausea, vomiting, cloudiness of consciousness, photophobia, seizures which can cause injury, numbness or decreased sensitivity of the body parts, speech disorder; • self care deficit and constipation due to limitations of the physical activity; • worry.

7. Preoperative nursing care (1) • providing a peaceful and secure environment, • providing information and its related risk factors and the nature of the cerebral artery aneurysm to patient and his/her relatives; • teaching and motivating apreoperative patient; • prevention of constipation and arterial blood pressure increase;

8. Preoperative nursing care (2) Endovascular therapy • monitoring of arterial blood pressure level, consciousness, body temperature maintenance, physical activity limitations, diet performance; • clarification of preoperative nursing principles and information about the operation nature, the possible surgery risks and the possible patient appearance changes. Surgical clipping

9. Experience • Based on the author´s own experience, it can be said that many pateints with cerebral aneurysm rupture have problems in memory abilities and perceptual speed.

10. Experience • To reduce anxiety, the information should be repeated to the patient several times. • It is an advantage if relatives and patients receive information concurrently, especially about the illness (Vogelsang et al. 2004: 557). • An important finding is that patients with cerebral aneurysm rupture have high level of anxiety. • Anxiety elevates the blood pressure, which increases the risk for bleeding (Smeltzer et al. 2008: 2228).