Alteration in tissue perfusion (cerebral) related to interruption in cerebral blood flow or increased ICP
OUTCOMES. Circulation status; Cognitive ability; Neurological status; Tissue perfusion: Peripheral; Communication: Expressive ability; Communication: Receptive ability
INTERVENTIONS. Cerebral perfusion promotion; Circulatory care; Intracranial pressure monitoring; Neurological monitoring; Peripheral sensation management; Circulatory precautions; Hypovolemia management; Vital signs monitoring; Emergency care; Medication management
The first priority is to evaluate and support airway, breathing, and circulation. For patients unable to maintain these functions independently, assist with endotracheal intubation, ventilation, and oxygenation, as prescribed. Monitor neurological status carefully every hour, and immediately notify the physician of any changes in the patient's condition.
Surgery is indicated to prevent rupture or rebleeding of the cerebral artery. The decision to operate depends on the clinical status of the patient, including the level of consciousness and severity of neurological dysfunction, the accessibility of the aneurysm to surgical intervention, and the presence of vasospasm. Surgical procedures used to treat cerebral aneurysms include direct clipping or ligation of the neck of the aneurysm to enable circulation to bypass the pathology. An inoperable cerebral aneurysm may be reinforced by applying to the aneurysmal sac such materials as acrylic resins or other plastics. Postoperatively, monitor the patient closely for signs and symptoms of increasing ICP or bleeding, such as headache, unequal pupils or pupil enlargement, onset or worsening of sensory or motor deficits, or speech alterations.
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