Primary Nursing Diagnosis

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; ICP monitoring; Neurological monitoring; Peripheral sensation management; Circulatory precautions; Hypovolemia management; Vital signs monitoring; Emergency care; Medication management

H PLANNING AND IMPLEMENTATION Collaborative

Surgery is the treatment of choice for a cerebral aneurysm that has ruptured into the subarach-noid space. Until a decision about surgery is made, however, the management of the patient is focused on preventing secondary injury and relieving symptoms.

Monitor ICP to detect brain swelling and hydrocephalus. Maintain fluid volume within a normal range because dehydration increases hemoconcentration, which may increase the incidence of vasospasm. If cerebral edema is present, maintain moderate fluid restriction and administer prescribed steroids; dexamethasone (Decadron) and methylprednisolone (Solu-Medrol) are the drugs of choice. Steroid therapy is continued for at least 1 week postoperatively. Pharmacologic management is also used to control hypertension to prevent rebleeding. The goal of therapy is to maintain the systolic blood pressure at 150 mm Hg. Hypotension must be avoided at all costs because it worsens ischemic deficits. Assess the intravascular volume status with either a central venous access monitor or pulmonary artery catheter, depending on the patient's condition.

860 Subarachnoid Hemorrhage

Complications during the immediate postoperative period include brain swelling, bleeding at the operative site, fluid and electrolyte disturbances, hydrocephalus, and the onset of cerebral vasospasm. If an intracranial monitoring system is in place, report ICP rises over 15 mm Hg. Calculate the CPP, and maintain the CPP greater than 50 mm Hg.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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