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Cerebral aneurysm
pn 141 test 2 book:burke pg 931
| Question | Answer |
|---|---|
| what is it | an abnormal outpouching or diation of a cerebral artery. It occurs at the point where the arterial wall is weakest |
| what is the weakness in the wall related to | atherosclerosis, HTN, congential defects |
| where in the cerebrum do they usually develop | in the circle of Willis |
| what are the four different types of them | berry, saccular, fusiform, dissecting |
| what is a berry aneurysm | a small sac on a stem or stalk |
| what is a saccular aneurysm | formed from distended small portion of the vessel wall |
| what is a fusiform aneurysm | an enlarged area of the entire blood vessel |
| what is a dissescting aneurysm | formed when blood fills the area between the tunica media and tunica intima |
| a rupture of a cerebral aneurysm is the most common cause of what type of CVA | a hemorrhagic CVA |
| at first, what happens to the weakened portion of the artery | it enlarges and presses on nearby cranial neves |
| when is it symptomatic | is it affects cranial nerve function |
| is it usually symptomatic or asymptomatc | asympotomatic |
| what may person c/o of | HA, N/V, pain in the back and neck |
| if the client has s/s b/c of a slow leak, when could they become asymptomatic again | if the clot spontaniously seals itself w/ a clot |
| where does the blood go when it ruptures | into the subarachnoid space at teh base of the brain |
| def of subarachnoid hemorrhage | bleeding into the subachnoid space of teh brain, it can cause meningeal irritation |
| subarachnoid hemorrhage: manis | sudden explosive HA, stiff neck (nuchal rigidity), change in LOC, photophobia, N/V, cranial nerve deficits |
| subarachnoid hemorrhage: major complications | rebleeding and vasospasm |
| subarachnoid hemorrhage: when can rebleeding occur after hemorrhage (time frame) | w/ in first 48 hours and later in 7-10 days |
| when does a cerebral vasospasm occur | when one or more cerebral arteries narrow leading to ischemia and infarction |
| does it have a high mortality rate | yes |
| how is it DX | by CT scan, angiography, lumbar puncture, |
| Diagnostic tests: what does a ct scan show | the location and size of the aneurysm |
| Diagnostic tests: what does a cerebral angiograpy reveal | it views the cerebral arteries, locates the aneurysm, and identifies a vasospasm |
| Diagnostic tests: what does a lumbar puncture confirm | if blood is in the CSF it confirms a cubarachnoid hemorrhage |
| meds: aminocaproic (amicar)- what does it do | prevents clot from being destroyed |
| meds: what does a calcium channel blocker do | it decreases vasospasms |
| meds: why is an anticonvulsants given | to prevent seizures |
| meds: why are stool softeners given | to prevent uneccessary straining that can increase IICP |
| meds: what is acetaminophen or codeine used for | pain relief |
| what is the tx of choice | surgery |
| Tx- surgery: when should it be done | asap (a soon as pt condition is stable) |
| Tx- surgery: what is done is surgery | the skull is opened and either a metal clip is placed at neck of aneurysm or the aneurysm is wrapped w/ synthetic material |
| nursing care | neuro checks, taking BP, P, RR, |
| Tx- surgery: post op precautions to prevent ICP and risk of rebleeding | place pt in quiet dark room, limit visitors to two family members at any one time, elevate HOB to 15-30 degrees, keep on complete bedrest, avoid activities that increase ICP |
| what activites increase ICP | coughing, sneezing, straining, blowing the nose, moving self up in bed, smoking |
| discharge teaching is similar to what other issue | a CVA |
| why are there no s/s | b/c it happens over time |
| what are s/s of a slow leek | HA, N/V, neck pain, s/s will come and go b/c it can be spontaneously sealed with a clot |
| s/s of a rupture | sudden, severe Ha, nuchal rigidity, change in LOC, drowsiness, photophobia, N/V, cranial nerve deficits |
| what is the prognosis with the rupture | poor |
| ways to prevent rebleed until surgery | no stimulation, bed rest, no coughing, no moving, BP meds, nothing to increase ICP, straining, complete bedrest, HOB up 15-30 degrees |
| when is surgery done | Tx choice when stable, option if aneurysm present |
| what meds should be held | ASA |
| why are osmotic diuretics given | to decreased ICP |
| why are calcium channel blockers given | they decrease vasospasms |
| why are anticonvulsants given | to prevent seizures |
| why are stool softeners given | to prevent straining |
| Nx Dx: ineffective tissue perfusion cerebral: nursing consideration | monitor for ICP, change of LOC, weakness, vision changes, elevated BP |
| Nx Dx: why is there a risk for ineffective airway clearance; what should be monitored | b/c of caroitid surgery; RR, provide oxygen, side lying (for aspiration) |
| Nx Dx: imparied verbal considerations- what are some nursing considerations | face client, speak clear/slow, don't raise voice, honest if not understanding, Yes/ no questions, gestures, blinking, nodding, cue cards |
| Nx Dx: disturbed sensory- what are some nursing considerations | approach unaffected side, teach to look around, encourage handling affected side |
| Nx Dx: imparied B&B- what are some nursing considerations | toilet q 2 hours, adequate fluids and fiber, stool softeners, increased physical activity |
| Nx Dx: imparied swallowing- what are some nursing considerations | upright, tilt head forward, oral care AC and PC, thickened and pureed, small bites to uneffected side |
| s/s of aspiration | red face, tears in eyes, coughing |
| what is the goal with rehab nrusing | foster independance, give adequate time for tasks, restore, prevent worsening |
| prevention | BP meds,DM <126, HTN (Ace andarbs), cholesterol LDL <100, wt, activity level, smoking |
Created by:
jmkettel
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