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MEDICAL MANAGEMENT

IDEAL ACTUAL

Other treatments for ruptured brain aneurysms are aimed at


relieving symptoms and managing complications. Medications:
Pain relievers, such as acetaminophen (Tylenol, others), may
• Nicardipine(PO)
be used to treat headache pain.
Calcium channel blockers prevent calcium from entering cells • Levetiracetam(PO)500 mg 1tab; BID
of the blood vessel walls. These medications may lessen the • Mannitol(IVTT)
erratic narrowing of blood vessels (vasospasm) that may be a • Salbutamol ½ neb + 2cc ambroxol q8h
complication of a ruptured aneurysm One of these • Chlorhexidine(oral care)
medications, Nimodipine (Nymalize), has been shown to • Paracetamol(600mg) IV q6h
reduce the risk of delayed brain injury caused by insufficient • Ketorolac (30mg) IV q6h in between dose of
blood flow after subarachnoid haemorrhage of a ruptured Paracetamol dose
aneurysm. • Ranitidine (50mg) IV q8h
• Mannitol 150cc IV q4h
• Levetiracetam (2tabs) BID
• Nimodipine 30mg/tab 2 tabs q4h
• Citicoline 1gm/tab q6h
• Cerebrolysin(10cc)IV q8h
SURGICAL MANAGEMENT

IDEAL ACTUAL
Surgical obliteration of the aneurysm with a metal clip Surgical clipping-a procedure to close off an aneurysm.
eliminates the risk of rebleeding. A craniotomy incision is neurosurgeon removes a section of the skull to access the
used; the surgeon dissects down to the aneurysm and places aneurysm and locates the blood vessel that feeds the
a metal clip over the neck of the aneurysm.
aneurysm. Then place a tiny metal clip on the neck of the
The craniotomy is then closed. Surgical obliteration of an
aneurysm is usually performed within 24 hours of rupture. aneurysm to stop blood flow to it.
Medical instability, delay in transfer from one hospital to Endovascular coiling-is a less invasive procedure than
another, and client or family reluctance to seek medical care clipping. The surgeon inserts a hollow plastic tube(catheter)
or consent to surgery may also delay prompt intervention. into an artery, usually in the groin and threads into the body to
Postoperatively, the client’s neurologic status is carefully the aneurysm.
monitored. The usual postoperative care is given, including
cardiac monitoring. As with any neurologic disorder, the
physician must be promptly notified about any neurologic
changes.
Surgical clipping-a procedure to close off an aneurysm. The
neurosurgeon removes a section of the skull to access the
aneurysm and locates the blood vessel that feeds the
aneurysm. Then place a tiny metal clip on the neck of the
aneurysm to stop blood flow to it.
Endovascular coiling-is a less invasive procedure than
clipping. The surgeon inserts a hollow plastic tube(catheter)
into an artery, usually in the groin and threads into the body to
the aneurysm.
Patient’s Name / Room No. | 1
NURSING MANAGEMENT

IDEAL ACTUAL

-Establish rapport Establish rapport


-Do v/s and intake and output hourly -Do vital signs and intake & output hourly
-Do neuro v/s q2h -Assess the patient
-Assess the patient -Determine the GCS score
Determine the GCS score of the patient -Do suctioning to remove secretions
-Position the patient q2h -Do NGT feeding for patient
-Do suctioning to remove secretions -Maintain head and neck in neutral alignment
-Do NGT feeding for patient
-Avoid valsava maneuver
-Elevate HOB 30 degrees
-maintain head and neck in neutral alignment
Patient’s Name /
Room No. | 2