Aneurysm precautions: a physiologic basis for minimizing rebleeding

It has been noted that the primary goal in the management of a patient with a subarachnoid hemorrhage secondary to a ruptured intracranial aneurysm is to prevent a recurrent hemorrhage during those first 2 critical weeks. Because the aneurysm itself has lost the capability of autoregulation and thus cannot control blood volume or pressure, it is subject to rupture with the sudden increases in mean systemic pressure or decreases in venous return to the heart. Factors which increase blood pressure and reduce venous return have been discussed, and the various comments regarding nursing management have been made. One certainly realizes that these activities cannot be prevented entirely. However, the nurse should be aware of the potential danger to the patient of performing Valsalva maneuvers, of encouraging static contractions, and of exposure to noxious stimuli that induce an acute stress reaction, in addition to the other activities discussed herein. When planning care for the patient placed on aneurysm precautions, it should be stressed that although not all these activities are preventable, care should be taken to avoid performing more than one of them at a time. The nurse can assist the patient to the extent that these activities are minimized or prevented until such time as an operation is indicated or the vascular tissue repairs itself.