Nursing Care of Patients with Cerebral Vasospasm Following Aneurysmal Subarachnoid Haemorrhage: A Case Study
Keywords:
cerebral vasospasm, aneurysmal subarachnoid haemorrhage, cerebral aneurysmAbstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a critical condition causing an increase in mortality and morbidity due to its significant complication, namely cerebral vasospasm (CVS). The consequence of CVS results in lessening blood supply to the brain; subsequently, there is delayed cerebral ischemia (DCI). An advancement in medical science has led to a shift in the prevention and management from the traditional approach. The case study in this paper demonstrated nursing care of the patient with cerebral vasospasm after aneurysmal subarachnoid hemorrhage utilizing the nursing process. These include closely assessing neurological deterioration, monitoring of re-bleeding, providing post-clipping care, preventing cerebral vasospasm, and promoting recovery using valid and up-to-date evidence. The ultimate goals are for patient safety and good quality of life.
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References
1. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Culebras A, Elkind MS, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS. An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013 Jul 1;44(7):2064-89.
2. Diringer MN, Zazulia AR. Aneurysmal subarachnoid hemorrhage: Strategies for preventing vasospasm in the intensive care unit. In seminars in respiratory and critical care medicine 2017 Dec (Vol. 38, No. 06, pp. 760-767). Thieme Medical Publishers.
3. Shah KB, Shrestha S, Jaiswal SK, Qian LB, Kui CL. Aneurysm clipping and outcome for Hunt & Hess
grade 4, 5 subarachnoid hemorrhage—A literature review. OJMN 2018 Mar 7; 8(02):215. DOI: 10.4236/
ojmn.2018.82018
4. Veldeman M, Höllig A, Clusmann H, Stevanovic A, Rossaint R, Coburn M. Delayed cerebral ischaemia
prevention and treatment after aneurysmal subarachnoid haemorrhage: a systematic review.
Brit J Anaesth 2016 Jul 1;117(1):17-40.
5. Hughes JD, Bond KM, Mekary RA, Dewan MC, Rattani A, Baticulon R, Kato Y, Azevedo-Filho H,
Morcos JJ, Park KB. Estimating the global incidence of aneurysmal subarachnoid hemorrhage:
A systematic review for central nervous system vascular lesions and meta-analysis of ruptured
aneurysms. World Neurosurg 2018 Apr 9.
6. Diringer MN, Bleck TP, Hemphill JC, Menon D, Shutter L, Vespa P, Bruder N, Connolly ES, Citerio G,
Gress D, Hänggi D. Critical care management of patients following aneurysmal subarachnoid
hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus
Conference. Neurocrit Care 2011 Oct 1;15(2):211. https://doi.org/10.1007/s12028-011-9605-9
7. Ayling OG, Ibrahim GM, Drake B, Torner JC, Macdonald RL. Operative complications and
differences in outcome after clipping and coiling of ruptured intracranial aneurysms. J Neurosurg
2015 Sep;123(3):621-8.
8. Ko ba-Gosztyła M, Czapiga B, Jarmundowicz W. Aneurismal subarachnoid hemorrhage: who
remains for surgical treatment in the post-ISAT era?. Arch Med Sci: AMS 2015 Jun 19;11(3):536. DOI:
10.5114/aoms.2013.37333
9. Kouwrobtum S. Management of unruptured intracranial aneurysm in Pasutharnchart N, Chutineth
O, Charnarong N., editors. Basic and clinical neuroscience 2013; 170-182; Chulalongkorn University
Printing House. (In Thai)
10. Inagawa T. Risk factors for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a
review of the literature. World Neurosurg 2016 Jan 1;85:56-76.
11. Tsyben A, Paldor I, Laidlaw J. Cerebral vasospasm and delayed ischaemic deficit following elective
aneurysm clipping. J Clin Neurosci 2016 Dec 1;34:33-8.
12. Salee K. Nimodipine. J Prapokklao Hosp Clin Med Educat Center 2015; 32 (2); 192-195. (In Thai)
13. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal
subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart
Association/ American Stroke Association. Stroke. 2012;43(6):1711- 1737. (http://stroke.ahajournals.
org/content/43/6/ 1711.full.pdf+html.)
14. Hemphill JC, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein
JN, Macdonald RL, Mitchell PH, Scott PA. Guidelines for the management of spontaneous intracerebral
hemorrhage: A guideline for healthcare professionals from the American Heart Association/
American Stroke Association. Stroke 2015 Jul 1;46(7):2032-60.
15. McBryde FD, Malpas SC, Paton JF. Intracranial mechanisms for preserving brain blood flow in health
and disease. Acta Physiol 2017 Jan 1;219(1):274-87.
16. Sadoughi A, Rybinnik I, Cohen R. Measurement and management of increased intracranial pressure.
Open Crit Care Med J 2013 Dec 27;6(1):56-65.
17. Engelborghs S, Niemantsverdriet E, Struyfs H, Blennow K, Brouns R, Comabella M, ... & Ganti L.
External ventricular drain placement. In Atlas of Emergency Medicine Procedures 2016; pp.
241-245. Springer New York.
18. Ou C, Chen Y, Wang S, Mo J, Hu W. Case report delayed symptomatic vasospasm after clipping of
an unruptured intracranial aneurysm: case report and literature review. Int J Clin Exp Med
2017;10(6):9697-703.
19. Tsaousi GG, Logan SW, Bilotta F. Postoperative pain control following craniotomy: a systematic
review of recent clinical literature. Pain Pract 2017 Sep 1;17(7):968-81.
20. Dunn LK, Naik BI, Nemergut EC, Durieux ME. Post-Craniotomy Pain Management: Beyond Opioids.
CURR NEUROL NEUROSCI. 2016 Oct 1;16(10):93.
21. Chaemlai K, Kitrungrote L, Petpichetchian W. Development of clinical nursing practice guidelines
for procedural pain management in surgical critical patients, Songklanagarind hospital. Proceeding
of the 4th Hat-Yai Academic Conference 2013. 2013,710: 31-39. (In Thai)
22. Lhaosupab N, Monkong S, Sirapo-ngam Y. Effect of stress management program for relatives of
critically ill patients on relatives’stress. Rama Nurs J 2014; 20(1); 67-81. (In Thai)
23. Karic T, Roe C, Nordenmark TH, Becker F, Sorteberg A. Impact of early mobilization and
rehabilitation on global functional outcome one year after aneurysmal subarachnoid
haemorrhage. J Rehabil Med 2016 Sep 5;48(8):676-82.
24. Del Bigio MR, Di Curzio DL. Nonsurgical therapy for hydrocephalus: A comprehensive and
critical review. Fluids Barriers CNS. 2015 Dec;13(1):3. https://doi.org/10.1186/s12987-016-0025-2
2. Diringer MN, Zazulia AR. Aneurysmal subarachnoid hemorrhage: Strategies for preventing vasospasm in the intensive care unit. In seminars in respiratory and critical care medicine 2017 Dec (Vol. 38, No. 06, pp. 760-767). Thieme Medical Publishers.
3. Shah KB, Shrestha S, Jaiswal SK, Qian LB, Kui CL. Aneurysm clipping and outcome for Hunt & Hess
grade 4, 5 subarachnoid hemorrhage—A literature review. OJMN 2018 Mar 7; 8(02):215. DOI: 10.4236/
ojmn.2018.82018
4. Veldeman M, Höllig A, Clusmann H, Stevanovic A, Rossaint R, Coburn M. Delayed cerebral ischaemia
prevention and treatment after aneurysmal subarachnoid haemorrhage: a systematic review.
Brit J Anaesth 2016 Jul 1;117(1):17-40.
5. Hughes JD, Bond KM, Mekary RA, Dewan MC, Rattani A, Baticulon R, Kato Y, Azevedo-Filho H,
Morcos JJ, Park KB. Estimating the global incidence of aneurysmal subarachnoid hemorrhage:
A systematic review for central nervous system vascular lesions and meta-analysis of ruptured
aneurysms. World Neurosurg 2018 Apr 9.
6. Diringer MN, Bleck TP, Hemphill JC, Menon D, Shutter L, Vespa P, Bruder N, Connolly ES, Citerio G,
Gress D, Hänggi D. Critical care management of patients following aneurysmal subarachnoid
hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus
Conference. Neurocrit Care 2011 Oct 1;15(2):211. https://doi.org/10.1007/s12028-011-9605-9
7. Ayling OG, Ibrahim GM, Drake B, Torner JC, Macdonald RL. Operative complications and
differences in outcome after clipping and coiling of ruptured intracranial aneurysms. J Neurosurg
2015 Sep;123(3):621-8.
8. Ko ba-Gosztyła M, Czapiga B, Jarmundowicz W. Aneurismal subarachnoid hemorrhage: who
remains for surgical treatment in the post-ISAT era?. Arch Med Sci: AMS 2015 Jun 19;11(3):536. DOI:
10.5114/aoms.2013.37333
9. Kouwrobtum S. Management of unruptured intracranial aneurysm in Pasutharnchart N, Chutineth
O, Charnarong N., editors. Basic and clinical neuroscience 2013; 170-182; Chulalongkorn University
Printing House. (In Thai)
10. Inagawa T. Risk factors for cerebral vasospasm following aneurysmal subarachnoid hemorrhage: a
review of the literature. World Neurosurg 2016 Jan 1;85:56-76.
11. Tsyben A, Paldor I, Laidlaw J. Cerebral vasospasm and delayed ischaemic deficit following elective
aneurysm clipping. J Clin Neurosci 2016 Dec 1;34:33-8.
12. Salee K. Nimodipine. J Prapokklao Hosp Clin Med Educat Center 2015; 32 (2); 192-195. (In Thai)
13. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal
subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart
Association/ American Stroke Association. Stroke. 2012;43(6):1711- 1737. (http://stroke.ahajournals.
org/content/43/6/ 1711.full.pdf+html.)
14. Hemphill JC, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein
JN, Macdonald RL, Mitchell PH, Scott PA. Guidelines for the management of spontaneous intracerebral
hemorrhage: A guideline for healthcare professionals from the American Heart Association/
American Stroke Association. Stroke 2015 Jul 1;46(7):2032-60.
15. McBryde FD, Malpas SC, Paton JF. Intracranial mechanisms for preserving brain blood flow in health
and disease. Acta Physiol 2017 Jan 1;219(1):274-87.
16. Sadoughi A, Rybinnik I, Cohen R. Measurement and management of increased intracranial pressure.
Open Crit Care Med J 2013 Dec 27;6(1):56-65.
17. Engelborghs S, Niemantsverdriet E, Struyfs H, Blennow K, Brouns R, Comabella M, ... & Ganti L.
External ventricular drain placement. In Atlas of Emergency Medicine Procedures 2016; pp.
241-245. Springer New York.
18. Ou C, Chen Y, Wang S, Mo J, Hu W. Case report delayed symptomatic vasospasm after clipping of
an unruptured intracranial aneurysm: case report and literature review. Int J Clin Exp Med
2017;10(6):9697-703.
19. Tsaousi GG, Logan SW, Bilotta F. Postoperative pain control following craniotomy: a systematic
review of recent clinical literature. Pain Pract 2017 Sep 1;17(7):968-81.
20. Dunn LK, Naik BI, Nemergut EC, Durieux ME. Post-Craniotomy Pain Management: Beyond Opioids.
CURR NEUROL NEUROSCI. 2016 Oct 1;16(10):93.
21. Chaemlai K, Kitrungrote L, Petpichetchian W. Development of clinical nursing practice guidelines
for procedural pain management in surgical critical patients, Songklanagarind hospital. Proceeding
of the 4th Hat-Yai Academic Conference 2013. 2013,710: 31-39. (In Thai)
22. Lhaosupab N, Monkong S, Sirapo-ngam Y. Effect of stress management program for relatives of
critically ill patients on relatives’stress. Rama Nurs J 2014; 20(1); 67-81. (In Thai)
23. Karic T, Roe C, Nordenmark TH, Becker F, Sorteberg A. Impact of early mobilization and
rehabilitation on global functional outcome one year after aneurysmal subarachnoid
haemorrhage. J Rehabil Med 2016 Sep 5;48(8):676-82.
24. Del Bigio MR, Di Curzio DL. Nonsurgical therapy for hydrocephalus: A comprehensive and
critical review. Fluids Barriers CNS. 2015 Dec;13(1):3. https://doi.org/10.1186/s12987-016-0025-2
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Published
2019-01-01
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กิจบรรยงเลิศ ส, เพชรพิเชฐเชียร ว. Nursing Care of Patients with Cerebral Vasospasm Following Aneurysmal Subarachnoid Haemorrhage: A Case Study. JBCN_Bangkok [internet]. 2019 Jan. 1 [cited 2026 Jan. 28];35(1):24-35. available from: https://he01.tci-thaijo.org/index.php/bcnbangkok/article/view/189167
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Article published Is the copyright of the Journal of Health and Nursing Research (Boromarajonani College of Nursing, Bangkok) Cannot be republished in other journals
