الفهرس 
Introduction and Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Cerebral aneurysm coiling is a minimally invasive procedure tends to treat an aneurysm by filling it with material that closes off the sac and reduces the risk of bleeding. It is performed from ”within” the artery (endovascular) through a polyethylene catheter inserted into the blood stream at the groin and guided to the brain. Tiny coils, glue, or mesh stents are used to promote clotting and close off the aneurysm. Localized access site hematoma formation, severe headache, severe nausea and neck stiffness are some of aneurysm coiling complications significantly threatening patients’ life. Implementation of nursing intervention protocol before, and after cerebral aneurysm coiling and frequent assessment of patient condition stability during coiling can prevent or at least decrease the incidence and severity of these complications. Therefore, the aim of the present study was to evaluate the effect of nursing interventions protocol on patients’ clinical outcomes undergoing peri cerebral aneurysm coiling. The study was conducted at the cerebral angiography unit, and neurology department at the Neuro-psychiatry Center affiliated to Tanta University. A Convenience sample of sixty adult patients undergoing cerebral aneurysm coiling procedure were selected according to the inclusion and exclusion criteria. The sample size calculation according to total Tanta main University Hospital records of patients undergoing cerebral aneurysm coiling was found to be 60 patients .The calculation was based on statistical power analysis Epi-info program for the studied subjects at 95% confidence. The subjects were divided into two groups: - group I (control group): It consisted of 30 adult patients undergoing cerebral aneurysm coiling received routine nursing care from the Neuro-psychiatry Center nursing staff. group II (study group): It consisted of 30 adult patients undergoing cerebral aneurysm coiling meeting all inclusion criteria, received nursing intervention protocol implemented by the researcher. Inclusion criteria: Subjects were selected according to the following criteria: - 1- Adult patients (21-60 years). 2-Both sexes’ patients 3- Conscious patients 4-Patient undergoing cerebral aneurysm coiling for the first time Four tools were used for data collection: - Tool (I) structured interview schedule: Structured interview sheet was developed by the researcher to collect the data after review of relevant literature and consisted of three parts: Part (1): Socio-demographic data which included patient’s code, age, sex, marital status, educational level, and occupation. Part (2): Medical and clinical data which included Past medical, surgical and neurological history, smoking history, allergy history to any contrast media or even to shellfish product, history of any diagnostic cerebral angiography procedure, history of any type of infection, illicit medication history , and alcohol consumption history, hemodynamic assessment including monitoring vital signs. Part (3): Cerebral aneurysm warning signs assessment tool: This tool was developed by the researcher after reviewing the relevant literature. It was used three times pre procedure, post procedure and one week post discharge to assess the cerebral aneurysm warning signs which include (blurred vision, Change in speech, Headache, Dizziness, Trouble walking, Neck pain or stiffness, and Seizure). It scored as present or absent. Presence of cerebral aneurysm warning signs equal to (score 1) and absence of warning signs equal to (score zero). Tool (II) Glasgow Coma Scale for assessment the level of consciousness of patient undergoing cerebral aneurysm coiling: It was originally created by Graham Teasdale and Bryan Jennett in 1974and it is modified by Gill M, et al in (2005) and Green SM in (2011). It adopted and used by the researcher three times pre, intra and post cerebral aneurysm coiling procedure to assess the level of consciousness; it rates three categories of patient responses, eye-opening, motor response, and verbal response. These determinants were evaluated separately according to a numerical value that runs from a high of 15 to a low of 3. Tool (III): Localized pain at puncture site assessment tool: It was developed by Cline M, et al (2006). It adopted and used by the researcher three times immediately post; eight hours post and one week post cerebral aneurysm coiling procedure to assess pain intensity level. It is a horizontal 10 point straight line scale which represents continuum pain severity ranging from (0) to (10) scale as (0) indicates no pain, (1-3) indicates mild pain. (4-6) indicates moderate pain, (7-9) indicates severe pain and (10) indicates worst pain Tool (IV) Post aneurysmal patient clinical outcomes assessment tool: It was adapted by the researcher and it consisted of four parts: Part (1): Cerebral angiography access site localized complications assessment tool: It was adopted by the researcher to evaluate access site localized hematoma formation, and bleeding post cerebral aneurysm coiling procedure. It comprised as follows. - Localized hematoma and bleeding assessment scale (Hemostatic Scale): It was originally created by christenson R , et al in 1976 and modified by Hogan-Miller, et al in 1995 and then by Ahmed K , et al in 2010 by adding measurement of the hematoma in centimeters. It used by the researcher three times, immediately post, eight hours post and one week post cerebral aneurysm coiling procedure to assess localized hematoma and bleeding which graded on an ordinal scale, from 0 to 4 in which 0 scores indicate no bleeding, no hematoma while 4 scores indicate large hematoma which needs surgical intervention (hematoma evacuation). Part (2): Headache Questionnaire assessment checklist:- It was developed by Thomas T, Bileena K and et al (2018).It modified and translated into Arabic by the researcher to assess general characteristics of headache which include 5 sections (Quality, location, associated symptoms, aggravation by physical activity and interference with the activity of daily living) based on researcher observation and patient interview .The patient recorded each character that was experienced three times post cerebral aneurysm coiling procedure and if he was illiterate the researcher asked him and recorded the answer. It scored as Yes or No, (Yes) equal to ”score 1” and (NO) equal to ”score 0” Part (3): Nausea assessment tool (0 to 5 Nausea Rating Scales): - It was originally developed by Halpin A , Loucine M, and Jessica L (2010).It adopted and translated into Arabic by the researcher to assess nausea and vomiting symptoms based on researcher observation and patient interview post cerebral aneurysm coiling .The patient recorded each symptoms that was experienced three times post cerebral aneurysm coiling procedure and if he was illiterate the researcher asked him and recorded the answer. It graded on an ordinal scale, from 0 to 5 with, no nausea equal to ”score 0” and sever nausea equal to ”score 5”. Part (4): Neck pain and stiffness assessment tool (Neck Disability Index): It was developed by Wheeler A, et al in 1999 and modified by Eva B, et al in 2011 . It is adapted, modified and translated into Arabic by the researcher to assess neck-specific disability based on researcher observation and patient interview post cerebral aneurysm coiling .The patient recorded each disability that was experienced three times post cerebral aneurysm coiling procedure and if he was illiterate the researcher asked him and recorded the answer. The questionnaire has 10 sections concerning (pain, personal care, lifting, reading, headache, concentration, work, driving, sleeping, and recreation), each section is scored from 0 to 5 (with the no pain and no disability response equal to ”score 0” and Higher scores represent greater pain and disability equal to ”score 35” The main results of the present study: - - Less than half (46.7%) (40.0%) of both study group I and control group II respectively range from 41-60 years old. Also, it shows that more than half (63.3%) of the study group I and about two third (73.3%) of control group II were female. In addition, it reveals that the approximately two third (73.3%) of the study group I and more than half (53.3%) of control group II were from rural area respectively. The present study reveals that the incidence of localized pain in the control group is higher than in the study group, which explained as Immediately post cerebral aneurysm coiling less than quarter (20.0%) of study group I and minority (3.3%) of control group II had no pain with high statistical significance difference at p level=0.001.Eight hour post cerebral aneurysm coiling the majority (86.7%) of study group I and minority (3.3%) of control group II had no pain with high statistical significance difference at p level=0.001 while one week post cerebral aneurysm coiling the majority (96.7%) of study group I and the minority (13.3%) of control group II had no pain with high statistical significance difference at p level=0.001. -In addition, the present study shows that the incidence of localized hematoma formation and bleeding in the control group is higher than in the study group, which explained as immediately post cerebral aneurysm coiling more than half (63.3%) of study group I and less than quarter (20.0%) of control group II had no localized hematoma with high statistical significance difference at p level=0.001.Eight hour post cerebral aneurysm coiling all patients (100.0%) of study group I and less than quarter (20.0%) of control group II had no localized hematoma with high statistical significance difference at p level=0.001while one week post cerebral aneurysm coiling all patients (100.0%) of study group I and less than two third (70.0%) of control group II had no localized hematoma with high statistical significance difference at p level=0.001. - The present study also reveals that the incidence of post aneurysmal headache in the control group is higher than in the study group, which explained as immediately post cerebral aneurysm coiling the majority (96.7%) of study group I and the minority (13.3%) of control group II had no post aneurysmal headache with high statistical significance difference at p level=0.001.Eight hour post cerebral aneurysm coiling the majority (86.7%) of study group I and the minority (10.0%) of control group II had no post aneurysmal headache with high Statistical significance difference at p level=0.001 while one week post cerebral aneurysm coiling the majority (90.0%) of study group I and less than quarter (20.0%) of control group II had no post aneurysmal headache with high statistical significance difference at p level=0.001. -In addition, the present study shows that the incidence of post aneurysmal nausea in the control group is higher than in the study group, which explained as immediately post cerebral aneurysm coiling more than one third (36.7%) of study group I and the minority (10.0%) of control group II had no post aneurysmal nausea with high statistical significance difference at p level=0.001.Eight hour post cerebral aneurysm coiling the majority (86.7%) of study group I and the minority (10.0%) of control group II had no post aneurysmal nausea with high statistical significance difference at p level=0.001while one week post cerebral aneurysm coiling the majority (90.0%) of study group I and the minority (16.7%) of control group II had had no post aneurysmal nausea with high statistical significance difference at p level=0.001. -Moreover, the present study illustrates that the incidence of post aneurysmal neck pain and stiffness in the control group is higher than in the study group, which explained as immediately post cerebral aneurysm coiling more than quarter (26.7%) of study group I and the minority (10.0%) of control group II had no post aneurysmal neck pain and stiffness with high statistical significance difference at p level=0.001.Eight hour post cerebral aneurysm coiling the majority (86.7%) of study group I and the minority (10.0%) of control group II had no post aneurysmal neck pain and stiffness with high statistical significance difference at p level=0.001 while one week post cerebral aneurysm coiling the majority (93.3%) of study group I and the minority (13.3%) of control group II had had no post aneurysmal neck pain and stiffness with high statistical significance difference at p level=0.001. Conclusion of present study: - Based on the results of this study, it could be concluded that Implementation of nursing interventions protocol enhancing the clinical outcome of the patients undergoing peri cerebral aneurysm coiling, as it was effective to decrease minor and major post aneurysmal complications such as localized pain, localized hematoma formation, aneurysmal headache, nausea and neck stiffness. Recommendations of present study: -Based on the finding of the current study, it has recommended that: 1-Recommendation for patients: The present study recommends that all patients undergoing peri cerebral aneurysm coiling must be given both written and verbal information about home care prior to discharge including access site care, dressing removal, physical activity, personal hygiene, medication, balanced diet and also, about warning signs of post discharge complication that require immediate medical attention including fever, local bleeding, convulsions, severe local pain, redness and localized swelling of the catheter site and severe pain in the lower back). 2- Recommendation for clinical practice: Pre procedure, the present study recommends that application of preliminary incision site skin preparation technique .Intra procedure, it recommends that close continuous monitoring of patient hemodynamic status. Post procedure, it recommends that the application of manual C shape finger light pressure technique. 3-Recommendations for future research studies: Development of in service training program for neuroradiology nursing staff of correct manual compression technique application and correct implementation of Swedish relaxation massage post cerebral aneurysm coiling.