Nursing Care of the Patient with Aneurysmal Subarachnoid Hemorrhage: A Clinical Practice Guideline (Guideline & Webinar)-AANN25_SAH CPG

AANN25_SAH CPG_FINAL

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The 2025 American Association of Neuroscience Nurses guideline updates recommendations for nursing care of patients with aneurysmal subarachnoid hemorrhage (aSAH). Because aSAH has distinct risks and care needs, it should not be managed as interchangeable with other stroke types. The guideline reviews evidence on severity assessment, complications, nursing interventions, and recovery, while noting that aSAH-specific nursing research remains limited.<br /><br />Hunt and Hess, Fisher and modified Fisher, and WFNS scales help predict complications and outcomes; the modified Rankin Scale tracks disability. Nurses should understand and use these measures. Consider palliative care alongside active treatment when symptoms are difficult to control or patients and families need support with goals of care or coping.<br /><br />Key nursing recommendations include routine oral care; chest physiotherapy and brief endotracheal suctioning when clinically indicated; elevating the head of the bed 30–45 degrees; and repositioning patients when increased intracranial pressure is absent, with close monitoring when pressure is suspected or present. Maintain euvolemia through accurate fluid measurement and avoid prophylactic hypervolemia. After aneurysm securement, provide mechanical or pharmacological venous-thromboembolism prophylaxis, with both considered for patients at high risk.<br /><br />Seizure prophylaxis is not routinely supported; consider it before aneurysm treatment or for high-risk patients, reassess medication duration, and include seizure activity in neurological checks. After endovascular treatment, use frequent standardized neurological assessments, vital-sign monitoring, and checks of the access site and distal circulation. For enteral feeding, assess gastrointestinal tolerance and avoid unnecessary interruptions. Assess pain with a standard tool; acetaminophen is suggested for mild pain and opioids for more severe pain, selecting short-acting agents that are less likely to obscure neurological assessment. Use protocols to promote normothermia.<br /><br />Overall, the guideline emphasizes vigilant assessment, prevention of secondary complications, and individualized care, while identifying substantial evidence gaps.

Keywords

aneurysmal subarachnoid hemorrhage

aSAH

neuroscience nursing

2025 guideline

Hunt and Hess scale

Fisher scale

modified Fisher scale

WFNS scale

venous thromboembolism prophylaxis

neurological assessment