| Purpose. To examine the relationship between hyperglycemia (glucose), glycemic control (hemoglobin A1c), stress (physiologic and psychologic) and stroke occurrence in individuals with pre-existing cerebral aneurysm undergoing neurosurgical intervention.;Design. Prospective, descriptive correlational.;Sample. 59 subjects undergoing cerebral aneurysm repair.;Methods. Upon admission, demographic data, 3 psychological tests (Perceived Stress Scale, Profile of Mood States and Roberts' Likert Scale), baseline brain computerized tomography (CT), glucose, hemoglobin A1c (HbA1c), cortisol, hematocrit (hct) and systolic blood pressure (SBP) were obtained. Following intervention, daily glucose, hct, SBP and CT were obtained until discharge from the hospital or stroke occurred. Stroke, clinically defined as areas of hypodensity on normal cerebral tissue, was diagnosed by CT.;Results. Admission ruptured aneurysm was significantly correlated to stroke (r = .387, p = .002). Post-intervention stroke occurred in 78% of those with admission ruptured aneurysm compared to 21% without admission ruptured aneurysm (p = .005). Those who stroked after intervention had higher pre-intervention HbA1c (5.68 vs. 5.41, p = .012), cortisol (19.37 vs. 12.02, p = .016), and glucose (162 vs. 141, p = .086) values, compared to those who did not stroke. Although pre-intervention self-reported psychological stress measures were not different between those with and without stroke, anxiety levels (18.7 vs. 18.2) and stress (17.5 vs. 17.7) were higher than in other studies. Post-intervention glucose (163 vs. 144, p = .013) and SBP (146 vs. 130, p < .001) were increased in the stroke group compared to those without stroke. Logistic regression demonstrated that pre-intervention glucose and admission ruptured aneurysm were predictive for stroke. Post-intervention SBP and admission ruptured aneurysm were explanatory for stroke.;Conclusions. Admission ruptured aneurysm was a major variable for stroke following cerebral aneurysm repair. Pre- and post-intervention hyperglycemia may be stress related. A small sample size may account for the lack of statistical significance between stroke occurrence and stress. Post-intervention glucose and admission ruptured aneurysm predicted stroke while post-intervention SBP and admission ruptured aneurysm were explanatory for stroke. Nursing implications include attention to aneurysm admission status (ruptured or nonruptured), glucose status (fasting and HbA1c) and stress level while caring for this acutely ill population. |
