Chapter 11 Clinical Exemplar

CLINICAL EXEMPLARS

There are many clinical exemplars of ICR. Common exemplars are presented in Box 11.2. Although exemplars are listed under a specific category, there are instances in which an exemplar could fit under more than one category. For example, brain tumors can be considered pathology and can also cause problems with neurotransmission. Similarly, if a brain tumor is large enough and exerts enough pressure, it can also disrupt perfusion. The categories are not meant to be all-inclusive or exclusive but, rather, a suggested organization framework for ICR conditions. A brief discussion of common clinical exemplars follows. For detailed explanations and the nursing care for all the exemplars, see medical–surgical, pediatric, and gerontology textbooks.

Featured Exemplars

Stroke

A stroke occurs when there is a loss of blood flow to an area of the brain, causing the neurons to die. Two major classifications of stroke are ischemic stroke and hemorrhagic stroke. Ischemic strokes often occur in the presence of dysrhythmias or arteriosclerosis, whereas hemorrhagic strokes often occur as the result of prolonged hypertension or a hypertensive crisis. Stroke is the third leading cause of death and serious long-term disability. Nearly three-quarters of all strokes occur in people older than age 65 years. The risk of having a stroke more than doubles each decade after age 55 years. In the United States, stroke death rates are higher for Black individuals than they are for White individuals, even at younger ages.19

FIG. 11.6 Intracranial Regulation and Interrelated Concepts.

BOX 11.2  EXEMPLARS OF INTRACRANIAL REGULATION

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Perfusion

Ischemic Stroke

• Embolic stroke

• Thrombotic stroke

Hemorrhagic Stroke

• Intracerebral hemorrhage

• Intraventricular hemorrhage

• Ruptured aneurysm

• Subarachnoid hemorrhage

Head Injury

• Epidural hematoma

• Skull fractures

• Subdural hematoma

• Traumatic brain injury

Neurologic Transmission

• Epilepsy

• Seizure

Pathology

Brain Neoplasm

• Benign brain tumor

• Malignant brain tumor

Degenerative Conditions

• Alzheimer disease

• Dementia

• Huntington disease

• Multiple sclerosis

• Parkinson disease

Inflammatory Conditions

• Bacterial meningitis

• Brain abscess

• Encephalitis

• Viral meningitis

Traumatic Brain Injury

Traumatic brain injury occurs when a blow to the head causes injury to the brain. Some common causes are motor vehicle accidents, falls, and violence. Brain injury can range from mild to severe. With significant injury, the brain tissue swells, leading to cerebral edema and increased ICP; intracranial bleeding may also occur, further contributing to increased ICP and ischemia of brain tissue. Traumatic brain injury is a major cause of death and disability in the United States.11

Epilepsy

Epilepsy, a type of seizure disorder, is characterized by recurrent unprovoked seizures. A seizure happens when abnormal electrical activity in the brain causes an involuntary change in body movement, sensation, awareness, or behavior. Risk factors are more common in children younger than age 2 years and adults older than age 65 years.20

Alzheimer Disease

Alzheimer disease is one of many degenerative conditions that affect ICR. It is the most common form of dementia, affects more than 5 million Americans, and is the sixth leading cause of death in the United States. Almost two-thirds of those with Alzheimer disease are women. The most common form occurs in individuals older than age 65 years.21 The exact cause of Alzheimer disease is unknown, but it is thought to be associated with abnormal plaque formation in the brain tissue and neuron tangles. This progressive disease results in memory loss, loss of physical function, and brain death over its course.

Meningitis

Meningitis is a pathologic condition affecting ICR that is caused by inflammation of the protective membranes covering the brain and spinal cord. Meningitis can be viral, bacterial, fungal, parasitic, amebic, and noninfectious.22 Viral meningitis is the most common type and less severe; bacterial meningitis is less common but is usually severe and associated with higher mortality. The populations at risk, transmission, and treatment vary widely, depending on the cause.