NLE Neurosensory Nursing — Cerebrovascular Disorders and Increased Intracranial PressureConcept Map

Concept

Cerebrovascular Disorders

Sub Concepts

• Ischemic Stroke (80-85%)
• Hemorrhagic Stroke (15-20%)
• Transient Ischemic Attack (TIA)
• Subarachnoid Hemorrhage

Relationship To Central

Primary pathology causing neurological emergency requiring immediate intervention

Concept

Increased Intracranial Pressure

Sub Concepts

• Pathophysiology (Monro-Kellie Doctrine)
• Clinical Manifestations
• Nursing Interventions
• Pharmacological Management

Relationship To Central

Secondary complication requiring continuous monitoring and aggressive management

Concept

Traumatic Brain Injury

Sub Concepts

• Epidural Hematoma
• Subdural Hematoma
• Basilar Skull Fracture
• Concussion

Relationship To Central

Alternative etiology causing acute neurological dysfunction and ICP elevation

Concept

Brain Tumors

Sub Concepts

• Primary vs Metastatic
• Clinical Manifestations
• Diagnostic Procedures
• Treatment Modalities

Relationship To Central

Chronic condition with acute complications including ICP elevation and neurological deficits

Concept

Nursing Management Framework

Sub Concepts

• Neurological Assessment
• Emergency Protocols
• Patient Education
• Complication Prevention

Relationship To Central

Systematic approach to assessment, intervention, and patient teaching for all conditions

To

Increased Intracranial Pressure

From

Stroke

Strength

strong

Relationship

Ischemic and hemorrhagic strokes both lead to cerebral edema and potential ICP elevation; hemorrhagic stroke causes both tissue destruction and ICP elevation

To

tPA Therapy

From

Ischemic Stroke

Strength

strong

Relationship

Treatment for ischemic stroke within the therapeutic window; dissolves thrombus to restore perfusion and salvage penumbra

To

tPA Therapy

From

Hemorrhagic Stroke

Strength

strong

Relationship

Absolute contraindication; tPA worsens bleeding and increases mortality

To

Full Stroke Risk

From

Transient Ischemic Attack

Strength

strong

Relationship

TIA is a major warning sign; significant proportion of TIA patients develop full stroke within days, requiring urgent secondary prevention

To

Ischemic vs Hemorrhagic Differentiation

From

Non-Contrast CT

Strength

strong

Relationship

Initial diagnostic test to distinguish stroke type; must be done emergently before any treatment to guide opposite therapies

To

Decreased Level of Consciousness

From

Cushing's Triad

Strength

strong

Relationship

Late sign of increased ICP; occurs after decreased LOC; indicates impending herniation

To

Cerebral Venous Drainage

From

Head Position 30 Degrees

Strength

strong

Relationship

Elevating head promotes venous return from brain; reduces ICP by facilitating fluid drainage

To

Osmotic Diuresis

From

Mannitol

Strength

strong

Relationship

Osmotic diuretic that pulls fluid from interstitial brain tissue into vasculature; reduces cytotoxic edema

To

Vasogenic Edema

From

Dexamethasone

Strength

strong

Relationship

Corticosteroid effective for vasogenic edema around brain tumors; not effective for ischemic stroke or traumatic edema

To

Lucid Interval

From

Epidural Hematoma

Strength

strong

Relationship

Classic presentation of epidural hematoma; brief initial loss of consciousness followed by apparent recovery, then rapid deterioration

To

CSF Rhinorrhea and Otorrhea

From

Basilar Skull Fracture

Strength

strong

Relationship

Basilar skull fracture damages dura, allowing CSF leakage from nose or ears; indicates meningitis risk

To

Increased Intracranial Pressure

From

Brain Tumor

Strength

strong

Relationship

Brain tumors raise ICP regardless of benignity because they occupy space in rigid skull; even benign tumors are dangerous

To

Aphasia

From

Left Hemisphere Stroke

Strength

strong

Relationship

Left hemisphere is language-dominant in most people; left hemisphere strokes cause expressive, receptive, or global aphasia

To

Unilateral Neglect

From

Right Hemisphere Stroke

Strength

strong

Relationship

Right hemisphere handles spatial perception; right hemisphere strokes cause neglect of left body/visual field

To

Aspiration Risk

From

Dysphagia

Strength

strong

Relationship

Dysphagia from stroke impairs swallowing; major risk for aspiration pneumonia requiring strict diet and swallowing precautions

To

Cardioembolic Stroke

From

Atrial Fibrillation

Strength

strong

Relationship

Irregular heart rhythm creates stasis and clot formation in left atrium; emboli travel to cerebral circulation causing ischemic stroke

To

Hemorrhagic Stroke

From

Hypertension

Strength

strong

Relationship

Chronic hypertension is the single most important modifiable risk factor for both ischemic and hemorrhagic stroke

To

Antiplatelet Therapy

From

Secondary Prevention

Strength

strong

Relationship

After stroke or TIA, antiplatelet agents (aspirin, clopidogrel) reduce risk of recurrent ischemic stroke

To

Stroke Recognition

From

FAST Assessment

Strength

strong

Relationship

Mnemonic for public education on acute stroke signs: Face drooping, Arm weakness, Speech difficulty, Time to call for help

To

ICP Pathophysiology

From

Monro-Kellie Doctrine

Strength

strong

Relationship

Principle that skull is rigid and contains brain tissue, blood, and CSF; any increase in one must be compensated by decrease in others

To

Reperfusion Target

From

Penumbra

Strength

strong

Relationship

Area of at-risk tissue surrounding ischemic core; salvageable if blood flow restored quickly via tPA or thrombectomy

To

Epidural Hematoma

From

Middle Meningeal Artery

Strength

strong

Relationship

Common source of arterial bleeding in epidural hematoma; rapid accumulation of blood between skull and dura

To

Worst Headache Ever

From

Subarachnoid Hemorrhage

Strength

strong

Relationship

Classic presentation of ruptured cerebral aneurysm causing SAH; sudden severe headache is pathognomonic

To

Neck Stiffness

From

Meningeal Irritation

Strength

strong

Relationship

Blood irritates meninges in SAH causing neck stiffness; positive Kernig and Brudzinski signs

To

Brain Tumor Resection

From

Craniotomy

Strength

strong

Relationship

Surgical procedure for brain tumor removal; primary treatment for accessible tumors

To

CSF Confirmation

From

Halo Ring Sign

Strength

moderate

Relationship

Yellow halo around blood on gauze in suspected CSF leak; presence of glucose confirms CSF rather than other fluids

To

ICP Elevation

From

Valsalva Maneuver

Strength

strong

Relationship

Straining, coughing, and bearing down increase intrathoracic pressure, which impedes venous return and raises ICP

To

Adequate Brain Oxygenation

From

Cerebral Perfusion Pressure

Strength

strong

Relationship

CPP = MAP minus ICP; maintains adequate pressure gradient to perfuse brain tissue; target CPP 60-70 mmHg

To

Increased Cerebral Metabolism

From

Fever

Strength

moderate

Relationship

Fever increases metabolic rate and cerebral metabolic demands; aggressive temperature management essential in ICP elevation

To

ICP Prevention

From

Antiseizure Prophylaxis

Strength

moderate

Relationship

Seizures dramatically increase cerebral metabolism and ICP; prophylaxis indicated when seizure risk is high

To

Cerebral Vasoconstriction

From

Controlled Hyperventilation

Strength

moderate

Relationship

Brief hyperventilation to PaCO2 30-35 mmHg causes cerebral vasoconstriction to reduce ICP in acute crisis; temporary measure only

To

Cerebral Hemispheric Dysfunction

From

Decorticate Posturing

Strength

moderate

Relationship

Arms flexed, legs extended; indicates dysfunction at midbrain/upper brainstem level from increased ICP

To

Brainstem Dysfunction

From

Decerebrate Posturing

Strength

moderate

Relationship

Both arms and legs extended; indicates lower brainstem dysfunction from severe increased ICP; worse prognosis than decorticate

To

Uncal Herniation

From

Pupillary Dilation CN III

Strength

strong

Relationship

Unilateral fixed dilated pupil indicates compression of CN III by uncus during herniation; emergency sign requiring immediate intervention

To

Neurological Outcome

From

Penumbra Salvage

Strength

strong

Relationship

Successful reperfusion of penumbra tissue salvages neurons and improves long-term functional outcome

To

tPA Eligibility

From

Last Known Well Time

Strength

strong

Relationship

Exact time of symptom onset is critical for tPA eligibility determination; unknown onset may exclude patient from thrombolytic therapy