Systemic cardiovascular effects of intracranial disorders: implications for nursing care

Autonomic nervous system imbalances are implicated in the genesis of cardiovascular systemic effects of brain disorders. With many potentially lethal cardiovascular problems, sympathetic predominance over parasympathetic stimuli prevails. Autonomic nervous system imbalances may be caused not only by over-activity or depression of either the sympathetic or parasympathetic nervous systems but also by unchanged activity of one and depression or overactivity of the other. Because the autonomic nervous system has representation in all levels of the brain, it becomes apparent why diverse brain disorders could trigger these effects. It is possible that more than one systemic effect may occur in a patient during the course of an acute brain insult. The hypothalamus, with its anterior parasympathetic nervous system centers and posterolateral sympathetic nervous system centers, plays an important role in the autonomic nervous system. Its role has been more clearly identified than other portions of the central autonomic system. Nursing implications for the care of patients with cardiovascular effects have been identified. Many of these effects may go unnoticed in the early stages because of lack of knowledge; consequently, opportunities for early therapeutic interventions are lost to the detriment of the patient. These effects, when unrecognized and untreated, compound the primary and secondary intracranial insults. They can contribute to the rapid deterioration and demise of the patient, especially if he is unstable and has lost intracranial compliance, autoregulation, and vasomotor tone. Because many of these patients, have had no evidence of cardiovascular problems prior to the acute brain insult, it behooves nurses to familiarize themselves with the signs and symptoms of the systemic cardiovascular effects and appropriately intervene to prevent or offset the complications they produce in the acutely brain-damaged patient.