Susceptible to a decrease in blood circulation to the brain

• Excessive alcohol consumption
• Excessive stress
• Inadequate action to address modifiable factors
• Inadequate arrhythmia treatment self-management
• Inadequate blood pressure self-management
• Inadequate knowledge of disease process
• Inadequate knowledge of modifiable factors
• Ineffective overweight self-management
• Sedentary behaviors
• Substance misuse
• Tobacco use

• Akinetic left ventricular wall segment
• Blood coagulation disorders
• Brain injuries
• Cardiovascular diseases
• Hypercholesterolemia
• Intracranial aneurysm
• Mechanical prosthetic valve
• Pharmaceutical preparations
• Sleep apnea
• Treatment regimen

• Cardiovascular status including heart rate and rhythm, blood pressure, and peripheral pulses
• Neurologic status including level of consciousness, orientation, motor activity, and strength of all extremities
• History of recent trauma, injury
• Results of diagnostic and laboratory tests

• Patient will understand the need for frequent neurologic assessments to evaluate for any changes.
• Patient will experience adequate cerebral perfusion evidenced by normal neurologic checks.
• Patient will remain hemodynamically stable.
• Patient will participate in diagnostic testing when necessary.
• Patient will verbalize strategies to minimize or decrease modifiable risk factors.

Suggested NOC Outcomes

• Assess patient for positive risk factors for decrease in cerebral perfusion, including carotid stenosis, hypertension, coagulopathies, atrial fibrillation, and smoking. Risk factor reduction will result in positive patient outcomes.
• Facilitate completion of diagnostic tests and provide postprocedural care to prevent complications to ensure accurate, safe, and timely diagnosis and treatment.
• Maintain adequate oxygenation to ensure cerebral perfusion.
• Educate at-risk patients of the signs of decreased cerebral perfusion and the importance of timely medical intervention for positive symptoms. Change in mental status is a sensitive indicator for decreased cerebral perfusion.
• Encourage at-risk patient and family to ask questions and share concerns to increase their confidence and ability to recognize and respond to warning signs of decreased cerebral perfusion.
• Collaborate with community organizations to educate public on risk factors for and symptoms of decreased cerebral perfusion and the appropriate response. Increased community awareness may result in a more timely intervention for decreased cerebral perfusion conditions.

Suggested NIC Interventions

• Patient accepts the need for frequent neurologic assessments to evaluate changes in condition.
• Patient condition reflects normal cerebral perfusion.
• Patient's hemodynamic status supports adequate cerebral perfusion.
• Patient participates in diagnostic testing.
• Patient identifies modifiable risk factors for decreased cerebral perfusion.

• Trending of neurologic assessments
• Vital sign results, including blood pressure, heart rate, and oxygenation status
• Patient tolerance and results of diagnostic tests
• Evaluations for expected outcomes

• He, M., Cui, B., Wu, C., Meng, P., Wu, T., Wang, M., … Sun, Y. (2018). Blood pressures immediately following ischemic strokes are associated with cerebral perfusion and neurologic function. Journal of Clinical Hypertension, 20(6), 1008-1015. doi:10.1111/jch.13310
• Kramer, A. H., Couillard, P. L., Zygun, D. A., Aries, M. J., & Gallagher, C. N. (2019). Continuous assessment of “optimal” cerebral perfusion pressure in traumatic brain injury: A cohort study of feasibility, reliability, and relation to outcome. Neurocritical Care, 30(1), 51-61. doi:10.1007/s12028-018-0570-4
• McNett, M., Livesay, S., Yeager, S., Moran, C., Supan, E., Ortega, S., & Olson, D. M. (2018). The impact of head-of-bed positioning and transducer location on cerebral perfusion pressure measurement. Journal of Neuroscience Nursing, 50(6), 322-326. doi:10.1097/JNN.0000000000000398
• Sharma, V. K., Tan, B. Y. Q., Sim, M. Y., Kulkarni, A., Seow, P. A., Hong, C. S., … Butcher, K. (2018). Rationale and design of a randomized trial of early intensive blood pressure lowering on cerebral perfusion parameters in thrombolysed acute ischemic stroke patients. Medicine, 97(40), 1-6. doi:10.1097/MD.0000000000012721