Promoting recovery is necessary in the event of brain injury through intracranial pathophysiological changes progression but a brain death procedure should be done in case of refractory injury and a final brain stem herniation.The final stage in refractory brain injury as a result of trauma, hemorrhage, ischemia or infarction, intracranial tumors and infections such as meningitis or encephalitis is terminal brain stem herniation. As the injury progresses and neurological function declines mostly due to non survivable traumatic injury of the brain serious brain hemorrhage could follow a rostral or caudal path with matching results at the end. Patients who have progressed brain edema and high intracranial pressure tend to have their cerebral cortex compressed against the inside surface of the skull. This leads to compromised micro vascular blood flow in higher centers of the brain and eventually dysfunction as can be seen by the progressive loss of consciousness. If the injury progresses further, it could result to pathological posturing and seizure activity (Savel & Munro, 2012).Brain stem distortion leads to a hypersensitive state as a response from reflex with an aim of maintaining brain perfusion. Final brain stem herniation leads to a total loss of sympathetic control. Evaluating changes in major signs after brain dysfunction can be included in the brain’s neurological assessment as there is a link between vital signs and brain stem herniation severity.Determining brain death is mainly is founded on clinical findings which affect the nursing professional directly clinical neurological examination included, papillary examination, as well as brain stem and apnea testing.. Less brain stem function, worrying findings on neurological examinations and recognition of brain damage calls for optimal care. Nurses have the responsibility of quickly identifying progressive injury and terminal brain stem herniation and as such should provide aggressive care to minimize the numbers of silent brain deaths (Arbour, 2013). However, the nurses may miss opportunities to intervene during the progression of the injury, recognizing the injury managing and declaring brain death. If the nurses could quickly recognize such problems, donor recognition could be improved; it could also lead to optimizing utilization of resources in the intensive care
Novitzky, D., & Cooper, D. K. C. (2013). The brain-dead organ donor: Pathophysiology and management. New York: Springer
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Savel & Munro. (2012). “Awakening (Mis) conceptions About Brain Death” .American Journal of Critical Care, 21:377–379.
Arbour Richard. (2013). Brain Death: Assessment, Controversy, and Confounding Factors. Crit Care Nurse. vol. 33 no. 6 27-46
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