Final N300 Intracranial Pressure

Front 1

What are the 3 components that make up the skull?

Back 1

brain tissue
blood
cerebralspinal fluid

Front 2

What is intracranial pressure?

Back 2

Way to monitor a pt with possible elevated pressures

Front 3

Intracranial pressure is from?

Back 3

Pressure exerted by the total volume of the brain tissue, blood, & cerebralspinal fluid
(should remain constant)

Front 4

What is normal intracranial pressure?

Back 4

0-15 mm HG

Front 5

What might happen in your brain if you start to have a bleed, or brain tissues get inflammed?

Back 5

Brain might ↓ Cerebral Spinal Fluid so blood has room to spread or ↓ blood so brain has room to enlarge

Front 6

How much volume is in the brain?

Back 6

120 ml of volume

Front 7

What factors that influence ICP?

Back 7

• Arterial pressure- HTN, clots can => blockages
• Venous pressure - HF with backup of fluids
• IntraABD & intrathoracic pressure-lifing, straining, coughing, bathroom, exercising
• Posture
• Temp -vasoconstrict or vasodilate

Front 8

How do blood gases affect ICP?

Back 8

Blood gases-
CO2 levels HIGH
H ion HIGH
or 02 levels LOW
-ALL CAUSE VASODILATION--
Increases blood flow, increase ICP

Front 9

How do factors effect the brain?

Back 9

We have a limited way of comp in our brain, but the degree of ICP ↑ depends on brains ability to accomodate

Front 10

The ability for the brain to adapt to slight changes in the skull is called? who does it not apply to?

Back 10

Modified Monro-Kellie doctrine
Does not pertain to neonates or ppl with displaced skull fractures

Front 11

Does the total intracranial volume in skull ever change?

Back 11

No
If Volume of one of the components ↑ = another one is displaced

Front 12

What are the normal comp mechniasms of the body to adapt to an ↑ in ICP (limited ability)?

Back 12

1. Can alter CSF production or absorption
2. Can displace excess CSF in spinal subarachnoid space
3. Vasoconstriction/Dilation
4. Distention of dura or compression of brain tissue

Front 13

How does the brain get glucose?

Back 13

It uptakes it itself- does not need insulin!
Lack of glucose for 5 min =>irreversible brain damage

Front 14

What regulates the brain flow?

Back 14

Brain itself b/c most important organ
Blood is shunted away from other organs in the body

Front 15

What is the equation for cerebral profusion pressure?

Back 15

CPP= Mean arterial pressure - Intracranial pressure

Front 16

What are the main factors that affect the cerebral BF?

Back 16

CO2
O2
H ions

Front 17

How does CO2 ↑ affect cerebral BF?

Back 17

↑ PaCO2 = relaxes smooth muscles & dilates cerebral vessels
INCREASES CEREBRAL BF (it wants 02)

Front 18

How does low 02 con/ high levels of H+ ions effect cerebral BF?

Back 18

Vasodilators (in pt with acidosis)

Front 19

↑ ICP is from?

Back 19

Any situation that => ↑ in brain tissue, CSF or blood in skull => ↑ ICP

Front 20

What kind of edema could be a cause of ↑ ICP?

Back 20

Cerebral edema

Front 21

What is cytoxic cerebral edema?

Back 21

Blood/brain barrier intact
Disruption in cell membranes-=> cerebral edema

Front 22

What is interstitial cerebral edema?

Back 22

Diffusion of cerebralspinal fluid in pt with uncontrolled hydrocephalus or systemic water excess

Front 23

What are the typical causes of cerebral edema?

Back 23

Brain surgery
Meningitis, encephalitis
Mass lesions
Hemorrhages
Head injuries
Vasular accident
Toxic or metabolic conditions-uremia, hepatic Encephalopathy
Arsenia/lead intoxication

Front 24

Explain how the body tries to fix its self but really is working against itself to fix cerebral edema?

Back 24

Insult-swelling-pushing on BV.
Brain tells body to vasodilate &bring 02 in so no ischmia =>more edema =. more ICP

Front 25

Earliest signs of ↑ ICP

Back 25

Vision Blurred
Headacge
projectile vomiting, No nausea

Front 26

#1 sign that says pt is having ↑ ICP =

Back 26

Change in LOC

Front 27

VS of pt with ↑ ICP

Back 27

Cushing's triad-
HTN (high Systolic with widening pulse pressure, Diastolic not too high)
Bradycardia
Irregular resp

Front 28

Why do you see the Cushings triad in ICP pt?

Back 28

ICP--pt
• ↓ CPP-activated SNS => vasoconstriction => ↑ heart contractability,↑ CO => HTN
• ↑ BP picked up by barorecptors in carotid arteries => stimulates vagal (flight response) => bradycardia • • Pressure on brain stem affects resp centers => CO2 build up

Front 29

Occular signs of ↑ ICP

Back 29

Pupil dilation &changes in reactivity
Unilateral at first depeneding on what side of brain affected -> then bilateral

Front 30

Dilated pupils can indicate?

Back 30

Pressure on crainial nerves
Pinpoint pupils = pons damage or on drugs

Front 31

Serious posturing in a pt with loss of motor function experiencing ↑ ICP (Decerabrate posturing) =

Back 31

Extensor -upper and lower limbs extended following a stimulus
Indicates brain damage below nucleus
VERY BAD

Front 32

What is the decorticate posturate position in coma pt?

Back 32

"mummy like" position- not as serious
Upper limbs flexed over body, lower limbs extended

Front 33

What is the Glascow coma scale used for & areas assessed?

Back 33

assess how pt is doing neuro wise:
eye opening
verbal response
motor response

Front 34

3-5 glascow scale number means?

Back 34

Probably fatal

Front 35

What diagnostic tests might pt need if suspect ICP?

Back 35

MRI
CT
Angiography-leaks
EEG-brain is firing
O2 measure
measuring ICP

Front 36

What is the nursing care for ↑ ICP

Back 36

Neuro check with glascow scale 1-2 hours, fluid/electrolyte assessment, grips, pupils
MAINTAIN AIRWAY

Front 37

Exact way to monitor the pt with ICP's respiratory/02 function =

Back 37

Pa02-maintain 100 mmHG or more
ABG analysis guides 02 therapy
Mechanical ventilator?

Front 38

What body postion should be maintained in ICP pt?

Back 38

HOB up 30 degrees, if not contraindicated

Front 39

What is the drug therapy for ICP pts?

Back 39

Mannitol-Osmoti diuretic
Corticosteriods- for swelling, watch for hypoglycemia, infections, GI bleed
Barbiturates- decrease metabolic rate and needs of brain
antiseizure meds-Dilantin-prevents seizure, preventing expenditure by body

Front 40

How should hyperventillation therapy be used in pt with ↑ ICP?

Back 40

Breif periods used for cerebral HTN
constricts BV -> ↓ cerebral BF => ↓ ICP
Only do every so often

Front 41

What is the key IV fluid for this pt?

Back 41

IV .9% NaCl

Front 42

Increased ICP from any cause =

Back 42

-↓ cerebral perfusion
-stimulates further swelling (edema)
-possible brain tissue shift resulting in herniation (freq. fatal)

Front 43

Increase ICP may reduce cerebral BF =>

Back 43

Ischemia & cell death

Front 44

In early stages of cerebral ischemia, vasomotor centers are stimulated =>

Back 44

-↑ systemic BP to maintain cerebral BF
- Slow bounding pulse
- Irregular resp
*These changes may suggest ↑ ICP

Front 45

↓ in PaCO2 =>

Back 45

vasoconstriction => limiting BF to brain
↓ venous outflow may also ↑ cerebral blood volume, => ↑ ICP

Front 46

↑ in PaCO2 =>

Back 46

Cerebral vasodilatio= > ↑ cerebral BF & ↑ ICP

Front 47

Autoregulation

Back 47

Brain's ability to change diameter of its BV to maintain a constant cerebral blood flow during alterations in systemic BP

Front 48

Cerebral edema =

Back 48

↑ brain tissue volume→ ↑ ICP

Front 49

Cerebral edema compensatory mechanisms

Back 49

-autoregulation
- ↓ production & flow of CSF

Front 50

CPP calculation

Back 50

MAP - ICP = CPP
Ex: MAP = 100 mm Hg, ICP = 15 mm Hg
100 - 15 = 85 (CPP)

Front 51

Normal CPP range

Back 51

60 -80 mm Hg

Front 52

As ICP ↑ & autoregulation fails CPP can =>

Back 52

↑ to > 100 mm Hg OR
↓ to < 50 mm Hg (=irreversible neurological damage)

Front 53

If ICP is = to MAP

Back 53

Cerebral circulation stops

Front 54

Cushing's triad occurs when =

Back 54

Brain's ability to autoregulate becomes ineffective & decompensation (ischemia & infarction) occurs
& pt exhibits sig changes in mental status & VS

Front 55

Cushing's Triad S&S

Back 55

-bradycardia
-hypertension
-bradypnea

Front 56

Herniation

Back 56

shifting of brain tissue from area of high pressure to area of low pressure; herniated tissue exerts pressure on brain & interferes with blood supply in that area

Front 57

Cessation of cerebral BF =>

Back 57

Ischemia→Infarction→Brain death

Front 58

↑ ICP s/s

Back 58

-LOC changes
-severe headache
-restlessness & irritability
-slowness to react
-dilated or pinpoint pupils
-altered breathing pattern (Cheyne Stokes respirations, hyperventilation, apnea)
-deterioration in motor function
-abn posturing (decerebrate, decorticate, flaccidity)

Front 59

Decortication

Back 59

Abnormal flexion of upper extremities & extension of lower extremities

Front 60

Decerebration

Back 60

Extreme extension of the upper & lower extremities

Front 61

↑ ICP Complications

Back 61

- Brain stem herniation
- Diabetes Insipidus ( d/t ↓ secretion of ADH)
-SIADH ( ↑ secretion of ADH)

Front 62

Diagnostic studies to determine cause of ↑ ICP & the one NOT used =

Back 62

-CT
-MRI
-Cerebral angiography
-PET
-Transcranial doppler (info about cerebral blood flow)
-Electrophysiologic monitoring
NOT Lumbar puncture (b/c sudden release of pressure in lumbar area can cause brain to herniate)

Front 63

↑ ICP nursing goals

Back 63

-Maintain patent airway
-Achieve adequate breathing pattern
-Optimize cerebral tissue perfusion
-Maintain neg fluid balance
-Prevent infection

Front 64

Nursing interventions to maintain patent airway in ↑ ICP pt

Back 64

-Suction PRN w/care to prevent ↑ ICP
-Discourage coughing
-Auscultate lungs q8h for adventitious sounds or areas of congestion
-Elevate HOB to aid in clearing secretions & improve venous drainage of brain

Front 65

Nursing interventions/care to optimize cerebral perfusion in pt w/↑ ICP

Back 65

-Proper positioning (head is kept in neutral midline position) to promote venous drainage
-HOB elevated 30-45 degrees
-Extreme rotation/flexion of neck avoided b/c compression or distortion of jugular veins => ↑ ICP
-Avoid extreme hip flexion to prevent ↑ in intra-abd & intra-thoracic pressures which => ↑ ICP

Front 66

Nursing interventions/care to achieve adequate breathing pattern in pt w/↑ ICP

Back 66

-Monitor for Cheyne-Stokes respirations (d/t ↑ pressure on frontal lobes or deep midline structures)
-Hyperventilation therapy to ↓ ICP (=> cerebral vasoconstriction & ↓ in cerebral blood volume)
-Maintain PaCO2 at <30 mm Hg

Front 67

Nursing interventions/care to maintain negative fluid balance in pt w/↑ ICP

Back 67

-Admin osmotic, loop diuretics (promote venous return)
-Corticosteroids (↓ cerebral edema)
-FR
-I&O *If UOP is >200mL/h for 2h could indicate diabetes insipidus
-Oral care due to mouth dryness from dehydration

Front 68

Interventions to ↓ cerebral edema

Back 68

-Osmotic diuretics (Mannitol)
-HOB elevated to 30 degrees (prevents impairment of venous return thru jugular vein)
-Corticosteroids (dexamethasone) for tumors (↓ edema around tumor)