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4 Cards in this Set

  • Front
  • Back
ICP
- ICP results form an increase in any or all of the three components of the skull
- Brain tissue, blood, and CSF

- Cerebral edema is an contributing factor
- results in tissue volume
3 types of CE:
- Vasogenic
- MOST COMMON. Occurs mostly in the white matter an dis attributes to changes in the endothelial lining of the cerebral capillaries
- Results in flow of fluid from the intravascular to the extravascular space

- Cytotoxic
- local disruption of the cell membranes and occurs most often in the gray matter
- Develops from destructive lesions or trauma to brain tissue

- Interstitial
- Result of the perventricular diffusion of ventricular CSF in a pt. with uncontrolled hydrocephalus. Causeed by enlargement of the extracellular space as a result of systemic water excess (hyponatremia)

*** All of these types can occur in a pt. from a single insult ***

Insults may result in:
- hypercapnia
- cerbral acidosis
- impaired autoregulation
- systemic hypertension ---) formation and spread of crebral edema

- Distorts the brain tissue ---) inncrease ICP ---) tissue hypoxia ---) acidosis ---) sustained increases ---) brainstem compression and herniation of the brain ---) further ischemia and edema

- Herniations force the cerebellum and brainstem downward through the foramen magnum.

-If the compression is not relieved, respiratory arrest occur

*** MAJOR COMPLICATION INDEQUATE CEREBRAL PERFUSION AND CEREBRAL HERNIATION ***
ICP manifestations with some interventions
- Change of LOC
- most sensitive and imp. indicator of the pt's neuro status

Changes in VS
- Cushing triad ing' systolic pressure - widening pulse pressure

**** INDICATES SERVERLY INCREASED ICP ****

- bradycardia w/ full and
bounding pulse

- irregular RR (may not
be an early sign

- can cause a change in
temp - effect of the ICP
on the hypothalamus

Ocular signs
- Compression of the
oculomotor nerve (CN III)
- dilation of the pupil

- sluggish response or
no response to light

- inability to move the eye
upward

- a fixed unilateral dilated
pupil *** NEURO
EMERGENCY- THAT
INDICATE BRAIN
HERNIATION

- Papiledema, a
nonspecific sign ass w/ ICP

Decrease in motor function
- contralateral hemiparesis or hemiplegia may be seen. If painful stimuli are used pt. may exhibit decerebrate or decorticate

Headache
- HA is continuous but worse in the morning
- brain is insensitive to pain
- avoid straining or movements

Projectile Vomiting
- usually w/o nausea is often a nonspecific sign of increased ICP

*** Identify and treat the underlying cause of increase ICP and to support the brain function ***
Diagnostics
Lumbar puncture
Not done if ICP is suspected because the risk of herniation
Interventions
Intervention:
-Ensure adequate o2,
-Get ABG's - guides o2 therapy
-Maintaing PaO2 @ 100 mm HG therefore pt. needs endotracheal tube or tracheostomy and mechanical ventilation
- If lesion of hematoma is the cause then, surgery is needed
- to redue tissue volume related to cerebral tissue swelling and edema includes the use of diurectics and corticosteroids