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4 Cards in this Set
- Front
- Back
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ICP
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- 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 *** |
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ICP manifestations with some interventions
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- 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 *** |
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Diagnostics
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Lumbar puncture
Not done if ICP is suspected because the risk of herniation |
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Interventions
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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 |
