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26 Cards in this Set
- Front
- Back
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Untreated increased ICP can lead to brain _____ and _____ |
Herniation, death |
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ICP increases whenever something unusual occupies _____ in the cranium |
Space |
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The earliest sign of increased ICP is.... |
Change in LOC |
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The pulse pressure _____ with increased ICP |
Widens |
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Whenever there is increased ICP the _____ pressure also rises? |
Systolic |
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When there is an increase in ICP the _____ pressure remains the same |
Diastolic |
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Which pulse rate is most commonly associated with increased ICP? |
Bradycardia |
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In increased ICP, the temperature (rises/falls)? |
Rises |
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Describe the respiratory pattern found in increased ICP? |
First = central hyperventilation End = Cheyne-Stokes |
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When ICP is increased, the pupils first show? |
Unilateral dilation with sluggish reaction |
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Eventually in increased ICP, the pupils become _____ and _____ |
Fixed, dilated |
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Will the client with increased ICP have a headache? |
Yes |
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What type of vomiting is present in increased ICP? |
Projectile |
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Why does hyperventilation treat increased ICP? |
It reduces CO2, resulting in vasoconstriction -CO2 is a vasodilator in the brain, vasodilation would cause blood to occupy more space, thus an increase in ICP |
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When a patient has an increased ICP, fluids are more likely to be encouraged or restricted? |
Restricted - in order to decrease edema in the brain |
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What is papilledema and how is it associated with increased ICP? |
It is edema of the optic disc -It is present when increased ICP pushes the brain tissue through the optic foramen -Can be seen with an ophthalmoscope |
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What environmental changes are necessary when there is an increased ICP? |
Dark, calm, quiet environment |
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When there is increased ICP, the nurse should first _____ the _____ of the bed to _____ degrees |
Position, head, 10-30 |
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After positioning the HOB, the nurse should then? |
Call the doctor |
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What activities/actions MUST be avoided in the client with increased ICP? |
Sneezing, coughing (non-productive), straining at stool or doing anything that requires the valsalva maneuver |
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When a client has increased ICP, the nurse should hypo- or hyperventilate the client? |
Hyperventilate |
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The most common osmotic diuretic used to decrease ICP is... |
Mannitol |
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The most common loop diuretic given to decrease ICP is... |
Lasix |
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The most common anti-inflammatory drug given to decrease ICP is... |
Decadron |
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If analgesia is needed for the patient with increased ICP, the doctor should order _____ |
Codeine |
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Why is codeine used alone for analgesia in increased ICP? |
Because it does not depress respirations or LOC as much as other narcotics *Also it suppresses cough |
