QUIZ #1 FINALS: ICP

Question 1

The brain contains ___% brain tissue, __% blood, and __% cerebrospinal fluid

Answer 1

80
10
10

Question 2

→ Normal Value of ICP: ____ mmHg

Answer 2

0 to 15

Question 3

❖ CAUSES OF INCREASED ICP

Answer 3

→ Subdural Hematoma.
→ Epidural Hematoma.

Question 4

→ This is responsible for the production of cerebrospinal fluid.

▪ CSF acts as a cushion for the brain and spinal cord, needed for the transport of neurotransmitters, and also removes waste products from the brain.

Answer 4

❖ CHOROID PLEXUS

Question 4

TO KNOW
→ Trauma, inflammation, or surgery can cause tissue edema, which in turn increases intracranial pressure (ICP) due to limited space.

The elevated ICP compresses the blood vessels in the brain, reducing cerebral blood flow. Consequently, decreased cerebral blood flow results in insufficient oxygenation, leading to brain cell death.

Answer 4

TO KNOW

Question 5

▪ Pooling of blood between the dura mater and arachnoid mater.

Answer 5

→ Subdural Hematoma.

Question 6

▪ Pooling of blood between the dura mater and the skull.

Answer 6

→ Epidural Hematoma.

Question 7

▪ It is a term used to characterize decreased blood supply in an area of the brain.
✔ It is caused by a clot of blood in the brain, which can obstruct the blood flow to an area of the brain.

Answer 7

→ Penumbra.

Question 7

▪ It is the ballooning of an artery in the brain, which can possibly rupture, leading to blood leakage into the brain.

Answer 7

→ Cerebral Aneurysm.

Question 8

▪ It is the buildup of fluid in cavities called ventricles deep within the brain.

Answer 8

→ Hydrocephalus.

Question 9

❖ STAGES OF INTRACRANIAL HYPERTENSION
▪ It refers to the abnormal displacement of brain tissue due to increased ICP.
▪ For example, if there is an aneurysm in the left hemisphere that enlarges and ruptures, pooling of blood can occur, leading to compression and displacement of brain tissue. This pooling of blood increases intracranial pressure (ICP) and can contribute to herniation, wherein the increased pressure displaces brain tissue from its normal position.
▪ The patient is near death

Answer 9

→ Stage 4. Herniation (swelling)

Question 9

▪ Blood clots can obstruct blood flow through the vessels of the _____, reducing the delivery of oxygen and nutrients to the brain tissue. This can lead to ischemia (lack of blood flow) and subsequent cell death, resulting in cerebral edema (swelling of the brain) and increased ICP.

Answer 9

circle of Willis

Question 10

❖ STAGES OF INTRACRANIAL HYPERTENSION
the body compensates by:
✔ The cerebral arteries constrict to reduce blood supply to the brain.
✔ The brain (choroid plexus) may decrease the production of cerebrospinal fluid or will increase CSF reabsorption.
✔ S/sx: drowsiness and slight confusion, but VS is still normal.

Answer 10

→ Stage 1. Compensatory

Question 11

▪ It is a condition characterized by the absence of capillaries.
▪ It is a congenital defect. Therefore, when you are born, you do not have capillaries; instead, there is a direct connection between the arteries and the veins. The pressure in the arteries is higher than in the veins, which can cause dilation of the veins and potentially lead to rupture, resulting in an aneurysm. Over time, when an aneurysm ruptures, blood will start to ooze into the brain, which can increase intracranial pressure (ICP).

Answer 11

→ Arteriovenous Malformation.

Question 11

✔ ______ are responsible for connecting the arteries and veins, facilitating the exchange of substances such as gases, electrolytes, glucose, etc. within the body.

Answer 11

Capillaries

Question 12

▪ ____, which can be expressive aphasia (inability to express oneself), receptive aphasia (inability to understand language), or global (mixed) aphasia.

Answer 12

Aphasia

Question 12

❖ STAGES OF INTRACRANIAL HYPERTENSION
▪ During this stage, there is a decrease in the level of consciousness due to the constriction of arteries in the brain, leading to reduced oxygen supply and accumulation of carbon dioxide.
▪ Good blood flow = removes CO2
▪ S/sx: deterioration in the LOC, confusion, pupils are still reactive and equal, breathing pattern is abnormal.

Answer 12

→ Stage 2. Constriction of Cerebral Arteries

Question 12

❖ STAGES OF INTRACRANIAL HYPERTENSION
▪ Accumulation of carbon dioxide will result in dilation of cerebral arteries. The dilation of cerebral arteries will further increase intracranial pressure (ICP), as it allows more blood to flow into the brain.
▪ S/sx: unequal pupils, widened pulse pressure, bradycardia (…. vagus nerve) , febrile (because hypothalamus is affected), projectile vomiting (due to increased pressure in the reflex center in the medulla)

Answer 12

→ Stage 3. Dilation of Cerebral Arteries.

Question 12

▪ ____ (inability to perform a previously learned action), as may be seen when a patient makes verbal substitutions for desired syllables or words.

Answer 12

Apraxia

Question 13

▪ Assessment:

Answer 13

✔ Snellen Test
✔ Confrontation Test (Peripheral Visual Field)

Question 13

▪ _____ (difficulty in speaking) or _____ (impaired speech), caused by paralysis of the muscles responsible for producing speech.

Answer 13

Dysarthria
dysphasia

Question 14

● It’s a type of breath seen in individuals near death. It begins with apnea (lasting 30 seconds to 2 minutes), followed by rapid breathing, which gradually becomes shallower until it stops altogether.

Answer 14

✔ Cheynes-Stokes Breathing

Question 14

→ Motor Impairment
▪ Early: ____ (weakness) or ___ (paralysis) of the contralateral side.
✔ If the lesion is in the right H, H & H would manifest on the ____ side. Conversely, if the lesion is in the left H, H & H would occur on the __ side.

Answer 14

Hemiparesis
Hemiplegia
left
right

Question 15

→ Homonymous Hemianopia
NURSING MANAGEMENTS

Answer 15

✔ Place objects within an intact field of vision.
✔ Approach the patient from the side of the intact field of vision.
✔ When educating the patient, do so within the patient’s intact visual field.
✔ Always orient the patient.
✔ Place the call button on the unaffected side.

Question 15

→ Motor Impairment
▪ Late: D__ or D__ positioning flaccidity.

✔ ____ = diencephalon is damaged (thalamus, epithalamus, and hypothalamus).
● The hypothalamus regulates pleasure sensations, emotions, thirst and hunger sensations, and sexual arousal.
✔ ___ = brainstem is damaged

✔ D__ and D__ posturing reflects significant brain dysfunction and are frequently associated with increased ICP and early herniation

Answer 15

Decorticate or Deccerabrate
Decorticate
Decerebrate
Decorticate AND Deccerabrate

Question 15

✔ _____: The pyramidal tracts control both hemispheres initially, but once they reach the brain stem, they cross over. Consequently, the right hemisphere controls the left side of the body, while the left hemisphere controls the right side.

Answer 15

Pyramidal Decussation

Question 15

▪ Normal: 30 to 40 mmHg
▪ Increased ICP diminishes blood supply to the brain, which can affect neurons due to inadequate nutrition, further exacerbating the increase in ICP.
✔ The brain should receive 700 cc to 1000 cc of blood every minute.

Answer 15

→ Widened Pulse Pressure (late manifestation)

Question 15

→ Bedridden/Paralyzed - NURSING INTERVENTIONS

Answer 15

✔ Use elastic compression stockings because they compress the muscles, causing the veins to contract and aiding in the push of blood toward the heart.
✔ Perform ankle pumps because these cause muscle contractions, which promote venous return to the heart.
✔ Perform passive exercises to promote venous return and prevent pooling of blood in the lower extremities.
✔ Encourage increased fluid intake to maintain adequate hydration, which helps prevent dehydration and reduces the viscosity of blood, thus preventing clot formation.
✔ Reposition the patient every 2 hours to prevent pressure ulcers and promote circulation, aiding in venous return.
✔ Never apply a pillow under the knees because it can cause pressure in the popliteal vein thus blood accumulation happens.

Question 16

▪ These manifestations indicate a very poor prognosis, and the damage in the brain is irreversible.
▪ Manifestations: - represents the brainstems final effort to maintain cerebral perfusion.
✔ Increased Pulse Pressure (Normal: 30 to 40 mmHg)
✔ Bradycardia
✔ Altered RR

Answer 16

→ Cushing’s Triad (late manifestation)

Question 17

❖ ANEURYSM PRECAUTION: NURSING CARE

Answer 17

→ Place the patient in a semi fowler’s position or sim’s position.
→ Any activity that suddenly increases the BP or obstructs venous return is avoided.
▪ Placing the patient in a 90-degree position because the blood in the lower extremities has a hard time returning to the right side of the heart due to hip flexion, which can lead to blood viscosity and thrombus formation.
▪ smoking - vasoconstriction
▪ drinking alcohol
▪ Valsalva maneuver (e.g., during bowel movements, pushing up in bed, reaching for an item on a bedside table that is out of reach, prompting the patient to take a deep breath and hold it)
▪ acute flexion or rotation of the head and neck
▪ pushing or pulling
▪ Sneezing or Coughing
✔ Advise the patient to avoid eating foods that can irritate their pharynx, such as popcorn, cornick, peanuts, crackers, to prevent coughing.
✔ Advise the visitors of the patient to avoid bringing flowers to prevent the patient from sneezing.
✔ Clean the room with a damp cloth or vacuum to prevent the patient from sneezing.
→ Place the patient on bedrest in a quiet setting.
→ Avoid the flexion, extension, and lateral rotation of the head and neck.
→ Avoid extreme hip flexion because the blood in the lower extremities has a hard time flowing to the right side of the heart.
▪ increases intrathoracic pressure and interferes with venous drainage
→ Assist the patient to turn and move self in bed; instruct the patient to exhale while turning or pushing up in bed.
→ Maintain patent airway and adequate ventilation of oxygen to prevent hypoxemia and hypercarbia.
▪ Hypercarbia can cause vasodilation, which can further increase ICP.
▪ The bronchi should be patent and not partially obstructed because it will reduce the oxygen supply to the brain.
✔ Turn the patient every 2 hours to mobilize the mucus.
✔ Humidify the air to facilitate the patient’s ability to cough out the mucus.
✔ Implement postural drainage.
✔ Increase fluid intake to thin the mucus if cerebral edema has been treated; the patient has stopped mannitol, indicating the absence of edema.
✔ Allow the patient to ambulate if paralyzed; otherwise, place them in a wheelchair.
▪ If obstruction occurs, suction the patient, but consider it as the last intervention due to its invasiveness.
✔ When suctioning a patient with increased ICP: suctioning can increase ICP, administer 100% oxygen inhalation for 5 minutes.
✔ Insert the catheter and release to suction only for 10 to 12 seconds, and rotate it as you withdraw.
✔ Repeat after 1 to 2 minutes, limiting suctioning to two passes.
✔ After removal, immediately oxygenate the patient.
→ Plan the patient care activities and nursing interventions.
▪ Avoid unnecessary additional disturbances.
▪ Allow patient up to 1 hour of rest between activities as frequently as possible.
▪ Engaging the patient in various activities can increase ICP, including sponge baths, turning, checking of vital signs, and changing linens. Allow the patient to rest for 15 to 20 minutes between activity periods.
→ Maintain Normothermia with external cooling or heating measures.
▪ If the temperature increases by just one degree Celsius, it elevates the brain’s metabolism by 10%. Increased metabolism results in the production of carbon dioxide. Elevated levels of CO2 cause vasodilation, leading to further increase in ICP.
✔ tepid sponge bath
✔ cool the room
✔ do not wrap the patient with blanket
✔ light clothing
→ With physician’s collaboration, control seizures with prophylactic and PRN anticonvulsants.
▪ Seizures can greatly increase the cerebral metabolic rate.
✔ side rails up
✔ pillows should be ready
✔ use dim lights so that they can sleep
→ Pleasant sensations such as:
▪ stroking the arm or forehead
▪ listening to music the patient likes

Question 18

Provide Quiet Environment

Answer 18

• limit the visitors of the patient
• place the patient in a private room if they can afford, if not use curtains to provide privacy
• turn off the televisions
• encourage the family of the patient to report if
• choose a room away from the noisiest area in the hospital (nurse’s station, elevators)