Intracranial regulation/increased ICP

Question 1

how long after a primary injury to the brain does a secondary injury occur?

Answer 1

hrs to days

Question 2

what is our goal regarding secondary injuires?

Answer 2

prevent futher damage as these can worsen the outcome significantly beyond a primary injury

Question 3

what are the three main componants that try to compensate for increased ICP?

Answer 3

brain tissue, blood, and CSF

Question 4

what is normal ICP?. at what ICP is there a risk for ischemia and infarction?

Answer 4

<15. 20mmgh

Question 5

how does the brain tissue compensate for increased ICP?

Answer 5

distention of dura, compression of tissue

Question 6

how does blood compensate for increased ICP?

Answer 6

vasoconstriction of cerebral vessels

Question 7

how does csf compensate for increased ICP?

Answer 7

production slows down and shifts to spinal column

Question 8

what is cerebral perfusion pressure? what is its normal range? what is the necessary number for adequate perfusion? at what number is it incompatible with life?

Answer 8

it is the pressure needed to ensure adequate cerebral perfusion (like BP for the brain). should be 70-100. minimum is 50-60. deadly is <30.

Question 9

what is the formula for CPP?

Answer 9

MAP - ICP

Question 10

if pt’s MAP is 85 and ICP is 19, what is their CPP? is this adequate?

Answer 10

66. it’s not ideal but its not deadly

Question 11

what could hypercarbia cause in a brain injury scenario?

Answer 11

dilation of cerebral vessels resulting in creased ICP

Question 12

if cerebral vessels were vasoconstricted and CPP was decreased, what could this be a resut of?

Answer 12

hypocarbia

Question 13

what three things are very important for nurse to monitor and keep withint normal range after a brain injury?

Answer 13

BP, O2 levels and CO2 levels (requires ABG)

Question 14

which things should a nurse keep in mind related to positioning when managing a patients ICP?

Answer 14

HOB at 30 degrees and avoid sudden changes (like abrupt standing).
keep head midline and avoid neck flexion.
avoid hip flexion
avoid coughing and straining

Question 15

which of these interventions is incorrect in managing a delicate ICP patient?
- give laxatives to prevent constipation
- give oxygen before and after suctining
- cluster care to give patient long rest periods
- maintain quiet environment and limit visitors

Answer 15

clustering care is incorrect. We want to give patient breaks between nsg care. they can’t handle a lot of interventions at once without having increased ICP

Question 16

when compensatory mechanisms are in tact, what are the signs of increased ICP we will see?

Answer 16

• unilateral pupil change in size, reactivity
• altered resp pattern (brady or irreg)
• unilateral hemiparesis
• speech and visual disturbances
• papilledema
• vomiting
  -headache
  -seizures

Question 16

a patient with head injury is vomiting, complaining of greying out of their vision, and one of the pupils is larger and less reactive than the other. are these early, late , or terminal signs of increased ICP?

Answer 16

early

Question 16

True or false: Cheyne-Stokes respirations are a terminal sign of increased ICP

Answer 16

false, these are LATE signs when the compensatory mechanisms are failing

Question 17

patient has hypertension with widened pulse pressure, and bradycardia. what is this considered?

Answer 17

cushings triad

Question 18

when a patient has decompensated with increased ICP, what is their LOC and what are their respirations like?

Answer 18

Coma, resp arrest

Question 19

what are early indicators of altered LOC?

Answer 19

restlessness, irritability

Question 20

if someone’s GCS is less than 8 and we need to monitor ICP closely and possibly drain CSF, what procedure would be done? What unit would this occur on?

Answer 20

external ventricular drain (EVD). ICU or stepdown

Question 21

three nursing considerations for EVD

Answer 21

high risk of infection (proph abx),
body position should not change
- transducer stays level with foramen of monro (tragus of ear)

Question 22

why would we give Lasix for IICP?

Answer 22

adjunctive to mannitol

Question 23

why would we give corticosteroids for IICP?

Answer 23

decrease inflammation from brain tumor

Question 24

what two reasons would we give NS 3% in head injury?

Answer 24

to reduce ICP, and to treat low sodium which is common in IICP

Question 25

is it indicated or contraindicated to insert an NG tube for IICP?

Answer 25

can be indicated to relieve pressure on diaphragm in order to increase respiratory impact. (However, if there might be a skull fracture it would not put on in)

Question 26

why would we monitor urinary output with IICP?

Answer 26

because brain tumor or injury can cause DI and SIADH

Question 27

why do we want to control fever and pain with IICP?

Answer 27

because higher temp means high metabolism which increases ICP

Question 28

what improves outcomes after brain injury?

Answer 28

early feedings

Question 29

IICP is a(n) ________ ________ and _______ state

Answer 29

increased hypermetabolic and catabolic

Question 30

why would someone with IICP be at risk for injury? how can we protect them?

Answer 30

because they have risk for seizures and and confusion/agitation. we can pad the side rails and possibly light sedation.