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168.362 > week 4 > Flashcards

week 4 Flashcards

1
Q

What is ICP?

A
  • Intracranial pressure

- The pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue

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2
Q

What is the Monro-Kellie Hypothesis?

A

Increase in volume of one of intracranial component must be compensated by decrease in one or more of other components so that volume remains fixed

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3
Q

What is normal intracranial pressure?

A
  • 5-15 mmHg

- Greater than 20mmHg must be treated

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4
Q

How to measure intracranial pressure?

A

With a intraventricular catheter

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5
Q

What is cerebral blood flow?

A

Amount of blood that passes through the brain at any time

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6
Q

What is autoregulation?

A

The automatic alteration in the diameter of the cerebral blood flow to maintain a constant flow of blood to the brain during during systemic arterial pressure

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7
Q

What is CPP?

A
  • Cerebral perfusion pressure

- Pressure to ensure blood flow to brain

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8
Q

What is normal CCP?

A

60-100mmHg

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9
Q

What does CCP of lower than 50mmHg indicate?

A

Ischaemia and neuronal death

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10
Q

What does CCP of lower than 30mmHg indicate?

A

Incompatibility with life

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11
Q

What is the nursing assessment of ICP and how frequently?

A
  • Frequent neurological observations (30 mins-1 hr)
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12
Q

Why must a nurse complete frequent neurological observations for possible increased ICP?

A

Because a small change in volume can have dramatic effect on ICP

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13
Q

What can increased ICP?

A
  • Anything that increased brain tissue, blood of CSF volume

- Cerebral oedema common factor

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14
Q

What causes cerebral oedema?

A

Mass lesion

  • Head injuries
  • Brain surgery
  • cerebral infection
  • Vascular insult
  • Toxic or metabolic encephalopathic conditions
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15
Q

What are complications of increased ICP?

A
  • Inadequate cerebral perfusion
  • Cerebral oedema
  • Cerebral herniation
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16
Q

What does herniation cause?

A

1) A potentially reversible process to become irreversible
2) Ischemia and oedema increase
3) Compression of brainstem and cranial nerves
4) Brain death

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17
Q

What is the progression of increased ICP?

A
  • Cranial insult
  • Tissue oedema
  • Increased ICP
  • Compression of blood vessels
  • Decreased cerebral blood flow
  • Decreased oxygen with death of brain cells
  • Oedema around necrotic tissues
  • Increased ICP with compression of brainstem and respiratory centre
  • Accumulation of carbon dioxide
  • Vasodilation - Increased ICP resulting from increased blood volume
  • Death
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18
Q

What are clinical manifestation of increased ICP?

A
  • Change in LOC
  • Change in vital signs (Cushings triad=high bP with low diastolic, bradycardia, increased temp, erratic/decreased breathing)
  • Ocular signs
  • Decrease in motor function
  • Headache
  • Vomiting (projectile without nausea)
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19
Q

What do we assess in a neurological assessment?

A
  • Glasgow coma scale
  • Pupillary check for size and response
  • Test strength and movement
  • Vital signs
    Checking for signs of Cushing’s triad which indicates severely increased ICP
20
Q

What is a decorticate response?

A

Flexion of arms, wrists and fingers with adduction in upper extremities. Extension, internal rotation and plantar flexion in lower extremities

21
Q

What is a decerebrate response?

A

All four extremities in rigid extension, with hyperpronation of forearms and plantar flexion of feet

22
Q

What is opisthotonic posturing?

A

When the back becomes extremely arched

23
Q

What are the types of head injuries?

A
  • Scalp laceration
  • Skull fractures
  • Head trauma: diffuse or focal
24
Q

What is a diffuse injury?

A
  • Generalised
  • Concussion
  • Diffuse axonal injury
25
Q

What is a focal injury?

A

Localised minor head injury. E.g:

  • Contusion
  • Hematoma
26
Q

How do you class head injuries?

A
  • Minor: GCS 13-15
  • Moderate: GCS 9-12
  • Severe: GCS 3-8
27
Q

What is a coup-contrecoup injury?

A

Cerebral contusion on the side of the brain opposite the area that was hit. The neck must not be bent backwards until considered safe

28
Q

What is a coup injury?

A

Cerebral contusion at site of impact with an object

29
Q

What is a concussion?

A
  • Minor head injury

- Sudden transient mechanical head injury with disruption of neural activity and a change in LOC

30
Q

What are signs of a concussion?

A
  • Brief LOC
  • Amnesia regarding the event
  • Headache
  • Post concussion syndrome can last 2 weeks to 2 months
31
Q

S/S of a concussion?

A
  • Persistent headache
  • Lethargy
  • Personality and behaviour changes
  • Short attention span
  • Decreased short-term memory
  • Changes in intellectual ability
32
Q

What something to be aware of with scalp laceration?

A

profuse bleeding

33
Q

What are different types of skull fracture?

A
  • Linear
  • Depressed
  • Simple
  • Comminuted
  • Compound
    Symptoms vary depending on where the fracture is
34
Q

What to watch for when a patient has a skull fracture?

A

CSP leaking from nose or ears- indicates tear in dura

35
Q

What are clinical signs of basilar skull fracture?

A
  • Periorbital oedema and bruising
  • Bruising behind the ears
  • CSF leaking
36
Q

What is a basilar fracture?

A

Base of skull fracture

37
Q

What is contusion?

A

Bruising

38
Q

Head trauma complications: types of hematoma

A
  • Subdural hematoma
  • Intracerebral hematoma
  • Epidural hematoma
39
Q

What is a subdural hematoma?

A

Bleeding between the dura mater and arachoid layer

40
Q

What is a intracerebral hematoma?

A

Bleeding within the brain

41
Q

What is a epidural hematoma?

A

blood between the dura and the skull

Neurological emergency as associated with arterial bleed

42
Q

What are nursing interventions during the acute phase (head injury/increased ICP)?

A
  • Maintaining respiratory function
  • Maintaining fluid and electrolyte balance
  • Monitoring ICP
  • Body position
  • Protection from injury
  • Psychological consideration
  • Care of the family/ significant other
43
Q

Why monitor respiratory function in the acute phase?

A

Injury stops brain regulating breathing

44
Q

Why monitor fluid and electrolyte balance in the acute phase?

A

Injury causes excessive loss of fluids in form of urine causing abnormalities

45
Q

What is diabetes insipidus?

A

Disease in which the pituitary hormone vasopressin is impaired, resulting in the production of very large quantities of dilute urine.

S/S- dehydration and insatiable thirst.

168.362 (4 decks)

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