Acute Intracranial Pressure

Question 1

What is normal ICP and when to treat?

Answer 1

5-15mmHg above 20 is considered abnormal and must be treated.

Question 2

Where does fluid go when there is a change in CSF volume?

Answer 2

Subarachnoid space

Question 3

What happens to ICP when there is a change in brain tissue volume

Answer 3

Distention into the dura or compression of brain tissue

Question 4

what happens when there is a change intracranial blood volume? 4

Answer 4

Collapse of cerebral veins, collapse of dural sinuses, cerebral vasoconstriction or dilation, changes in venous outflow.

Question 5

normal cerebral blood flow

Answer 5

50ml/min/100g of brain tissue

Question 6

Autoregulation

Answer 6

the autonomic adjustment made to the cerebral blood vessels by the brain. The brain regulates its own flow in response to metabolic needs.

Question 7

stages of ICP and one thing about each

Answer 7

1. Body compensates-feeling of doom
2. Decreasing compensation- risk for secondary injury
3. Failing compensation-Manifestations of ICP (Cushings triad) This is emergent.
4. Herniation-pressure is placed on brainstem-death.

Question 8

Cerebral Perfusion Pressure math

Answer 8

CPP=MAP(mean arterial pressure) -ICP

Question 9

Normal Cerebral Perfusion Pressure

Answer 9

60 or 70mmHg-100mmHg

Question 10

When is Cerebral perfusion pressure associated with tissue ischemia? When is it incompatible with life?

Answer 10

50mmHg

30mmHg

Question 11

Damage of brain tissue can cause 5 and they all cause?

Answer 11

Hypercapnia, Acidosis, Impaired auto-regulation,HTN, brain herniation and they all cause edema.

Question 12

Vasogenic and one thing to remember

Answer 12

Type of cerebral edema caused by large molecules leaking into interstitial space.(Tumors, Toxins, Abscesses) *BBB is weakened.

Question 13

Cytotoxic and one thing to remember

Answer 13

Type of cerebral edema caused by disruption in the integrity of cell membrane causes fluid to shift into cells. causing tissue hypoxia. (Trauma, lesions) *BBB is still intact.

Question 14

Interstital Cerebral edema

Answer 14

Build up of fluid in ventricles AKA hydrocephalus caused by obstruction of flow.

Question 15

What is the MOST sensitive and reliable indicator of neurological status?

Answer 15

Change in LOC

Question 16

When ICP increases people vomit what is different about this?

Answer 16

No nausea beforehand

Question 17

Ptosis

Answer 17

Drooping up upper eyelid

Question 18

Ocular signs of ICP 6

Answer 18

unilateral pupil dilation, sluggish response to light, inability to move eye up, eyelid ptosis, papilledema, positive oculo-cephalic reflex

Question 19

what do pinpoint pupils mean?

Answer 19

Pons damage or drugs

Question 20

Decorticate positioning and what does it mean?

Answer 20

flexed and in (don’t forget about legs) and it means that there are problems with cervical spinal tract or cerebral hemisphere

Question 21

Decerebrate positioning and what does it mean?

Answer 21

Extensor problems within midbrain or PONS

Question 22

things the Glasgow coma scale assesses and when is it a problem

Answer 22

Eye opening, verbal response, Motor response. less than 8.

Question 23

Cushings triad

Answer 23

Increase in systolic BP, decrease in pulse, decreased respirations.

Question 24

apneustic breathing related to… and what does it look like?

Answer 24

Related to pons Prolonged inspiratory phase or pauses alternating with expiratory incompletion

Question 25

Drugs for ICP 9

Answer 25

Mannitol, hypertonic saline, corticosteroids, H2 receptor antagonists, Anti seizure meds, antipyretics, Sedatives, analgesics, barbiturates.

Question 26

What does mannitol do?

Answer 26

Osmotic diuretic from ISF to ECF

Question 27

Why use H2 receptor antagonists?

Answer 27

prevent GI bleeds and ulcers

Question 28

Why use sedatives, analgesics, barbiturates?

Answer 28

Paralyze so we can intubate

Question 29

Patient position for ICP

Answer 29

HOB 30 head in neutral, midline position

Question 30

Where do you want systolic BP to be?

Answer 30

100-160mmHg

Question 31

Suction time? Why

Answer 31

Less than 10-15 seconds to prevent cough

Question 32

Why give laxatives?

Answer 32

avoid straining.

Question 33

What is a brain abscess?

Answer 33

Build up of puss from local or systemic infection

Question 34

Nursing measures to treat brain abscess

Answer 34

similar to meningitis and IICP

Question 35

Primary bacteria associated with Abscess?

Answer 35

Staph and strep

Question 36

S/S of meningitis 4 you don't know

Answer 36

Nuchal rigidity, photophobia, positive kernigs or brudzinski sign.

Question 37

What is Brudzinski's sign?

Answer 37

patient neck is flexed by the primary and patient will flex their hips and knees.

Question 38

what is kernigs sign

Answer 38

the primary is unable to extend the patients leg at the knee when the thigh is flexed due to stiffness of the hamstrings.

Question 39

Neisseria Meningitis common with? S/S

Answer 39

College students, Cough, HA, Sore throat, upper respitor symptoms, mid stage-flu like symptoms, and petechial skin rash, purpura

Question 40

Bacterial meningitis differences 5

Answer 40

Turbid, purulent, higher protein levels, glucose is decreased, neutrophils

Question 41

Why manage a fever with meningitis? 5

Answer 41

Fever increases cerebral edema, IICP, seizures, and metabolic rate, can lead to neuro damage

Question 42

Viruses that cause meningitis? 4 and most spread by

Answer 42

Enterovirus, arbovirus, herpes, HIV contact with respiratory secretions.

Question 43

What is encephalitis? caused by? 6

Answer 43

Acute inflammation of the brain. Vectors, measles, mumps, Chicken pox, HSV, cytomegalovirus

Question 44

What to remember about s/s for encephalitis

Answer 44

Any CNS abnormality can occur.

Question 45

hemiparesis

Answer 45

Weakening on one side of the body

Question 46

Treatment for encephalitis

Answer 46

Care that you would give everyone! atelectasis, skin breakdown, DVT, fluids, nutrition, constipation

Question 47

MAP normal and equation

Answer 47

70-150 and SBP+2DBP/3