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Flashcards in Acute Intracranial Problems - Modified SG Deck (69)
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1

Calculate CPP

CPP = MAP - ICP
CPP = Flow x Resistance
MAP = ((SBP-DBP)1/3) + DBP

2

Clinical Manifestations of Increased ICP

Changes in LOC - most reliable
Cushing's Triad
Changes in Pupils
Decrease in Motor Functions
Nocturnal Headache or Morning headache that's worsened with straining, agitation, and movement
Projectile vomiting or Vomiting with no nausea

3

Cushing's Triad

MEDICAL EMERGENCY
Systolic HTN with widening pulse pressure
Bradycardia with bounding pulses
Irregular respirations

4

How does Compression of cranial Nerve III look like?

Dilated pupils on same side as mass lesion (ipsilateral)
Sluggish or no response to light
Inability to move eye upward and adduct
Ptosis (eye drooping)

5

Neurologic emergency for eyes

Fixed, unilateral, dilated pupil

6

Clinical Manifestations of CN II (optic), CN IV (trochlear,), CN VI (abducens) damage

Blurred vision
Diplopia
Changes in extraocular eye movements

7

Clinical Manifestations Central Herniation

Sluggish but equal pupil response

8

Clinical Manifestations Uncal Herniation

Dilated unilateral pupil

9

Clinical Manifestations Papilledema

Edematous optic disc on retinal examination
Nonspecific signs but always with increased ICP

10

Decrease in Motor functions

Contralateral hemiparesis or hemiplegia
Decorticate posture
Decerebrate posture

11

Decorticate posture

Internal rotation and adduction of the arms with flexion of elbows, wrist and fingers.
Extension, internal rotation and plantar flexion of lower extremities

12

Decerebrate posture

Arms are stiffly extended, adducted and hyperpronated.
Hyperextension of the legs with plantar flexion of the feet.

13

Important Nursing Assessment of increased ICP (and Head Injury)

Glasgow Coma Scale
Neuro Assessment:
Comparing pupils with one another
Test pupils with light reaction
Assess eye movements
Test motor strength for awake and cooperative pts.
Assess for motor response with unconscious or unresponsive pts.
Record v/s

14

GCS

Lowest score: 3, Highest score: 15
Eyes Open (4 total)
Verbal Response (5 total)
Motor Response (6 total)
If any category is unstable, they get a U

15

GCS Eyes Open

Eyes Open (4 total)
Spontaneous response- 4
Opening eyes to name or command - 3
Lack of eye opening to previous stimuli but opens to pain - 2
Does not open eyes to any stimulus - 1

16

GCS Verbal Response

Verbal Response (5 total)
AOx 4 and appropriate conversation- 5
Confused, conversant but disoriented in 1 or more spheres - 4
Inappropriate or disorganized word choices or lack of sustained conversation - 3
Incomprehensible words or sounds - 2
Lack of sound with painful stimuli - 1

17

GCS Motor Response

Motor Response (6 total)
Obedience of command - 6
Localization of pain, lack of obedience but presence of attempts to remove offending stimulus - 5
Flexion withdrawal, Arms flexed with pain but not abnormally - 4
Abnormal flexion, making a fist, flexing of arm at elbow and pronation - 3
Abnormal extension, extension of arm at elbow usually with adduction and internal rotation of arm at shoulder - 2
Lack of response - 1

18

Nursing Management of increased ICP

Maintain ABCs, esp, respiratory function
Sedate pt to deal with pain
Monitor fluid and electrolyte balance
Monitor ICP
Maintain proper body position
Protect pt from injury with surroundings
Assess psychologic considerations

19

How do you promote respiratory function?

Maintain airway patency
Monitor breathing patterns - Snoring sounds indicate obstruction and need immediate intervention
Intubate PRN,
Suctioning should only be done when necessary because it can increase ICP
Monitor and evaluate ABGs
NG tube to prevent abd distention but not with facial or skull fractures

20

Opioids

Fast response with minimal effect on CBF and O2 metabolism

21

Propofol (Diprivan)

Opioid used to manage anxiety and agitation

22

Dexmedetomidine (Precedex)

Alpha2- adrenergic agonist used for continuous IV sedation of intubated and mechanically ventilated pts in ICU for 24 hours
Hypotension - lowers CPP

23

Nondepolorizing neuromuscular blocking agents

Used for complete ventilatory control in treatment of refractory intracranial HTN.

24

Benzodiazepine

Avoided due to hypotensive effect and long half-life

25

How do you monitor fluid and electrolyte balance in pts with increased ICP?

Record I&O and daily weights
Monitor serum electrolytes
Monitor urine output for DI and SIADH
DI- increased urine output and hypernatremia
SIADH- decreased urine output and dilutional hyponatremia

26

What should the pt with increased ICP should avoid doing?

Coughing, sneezing and Valsalva maneuver.

27

Proper positioning in pts with increased ICP

Head-up position with head in midline position.
Elevate HOB to promote drainage from head
Turn the pts with slow, gentle movements
Avoid extreme hip flexion

28

How do you protect pt with increased ICP from injury?

Quiet, nonstimulating environment with calm, reassuring approach.
Use restraints PRN
Antisz precautions

29

Types of Head Injuries

Scalp Lacerations
Skull fractures
Head trauma

30

Scalp Lacerations

External head trauma with profuse bleeding