ICP + TBIs Flashcards
(67 cards)
1
Q
brain metabolic activity
A
20% of cardiac output
25% of total body glucose
2
Q
autoregulation
A
ability of brain to maintain a constant perfusion despite wide variations in blood pressures
ensures cerebral blood vessels dilate in response to a perceived increase in requirements
3
Q
MonroKellie Hypothesis
A
intracranial volume (VIC) = brain volume + blood volume + CSF volume + lesion volume
4
Q
cerebral perfusion pressure (CPP)
A
CPP = MAP-ICP
normal CPP = 50-60
5
Q
normal MAP
A
60-90
6
Q
normal ICP
A
5-15
7
Q
low CPP
A
CPP < 40-50 leads to hypoxia of cerebral tissue and loss of autoregulation
8
Q
increased ICP results in
A
decreased CPP
9
Q
primary causes of IICP
A
brain tumor trauma nontraumatic cerebral hemorrhage ischemic stroke hydrocephalus post operative cerebral edema meningitis
10
Q
secondary causes of increased ICP
A
airway obstruction hypoxia/hypercarbia HTN/hypotension position hyperthermia seizures metabolic disorders (hyponatremia)
11
Q
hourly neuro assessment includes
A
GCS
pupillary response to light
motor function
vitals
12
Q
GCS
A
assesses level of consciousness, motor response to stimulus
reliable if it has been obtained prior to intubation or sedating medications
13
Q
GCS categories
A
eye opening (4) motor response (6) verbal response (5)
14
Q
GCS values
A
13-15 mild/no brain injury
9-12 moderate brain injury
< 8 severe brain injury
15
Q
causes of small pupils
A
bright room
glaucoma meds
opiates
damaged pons
16
Q
causes of dilated pupils
A
fear
anxiety
cocaine use
brainstem compression
17
Q
blown pupil
A
> 4mm
18
Q
3 types of downward herniation
A
uncal
central
tonsillar
19
Q
Cushing response triad
A
bradycardia
hypertension (widened pulse pressure)
respiratory variation
suspected herniation requires immediate response
20
Q
indications for ICP monitoring
A
severe head injury with GCS 3-8 subarachnoid hemorrhage hydrocephalus brain tumor stroke meningitis
21
Q
leading causes of TBI
A
falls
MVCs
assaults
sports related injury
22
Q
TBI patho
A
direct damage to cerebral parenchyma and axonal injury 2/2 impact to the head
23
Q
concussion
A
caused by sudden deceleration of brain against the skull
not associated with underlying parenchymal damage
24
Q
MBI sx
A
amnesia headache anxiety dizziness fatigue
25
cerebral contusions and diffuse axonal injuries
often result of acceleration/deceleration injuries
26
contusions
brain accelerates against fixed skull
disruption of underlying cerebral parenchyma and blood vessels
brain may recoil and impact skull on opposite side
coup/countercoup injury
cerebral edema develops in 24-72 hrs
may result in IICP
27
diffuse axonal injuries
deceleration and shearing between different densities of white and grey matter in the brain
graded from I-III
28
linear skull fracture
nondisplaced
| occur from low velocity impact
29
depressed skull fracture
depression of bone at point of impact
| may be closed or open
30
basilar fractures
occur at base of skull
31
vascular injuries
may result from bleeding of arteries and veins between the brain and the skull or in the brain tissue
bleeding that occurs between the brain and the skull is a surgical emergency !!!
32
epidural hematoma
```
bleeding between dura mater and skull
associated with skull fx
2/2 laceration in middle meningeal artery
develops rapidly
requires surgical evacuation
```
33
epidural hematoma sx
initial LOC
lucid interval
sudden re-LOC
rapid deterioration in neurologic status
34
subdural hematomas
usually 2/2 countercoup injuries and a venous bleed
| classified as acute, subacute, and chronic
35
acute subdural hematoma
```
develops within 24-48 hrs of injury
initial LOC followed by deteriorating GCS
hemiparesis
dysphagia
IICP
requires evacuation
```
36
subacute subdural hematoma
develops days-weeks following injury
clot usually liquefies
evacuation is on an elective basis
37
chronic subdural hematoma
more common in older adults
develops weeks after injury
nonspecific sx (headache, confusion, speech deficits)
may require burr holes for drainage
38
subarachnoid hemorrhage
bleeding between arachnoid and pia mater
| can be traumatic or 2/2 preexisting aneurysm
39
factors that predict death/disability for severe TBI
```
age
GCS prior to intubation
pupillary size/reaction to light
presence of extracranial injury
CT findings
presence of hypotension
```
40
severe TBI collaborative care
```
early intubation
transport
fluid resuscitation
CT scan
immediate evacuation of mass/lesion
ICU care with ICP monitoring
```
41
TBI oxygenation and perfusion
```
maintain PaO2 >60, SpO2 >90
positioning, supplemental O2
avoid hypercarbia (increases ICP)
```
42
TBI sedation and pain relief
agitation + pain increase BP and ICP
benzos (except midazolam) for sedation
propofol decreases ICP and can be titrated for neuro assessments
morphine for pain
43
osmotherapy
can decrease ICP
mannitol (diuretic)
hypertonic saline
44
CSF drainage
intraventricular catheter and a pressure transducer can drain
negligible effects on cerebral blood flow
should lower ICP immediately
45
high dose barbiturate therapy nursing considerations
```
used for refractory IICP
assess for:
hypotension
continuous ICP monitoring
mechanical ventilation
pneumonia
ileus
protect corneas
```
46
therapeutic hypothermia
| AKA target temperature mgmt
decreases ICP
prevent shivering
adverse effects: arrhythmias, coagulopathies, pulmonary infection, electrolyte imbalances, hypothermia induced diuresis
47
decompressive craniectomy
may be used in conjunction with duroplasty
indicated if continuous deterioration and s/s herniation
maintain adequate cerebral perfusion and oxygenation
48
TBIs and seizures
```
risk factors:
GCS < 10
cortical contusion
depressed skull fx
subdural, epidural, or intracranial hematomas
penetrating head wounds
a seizure within 24 hrs post injury
```
49
TBIs and nutrition
TBI pts have increased metabolic needs
TBI increases metabolic rate to 120-240% of expected
begin enteral feedings within 72 hrs
monitor blood glucose 80-120
50
TBI complications
pneumonia
ARDS
DVT
sodium imbalance
51
TBI recovery predictive factors
duration and severity of coma
duration of posttraumatic amnesia
location/size of contusions and hemorrhages in brain
other injuries
52
earliest sign of increasing ICP
change in level of consciousness
| slowed speech, delayed responses to verbal suggestions
53
vitals changes with IICP
```
increased systolic pressure
widened pulse pressure
decreasing HR
wide fluctuations in HR
hyperthermia
```
54
late s/s IICP
Cushing triad (bradycardia, HTN, bradypnea)
projectile vomiting
deterioration of LOC
hemiplegia, decortication, decerebration, flaccidity
Cheyne-Strokes respirations
loss of reflexes (pupil, gag, corneal, swallowing)
55
IICP nursing dx
```
ineffective airway clearance
ineffective breathing pattern
ineffective cerebral perfusion
deficient fluid volume r/t fluid restriction
risk for infection r/t ICP monitoring
```
56
IICP complications
brainstem herniation
diabetes insipidus
SIADH
57
pt goals
```
maintain patent airway
normalize respirations
adequate cerebral tissue perfusion
fluid balance
absence of infection
absence of complications
```
58
IICP interventions
elevate HOB to 60 degrees to promote venous drainage
frequent respiratory assessment and maintain patent airway
maintain calm atmosphere
monitor fluid status every hour I&O
use strict aseptic technique for ICP monitoring system
59
IICP things to avoid
hip flexion
valsalva maneuver
abdominal distention
any stimuli that may increase ICP
60
craniotomy
opening of skull to remove tumor, relieve IICP, evacuate clot, control hemorrhage
61
craniectomy
remove portion of skull
62
cranioplasty
repair of cranial defect using a plastic or metal plate
63
Burr holes
circular openings for exploration or diagnosis to provide access to ventricles or for shunting procedures , to aspirate a hematoma or abscess, or make a bone flapp
64
preoperative care for cranial surgery
corticosteroids, fluid restriction, mannitol/diuretics to reduce cerebral edema
abx
diazepam
65
pt care after cranial surgery
```
monitoring of respiratory fxn
frequent vitals/LOC
assess dressing for bleeding/CSF drainage
monitor for potential seizures
monitor fluid status
```
66
cranial surgery nursing dx
```
ineffective cerebral tissue perfusion
risk for imbalanced body temperature
potential for impaired gas exchange
disturbed sensory perception
body image disturbance
impaired communication (aphasia)
risk for impaired skin integrity
impaired mobility
```
67
maintaning cerebral perfusion actions
monitor respiratory status to prevent hypoxia/hypercapnia
vitals q15 min
strategies to reduce cerebral edema (peaks 24-36 hrs)
avoid extreme head rotation
