Increased ICP General Care

Question 1

Normal ICP?

Answer 1

0-15 mmHg

Question 2

Early signs of increased ICP

Earliest sign?

Answer 2

Change in LOC

Question 3

Early signs of increased ICP

Speech

Answer 3

Slurred or slowed

Question 4

Early signs of increased ICP

Delay in response to ____ suggestion

Answer 4

Verbal

*slow to respond to commands

Question 5

Early signs of increased ICP

Increase ___

Answer 5

Drowsiness

Question 6

Early signs of increased ICP

___ with no apparent reason

Answer 6

Restless

Question 7

Early signs of increased ICP

Confused?

Answer 7

Yes

Question 8

Late signs of increased ICP

Marked change in LOC progressing to ___ then ___

Answer 8

Stupor then coma

Question 9

Late signs of increased ICP

VS changes?

Answer 9

Cushing triad!!! –Immediate intervention to prevent brain ischemia

Question 10

Late signs of increased ICP

What is cushing triad?

Answer 10

Systolic HTN with widening pulse pressure
Slow, full, bounding pulse
Irregular respirations

Question 11

Narrow pulse pressure = ?

Answer 11

Cardiac tamponade

Question 12

Wide pulse pressure= ?

Answer 12

Late sign of increased ICP

Question 13

Late signs of increased ICP

What respiration pattern?

Answer 13

Cheyne stokes or ataxic respirations

Question 14

Late signs of increased ICP

Posturing

Answer 14

A response to painful or noxious stimuli

*posturing indicates that the motor response centers of the brain are compromised

Question 15

Late signs of increased ICP

What is decorticate posturing?

Answer 15

Arms flexed inward and bent toward the body and legs are extended

Arms flexed
Legs extended

Question 16

Late signs of increased ICP

What is decerebrate posturing?

Answer 16

All 4 extremities in rigid extension

Question 17

Late signs of increased ICP

What is worse: decorticate or decerebrate?

Answer 17

Decerebrate

Question 18

Misc. signs?

Answer 18

HA
Changes in pupils and pupil response
Projectile vomiting

Question 19

Misc. signs

Pupils in profound coma?

Answer 19

Fixed and dilated

Question 20

Misc. signs

Why projectile vomiting?

Answer 20

Vomiting center in brain is being stimulated

Question 21

Complications of increased ICP?

Answer 21

Brain herniation

DI and SIADH

Question 22

Treatment of increased ICP

Maintain ___

Answer 22

Oxygenation –most controlled with vent

*decreased O2 and high CO2 cause cerebral vasodilation which increases ICP

Question 23

Treatment of increased ICP

Maintain adequate cerebral perfusion. How?

Answer 23

Don’t want hypotension or bradycardia bc that would decrease brain perfusion

Give isotonic saline and inotropic agents (dobutamine and norepinephrine)

Question 24

Treatment of increased ICP

Keep temp at?

Answer 24

Below 100.4 F

• increased temp = increase cerebral metabolism = increase ICP
• hypothalamus may not work and you would need to get a cooling blanket
• hypotheremia is used as a tx to decrease cerebral edema by decreasing the metabolic demands of brian

Question 25

Treatment of increased ICP HOB

Answer 25

Elevate Keep head midline so jugular veins can drain *watch ICP monitor when turning client

Question 26

Treatment of increased ICP Avoid

Answer 26

``` Restraints Bowel/bladder distention Hip flexion Valsalva Isometrics No sneezing No nose blowing Limit suctioning and coughing ```

Question 27

Treatment of increased ICP Nursing interventions

Answer 27

Space them --anytime you do something with client, it increased ICP

Question 28

Treatment of increased ICP Monitor GCS...explain

Answer 28

GCS below 8, intubate

Question 29

Treatment of increased ICP VS

Answer 29

Monitor for cushing

Question 30

Treatment of increased ICP What does barbiturate induced coma do?

Answer 30

Decreases cerebral metabolism

Question 31

Treatment of increased ICP What does osmotic diuretics do?

Answer 31

Pull fluid from brain cells and filters out through kidneys *osmotic diuretics can crystallize

Question 32

Treatment of increased ICP What do steroids like dexamethasone do?

Answer 32

Decrease cerebral edema

Question 33

Treatment of increased ICP ICP monitoring device Greatest risk? No loose ____ Keep dressings moist or dry?

Answer 33

Ventricular catheter monitor or subarachnoid screw Infection No loose connections Keep dressings DRY (bacteria can travel through something that is wet much easier than something that is dry)