Increased intracranial pressure

Question 1

what does increased intracranial pressure mean?

Answer 1

high amounts of pressure in the head; which can lead to squishing the brainstem and lead to breathing issues and heart rate

Question 2

what are some causes of increased intracranial pressure?

Answer 2

stroke
inflammation- head trauma
tumor

Question 3

can you explain and walk through the patho behind increase icp?

Answer 3

with the amount of pressure in the brain increasing, it can place pressure on the vessels and arteries that carry out oxygen to the rest of the body.

This compression and lack of oxygen ends up leaving our patient with a reduced level of consciousness or decreased mental status - hypoxia

Question 4

what is the earliest/ first sign of increased intracranial pressure?

Answer 4

altered level of consciousness
decreased mental status

Question 5

what are some other early signs that a patient with increased icp may have?

Answer 5

altered LOC ; irritability, restlessness

decreased mental status

sleepiness

flat affect and drowsiness

Question 6

what are moderate signs and symptoms (2)?

Answer 6

headache - constant

sudden vomitting without nausea

Question 7

what is a way the body helps regulate and maintain icp?

Answer 7

monro-kellie doctrine

Question 8

what is the monro-kellie doctrine?

Answer 8

in essense
increased CSF
decrease blood and brain tissue

Question 9

what is normal icp ?

Answer 9

5-15

Question 10

what is the range of pressure that is needed to maintain blood flow to the brain?

Answer 10

60-100

Question 11

what are the 4 stages of increased icp?

Answer 11

stage 1. compenstation
stage 2. decreaed comp
stage 3. cushing triad
stage 4. herniation and death

Question 12

late and deadly signs include what?

lungs -
neck -
eyes -
foot -

Answer 12

irregular respirations
( cheyne-stokes respirations )

nuchal rigidity
( stiff neck )

pupils are fixed and dilated or unequal

babinksi relfex is positive

Question 13

typically on a test, when a patient complains about not being able to flex chin towards the chest, we want to think about what?

Answer 13

a late, deadly sign of increased intracranial pressure

Question 14

what is normal dilation of the pupil?

Answer 14

2-6

Question 15

what type of eye movement do we want or looking for when we are turning the patient ?

Answer 15

dolls eyes
- their eye move in the opposite direction when the head is turned

Question 16

when do we see seizures and comas typically for patients in increased icp?
early, moderate or late signs?

Answer 16

late signs

Question 17

when do we see abnormal posturing in patients with increased icp?
early, moderate or late sign

Answer 17

late

Question 18

what are the two postures and briefly describe them ?

Answer 18

decortibate - flex to core
decerebreate - extension out of core

Question 19

we talked about cushing triad in another flashcard group, can you tell me the 4 signs and symptoms that happen in late increased icp?

Answer 19

widening pulse pressure
hypertension
bradycarida
decreased respirations

Question 20

what are diagnostic studies we do for patients with increased icp?

Answer 20

CT scan

Question 21

why do we not do a spinal tap or lumbar puncture for a patients with icp?

Answer 21

can cause herniation

Question 22

client found on the floor, appearing lethargic, bleeding at the back of the head, heart rate of 45 bpm, and a blood pressure of 220/88. What is the first action?

Answer 22

immediately c-spine immbolization & ct-scan to rule out intracranial bleeding

Question 23

what is the anagram that we can use for a patient with increased icp to help remember the nursing interventions?

Answer 23

ICPS

Question 24

what does icps stand for ?

Answer 24

immbolize head ( c-spine )
- head in neutral position
- log roll as one unit

Co2 LOW - aids with vasodilation
( normal is 35-45)
- hyperventilate to blow off co2

positiong
semi-fowlers (30-35)
NO FLEX OR BENDING
no coughing, sneezing, blowing nose, valsalva manevuers

suctioning
10 seconds or less
limit it
100% oxygen before and after

Question 25

what type of movement are we going to do for a patient with an immbolize head in a c-spine ?

Answer 25

log roll them - as if they were one unit

Question 26

why do we want carbon to be low for a patient with increased icp?

Answer 26

because lowering carbon can help aid with vasodilation and promote reducation of pressure - this is why we hyperventilate if they are on a machine to push out all the carbon

Question 27

what type of position do we want patients with icp to be in? what is the head of the bed at?

Answer 27

semi-folwers 30-35

Question 28

what are we instructing the patient to not do? (6) these things increase the pressure in the brain

Answer 28

cough, sneeze, blowing, flexing, bending, valsva manuvers

Question 29

if the patient wants to move, what do we instruct them to do in order to help avoid pressure in the head?

Answer 29

exhale when turning or moving in bed

Question 30

immediate intervention when client with icp states - i will turn cough and deep breathe why is this super bad!!

Answer 30

because it creates so much pressure

Question 31

how long are we going to be suctioning for? should we do this often?

Answer 31

10 seconds or less no, limit it as much as possible

Question 32

before and after we suction a patient with increased intracranial pressure, what are we going to do?

Answer 32

hyperoxygenated 100% oxygen

Question 33

what type of scale are we going to use to measure level of consciousnes?

Answer 33

GCS

Question 34

what is the range of gcs? lower than ___we intubate whats the lowest ?

Answer 34

3-15 8 3

Question 35

client recovering from a head trauma, gcs of 14 over 2 ohurs ago but now reporting a gcs score of 11, what do we do ?

Answer 35

report to the hcp immediately

Question 36

if a patient doesnt have a gag reflex, should we intubate them?

Answer 36

yes

Question 37

inaccurate readings can be caused by csf leaks, obstruction, differences in height of bolt, bubbles or air in the tubing, so we should always base our assessment on what rather than what?

Answer 37

assess patient first before machine

Question 38

increased intracranial pressure is a what and not a what?

Answer 38

symptom not a condition

Question 39

we can control icp by removing csf with what?

Answer 39

ventricular catheter with intermittent or continous drainage

Question 40

why is infection at its highest here with a ventricular catheter?

Answer 40

direct entry way to the brain - highest risk if its still in placed for more than 5 days

Question 41

drug therapy now regarding increased icp what are we going to use to help pull out the fluid from the head (2)? what are we goint to use to help with the swelling and inflammation in the head? (2) what are we going to use to prevent seziures?

Answer 41

mannitol or hypertonic saline corticosteroids and barbitues phenytoin

Question 42

if we are going to manage the pain for patients with icp with opioids, what shuold we take into consideration?

Answer 42

sedation - causes drowsy and can distrub neuro exams

Question 43

what is the best pain medication we like giving to patietns with icp and why?

Answer 43

propofol (diprivan) - short half life, so easy to do neuro exams

Question 44

what is the amount of fluid these patients can consume?

Answer 44

1200 per day

Question 45

why would the patient shivering be a bad sign and should be corrected for a patient with icp?

Answer 45

shivering can increase the pressure

Question 46

why would we want to give antipyrteics?

Answer 46

helps avoid a fever

Question 47

why would we give msucle relaxnats?

Answer 47

it would help prevent shivering