Week 11 ICP

Question 1

What is normal ICP?

Answer 1

<15 mm Hg

Question 2

risk of ischemia and infarction occurs at what measurment of ICP?

Answer 2

> 20 mm Hg

Question 3

What are the 3 components that try to compensate for increased ICP?

Answer 3

1. brain tissue (distention of dura, compression of tissue)
2. Blood (vasoconstriction)
3. Cerebrospinal fluid (make less, displace down spinal column)

Question 4

What is normal CPP?

Answer 4

70-100 mm Hg

Question 5

What CPP is neccessary for adequate perfusion?

Answer 5

50-60 mm Hg

Question 6

What CPP is incompatibe with life?

Answer 6

<30 mm Hg

Question 7

how do we determine CPP?

Answer 7

MAP- ICP= CPP

Question 8

How do we increase CPP?

Answer 8

decrease ICP
or
increase MAP

Question 9

What is hypercarbia?

Answer 9

Increased PaCO2 causes dilation of cerebral vessels which can increase ICP

Question 10

What is Hypocarbia?

Answer 10

Decreased PaC02 causes vasoconstriction of cerebral vessels which can decrease perfusion

Question 11

What is Hypoxemia?

Answer 11

damages brain tissue and causes dilation of cerebral vessels which can increase ICP

Question 12

What do nurses monitor to avoid ICP increase?

Answer 12

BP
O2
CO2

Question 14

What do nurses want to prevent, primary or secondary brain injury?

Answer 14

secondary brain injury!

Question 15

How do we prevent and manage increased ICP?

Answer 15

1. HOB elevated 30* - no sudden vertical changes
2. Keep head midline - no neck flexion to squish blood vessels
3. no Hip flexion
4. no coughing /straining/ constipation
5. O2 want >95% (ambubag before & after suction)
6. Quiet environment
7. DO NOT cluster care d/t stress/clenching
8. VS, mouth care, etc
9. monitor closely BP, HR, temp, ICP, MAP, report inadequate CPP

Question 16

What is the first sign of IICP?

Answer 16

altered LOC

Question 17

What is a late sign of IICP?

Answer 17

Cushings triad - then Cheyenne Stokes

Question 18

What are three signs of altered LOC?

Answer 18

1. unilateral pupil change in size, equality and/or reactivity
2. altered respiratory pattern
3. unilateral hemiparesis (opposite side)

Question 19

What are the 3 signs of decreased LOC (stupor)?

Answer 19

1. Unilateral or bilateral pupil changes
2. cheyne- stokes
3. decorticate or decerebrate posturing

Question 20

What are 3 signs of coma?

Answer 20

1. bilaterally fixed and dilated pupils
2. Respiratory arrest
3. absence of motor response (flaccid)

Question 21

What do we do if there are changes that suggest an increase in ICP?

Answer 21

tell physician immediately!

Question 22

What is an early indicator of decreasing LOC?

Answer 22

restlessness & irritability

Question 23

What is cushings triad?

Answer 23

1. BP goes up
2. HR goes down
3. irregular resps (cheyne stokes)

Question 24

What are 4 components of neuro assessment?

Answer 24

1. LOC
2. Pupils
3. VS
4. Limb movement/strength

Question 25

Which posture is worse, decerebrate or decorticate?

Answer 25

Decerebrate

Question 26

External Ventriculr Drain (EVD). What, When, Why, How

Answer 26

what: Catheter inserted into ventrical (ventriculostomy) When: Usually when GCS is less than 8 (coma) Why: Used to monitor ICP and guide clinical care How: Can also remove cerebral spinal fluid to decrease intracranial pressure

Question 27

What are 3 considerations when using EVD?

Answer 27

1. high risk of infection (prophylactic antibiotics and aspectic technique) 2. Keep body position still 3. transducer level with ear (use level)

Question 28

What drugs are used with ICP and why?

Answer 28

1. Osmotic diuretic - Mannitol = increase MAP (blood less thick) 2. Hypertonic Saline 3% = increase Na 3. Loop diuretic - Lasix = adjunct to mannitol 4. Anti-seizure meds - Dilantin (phenytoin) 5. Barbs/sedation - propofol if ICP very high to decrease cerebral metabolism 6. Corticosteroids - antiinflammatory for brain tumour (Decadron) 7. Stool softeners - Colace (docusate sodium) 8. Analgesics- fentanyl 9. Antibiotic - broad spectrum 10. Antipyretics - Tylenol - b/c TBI = hypermetabolic=fever

Question 29

How do we position a patient with high ICP in a coma and why?

Answer 29

side lying prevent tongue obstructing airway

Question 30

What two things must we remember when suctioning someone with high ICP?

Answer 30

1. Abubag before and after to replace oxygen 2. limit suction to 2 passes <10sec

Question 31

What do we put in to relieve pressure on diaphragm for someone with high ICP?

Answer 31

Nasogastric

Question 32

What is used to maintain airway if necessary?

Answer 32

intubation mechanical ventilation

Question 33

What are the 7 things we must do to care for patients with IICP?

Answer 33

1. Maintain airway/resp 2. Fluid & electrolytes balance 3. Body positioning 4. Nutrition therapy - needs lots of calories- hypermetabolic 5. Supportive therapy 6. Protect from injury 7. Psychological care (patient & family)

Question 34

What 3 ways do we monitor fluid and electrolyte balance?

Answer 34

1. amount accurately (I&O) - too much can increase ICP 2. Monitor electrolytes - diuretics and IV fluid can affect them 3. Monitor urinary output- -DI - SIADH (b/c pressure on pituitary= too much antipee hormone = increase Na)

Question 35

What is supportive therapy for ICP care?

Answer 35

Reduce metabolic demands as much as possible to prevent further increase in ICP -Control fever to keep energy burning down ,monitor for seizures -Manage Pain -Decrease Stimuli

Question 36

How do we protect from injury (confusion, agitation, seizures) in ICP care?

Answer 36

-Least restraint approach b/c it stresses the fuck out of everyone and increases ICP -Pad side rails -Light Sedation when appropriate -Calm reassuring approach

Question 37

How do we provide psychological care for patients and families when caring for increased ICP?

Answer 37

-Competent assured manner -Short simple explanations -Allow family participation in care when possible