Week 3 - Acute Neurological Conditions

Question 1

Define intracranial pressure.

Answer 1

Pressure inside the skull thus in brain and CSF.

Question 2

Normal ICP.

Answer 2

0-15mmHg.

Question 3

What is autoregulation?

Answer 3

Automatic change in cerebral blood vessels in response to varying systemic changes in BP to maintain a continuous perfusion pressure without wide fluctuations of blood flow.

Question 4

What is monroe-kellie hypothesis?

Answer 4

Describes the skull encasing a closed system with 3 components:

1. Blood (10%)
2. CSF (10%)
3. Brain tissues (80%)

If any of these components increase without a concurrent decrease in one of the other, this increases ICP.

Question 5

Raised ICP signs and symptoms:

Answer 5

• Headache
• Dizziness
• Nausea/vomit
• Amnesia
• Decreased LOC
• LOC
• Confusion
• Combativeness
• Change in pupil size and reactivity to light
• Increased BP
• Slowing pulse

Question 6

What is Cushing response?

Answer 6

• Characterised by HTN, bradycardia, and irregular RR and patterns
• Can he seen as a late stage of RICP
• Also indicative of worsening brain ischaemia

Question 7

Difference between retrograde and anterograde amnesia.

Answer 7

Retrograde - loss of memories formed before a trauma/accident

Anterograde - inability to form new memories after trauma/accident

Question 8

Significance of midline shift?

Answer 8

• The delicate structures of the central portion of the brain, such as the ventricles and brain stem have been displaced laterally
• Brain tissue displacement is poorly tolerated and leads to area of ischaemia

Question 9

Why is hyperthermia, hypoxia, and hypercapnia important to control?

Answer 9

• Will cause increased cerebral blood flow due to vasodilation
• Hyperthermia also increases metabolic demand and resulting in greater O2 demand

Question 10

What secondary effects of head injury would you monitor for?

Answer 10

• Hypoxia (contributes to neurological damage)
• Hypercapnia (can cause headaches, lethargy, drowsiness, confusion and if serious can lead to coma or death)
• Hypotension (decreased BP results in decreased cerebral perfusion therefore worsening the ischaemia to affected brain tissue)

Question 11

Symptoms of hypercapnia.

Answer 11

• Flushed
• Warm to touch
• Flapping tremor of hands

Question 12

Cerebral perfusion pressure (CPP).

Answer 12

• 70-100mmHg

* BP gradient across the brain

Question 13

Nursing management of ICP.

Answer 13

• Neurological assessment
• Establish and maintain patient airway
• O2 therapy
• Positioning of patient
• Strict fluid balance