4 Nervous System Alterations Part 2 Flashcards
Increased ICP late signs
Cushings triad:
—Widening pulse pressure (HTN present)
—Bradycardia
—Cheyne-stokes respirations
Cerebral edema tx
Prevention is key
Corticosteroids
Osmotic diuretics (pulls fluid off brain)
Causes of ICP (vasogenic edema)
Most common what?
What does it do?
Common causes? (4)
Most common reason of increased ICP
A disruption in the BBB with increased capillary permeability (increased ECF)
Causes:
—brain tumors
—cerebral abscess
—ischemic/hemorrhagic stroke
Causes of increased ICP (cytotoxic edema)
What happens
Causes (2)
Swelling of neurons and endothelial cells
(Increased ICF)
Causes:
—anocia
—hypoxic injury
Worries with increased ICP
Herniation:
—displaced tissue through opening
—compresses the CNS
ICP and CPP goals
Nursing interventions (4)
ICP <20
CPP >70
Interventions:
—HOB 30
—head midline
—pre-oxygenate prior to suctioning
—avoid excess stimulation
ICP
—adequate oxygenation labs (3)
—intervention to do it
—what a short term to remove CO2
—normal CO2
PaO2 >80
Normal hgb and Hct
Mechanical vent
Normal co2 35-45
Hyperventilation decreases co2 short term
Management of ICP
—2 main things to watch/do and how to do that
—GOALS
—What meds
Fluids:
—all fluids and piggybacks in NS
(no hypotonic/dextrose)
(Monitor CVP/BP/BUN/Creat/UOP)
BP:
Arterial BP (GOAL MAP: 70-90, CPP >70)
CBB: calcium channel blockers
What calcium channel blockers for ICP
Nimodipine:
—PO
—prevents vasospasms w/ SAH
Nicardipine:
—IV
—decrease BP
Interventions to reduce metabolic demands in ICP:
—Temp
—Sedation
temp:
—34-35 degree for 24-72hrs
Sedation:
—decreased ICP r/t agitation
—propofol/fentanyl/morphine/benzodiazepines
Interventions to reduce metabolic demands in ICP:
—Seizure prophylaxis
—Barbiturate coma
Seizure prophylaxis:
—phenytoin/fosphenytoin/levetiracetam
—SE: bradycardia/HOTN
Barbiturate coma:
—purposeful coma to decrease metabolic demands
—SE: HOTN/apnea
ICP monitoring
What we use
Risk
Intraventricular monitoring device
Risk of infection
Spinal drain:
Drains with what:
Location of lazer for zeroing
Drains to gravity
Zero to tragus of ear (foreman of monroe)
EVD (Extra-ventricular drain)
—inserted where to do what
—can be done where with what?
—inserted at what point
—Inserted into hemipheres to drain CSF d/t hydrocephaly
Done at bedside with a crank drill
Inserted at kocher’s point
When do we start using ICP monitoring (criteria)
Contra indications for ICP monitoring
do it:
—TBI w/GCS <9
CI:
—systemic infection
—infection at insertion site
—CNS infection
—coagulopathy
At what ICP are the ICP treatments initiated?
> 15
1st tier of ICP treatment? (4)
Mannitol
Hypertonic saline solutions (3%-7.5& NaCl)
Respiratory support
Analgesia and sedation (reduce agitation)
1st tier ICP tx
—mannitol:
What does it do
May lower what d/t what
—hypertonic saline solutions
What solutions
What they do
Long term does what
mannitol:
—diuretic to decrease ICP
—may lower CPP d/t decreaseing BP
So you need to moniro BP/UOP w/FC
hypertonic saline solutions:
—3%-7.5%
—ICF pulled out and shrinks brain = decreased ICP
—increased MAP and CPP in the long term
1st tier ICP treament
Respiratory support:
-keep what
Analgesia/sedation:
-does what
-meds
Keep adequate oxygenation
(increase PEEP by increasing mean airway pressure)
Analgesia/sedation:
—reduce agitation
—mechanical vent
—opiods are drug of choice (fentanyl/morphine)
2nd tier ICP treatment
2 things
Hypothermia:
Barbiturate coma
2nd tier ICP tx
Hypothermia
—temp
—what increase in C = what increase demand
—what is does
36-37.7C
every 1C increase body metabolic demands increases 5-10%
decreased cerebral metabolic rate = decreased CO2 and lactate build up
2nd tier ICP treatment
Barbiturate coma
—what is it
—meds
—decreases what 3 things
—what hour we start it
—when to d/c
36-37.7C
every 1C increase body metabolic demands increases 5-10%
decreased cerebral metabolic rate = decreased CO2 and lactate build up
Hyperventilation
—increased PaCO2 leas to what 2 things
—what does PaCO2 do to ICP by doing what to CBF
—diminished blood flow may do what
—only do for what
Increased PaCO2 = increased CBF/vasodilation
PaCO2 = decreased ICP d/t decreased CBF
Diminished blood flow may compromise cerebral oxygenation
—only do it for immediate neurological emergencies
Why is hyperventilation short term for decreasing CO2 and ICP
It decreased CBF which decreases oxygenation to brain (NOT GOOD)
