Acute intracranial conditions Flashcards
what are the 3 components of the skull?
1) brain tissue - neurone, neurological cells, ICF, ECF (LARGEST)
2) blood - arterial, venous, capillary networks
3) Cerebral spinal fluid
discuss primary vs secondary injury
primary : ccurs at time of initial injury
resulting in displacement, bruising or damage
secondary: occurs hours-days after
initial injury from hypoxia, ischemia,
hypotension, edema
what is the normal ICP?
5-15 mm Hg
when do you need to treat increased ICP?
when it gets higher than 20 mm Hg
a medical emergency
how does the brain compensate when pressure gets too high?
involves changes in CSF volume achieved by displacement of CSF
into spinal subarachnoid space or basal
subarachnoid cisterns
can the brain store oxygen and glucose?
no. it needs a steady supply
discuss cerebral blood flow - watch nurse RN
norm CPP 70 - 100 mm Hg, minimum of 50 - 60 mm Hg is needed
what does CPP of < 50 or <30 mean?
< 50 mm Hg means cerebral ischemia
< 30 mm Hg means cellular ischemia which is incompatible with life
what does compliance mean in terms of the brain?
compliance means expandability of the brain. low compliance means small increases in volume resulting in increasing pressure
basically the brain is able to adapt but it has its limits
what is neuromonitoring?
Use when GCS < 8 and abnormal CT scan or MRI there are different forms but the gold standard is Ventriculostomy
what is ventriculostomy in terms of neuromonitoring?
it directly measures the pressure within the ventricles and facilitates removal or sampling of CSF
NOTE: the reference point is tragus of the ear
what is cerebrospinal fluid drainage in terms of neuromonitoring?
a closed ventricular catheter into the brain and the gravity drains the fluid into the drainage bag
what’s something to consider when neuromonitoring?
Infection is serious consideration with ICP monitoring – prophylactic systemic antibiotics
what are the inter professional care for ICP?
Oxygen is necessary; goal PaO2 > 100 mm Hg
theres also surgery, meds, nutritional therapy
discuss Glasgow coma scale
measures how much the pt consciousness
3 indicators:
1) eye opening
2) best verbal response
3) best motor response
the higher the score the higher the level of brain functioning
score 15 = fully alert, highest score
<8 = generally indicate of coma (remember 8 rhymes with intubate)
3 = lowest score
what do we need to remember with suctioning for ICP?
It increases ICP so you are limited to maybe 2 passes
what are the 4 ICP acute intervention?
1) respiratory function
- maintain patent airway
- suction needed for secretions but be careful not to overdo bc it can increase ICP
2) fluid and electrolytes
3) body position
- head up, no extreme neck flexion, HOB 30 degrees, turn pt slowly bc too fast can increase ICP
4) protection from injury
what are the 5 types of head injuries?
1) scalp laceration - most minor
2) skull fracture
3) diffuse injury
4) diffuse anoxic injury
5) focal injury
- contusion aka brusing of the brain tissue
skull fractures clinical manifestations
find a YouTube video on this theres too much info on slides
what are 4 head injuries complications?
1) epidural hematoma
2) intraparenchymal hematoma
3) subdural hematoma
4) traumatic subarachnoid hemorrhage
what are the head injuries diagnostic tests completed?
CT scan
MRI - mostly to detect lesions
how do you care for someone who has a head injury?
ABC and stabilize cervical spine
note: also assess for thinorrhea, otorrhea or scalp wounds
when is a craniotomy needed?
Craniotomy necessary when there are loose fragments from skull
fracture
Craniectomy – bone removed and cranioplasty done at later time
how do brain tumours work?
can arise from tissue within the brain or secondary from metastasis which is usually the most common
frontal lobe
impulsivity, intellectual basically behaviour chnages
occipital lobes
vision and writing
temporal lobe
memory short term, hearing, smell and taste
partial lobe
sensory
what are the 6 types of surgeries?
1) burr hole
2) craniotomy
3) craniectomy
4) cranioplasty
5) stereotaxis
6) shunt procedures
in terms of 3 types of inflammatory conditions of the brain what are they?
1) bacterial meningitis - medical emergency, if untreated you WILL DIE FR FR
2) Encephalitis - caused by virus; risks increases with ticks and mosquitos
3) brain abscess - accumulation of pus in the brain tissue; if you have an abscess in your teeth and its not treated it can go up to the brain lol also include ear and sinus infections
- antibiotics needed for 4-8 weeks and may require surgery to drain it.
