Acute intracranial conditions

Question 1

what are the 3 components of the skull?

Answer 1

1) brain tissue - neurone, neurological cells, ICF, ECF (LARGEST)
2) blood - arterial, venous, capillary networks
3) Cerebral spinal fluid

Question 2

discuss primary vs secondary injury

Answer 2

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

Question 3

what is the normal ICP?

Answer 3

5-15 mm Hg

Question 4

when do you need to treat increased ICP?

Answer 4

when it gets higher than 20 mm Hg

a medical emergency

Question 5

how does the brain compensate when pressure gets too high?

Answer 5

involves changes in CSF volume achieved by displacement of CSF
into spinal subarachnoid space or basal
subarachnoid cisterns

Question 6

can the brain store oxygen and glucose?

Answer 6

no. it needs a steady supply

Question 7

discuss cerebral blood flow - watch nurse RN

Answer 7

norm CPP 70 - 100 mm Hg, minimum of 50 - 60 mm Hg is needed

Question 8

what does CPP of < 50 or <30 mean?

Answer 8

< 50 mm Hg means cerebral ischemia

< 30 mm Hg means cellular ischemia which is incompatible with life

Question 9

what does compliance mean in terms of the brain?

Answer 9

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

Question 10

what is neuromonitoring?

Answer 10

Use when GCS < 8 and abnormal CT scan or MRI there are different forms but the gold standard is Ventriculostomy

Question 11

what is ventriculostomy in terms of neuromonitoring?

Answer 11

it directly measures the pressure within the ventricles and facilitates removal or sampling of CSF

NOTE: the reference point is tragus of the ear

Question 12

what is cerebrospinal fluid drainage in terms of neuromonitoring?

Answer 12

a closed ventricular catheter into the brain and the gravity drains the fluid into the drainage bag

Question 13

what’s something to consider when neuromonitoring?

Answer 13

Infection is serious consideration with ICP monitoring – prophylactic systemic antibiotics

Question 14

what are the inter professional care for ICP?

Answer 14

Oxygen is necessary; goal PaO2 > 100 mm Hg

theres also surgery, meds, nutritional therapy

Question 15

discuss Glasgow coma scale

Answer 15

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

Question 16

what do we need to remember with suctioning for ICP?

Answer 16

It increases ICP so you are limited to maybe 2 passes

Question 17

what are the 4 ICP acute intervention?

Answer 17

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

Question 18

what are the 5 types of head injuries?

Answer 18

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

Question 19

skull fractures clinical manifestations

Answer 19

find a YouTube video on this theres too much info on slides

Question 20

what are 4 head injuries complications?

Answer 20

1) epidural hematoma

2) intraparenchymal hematoma

3) subdural hematoma

4) traumatic subarachnoid hemorrhage

Question 21

what are the head injuries diagnostic tests completed?

Answer 21

CT scan

MRI - mostly to detect lesions

Question 22

how do you care for someone who has a head injury?

Answer 22

ABC and stabilize cervical spine

note: also assess for thinorrhea, otorrhea or scalp wounds

Question 23

when is a craniotomy needed?

Answer 23

Craniotomy necessary when there are loose fragments from skull
fracture

Craniectomy – bone removed and cranioplasty done at later time

Question 24

how do brain tumours work?

Answer 24

can arise from tissue within the brain or secondary from metastasis which is usually the most common

Question 25

frontal lobe

Answer 25

impulsivity, intellectual basically behaviour chnages

Question 26

occipital lobes

Answer 26

vision and writing

Question 27

temporal lobe

Answer 27

memory short term, hearing, smell and taste

Question 28

partial lobe

Answer 28

sensory

Question 29

what are the 6 types of surgeries?

Answer 29

1) burr hole
2) craniotomy
3) craniectomy
4) cranioplasty
5) stereotaxis
6) shunt procedures

Question 30

in terms of 3 types of inflammatory conditions of the brain what are they?

Answer 30

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.