Acute Intracranial Problems Flashcards
3 Compartments of total volume of ICP
brain tissue, blood, cerebrospinal fluid (CSF)
Increased ICP clinical manifestations
changes in level of consciousness
vital signs - HTN, bradycardia, full bounding pulse, irregular respirations
Ocular Signs - pupil dilation
Motor Function - hemiparesis or hemiplagia
headache/vomiting
Spontaneous abnormal motor function
occurs without regard to external stimuli and may not occur by request
Localization abnormal motor function
occurs when the extremity opposite the extremity receiving pain crosses middling of the body in an attempt to remove the noxious stimulus from the affected limb
withdrawal abnormal motor function
occurs when the extremity receiving the painful stimulus flexes normally in an attempt to avoid the noxious stimulus
Decortication abnormal motor function
abnormal flexion response that may occur spontaneously or in response to noxious stimuli
Flaccid abnormal motor function
no response to painful stimuli
Decerebrate posture
results from damage to the upper brain stem
the arms are adducted and extended with the wrists pronated and the fingers flexed. The legs are stiffly extended with plantar flexion of the feet
Decorticate posture
Results from damage to 1 or both corticospinal tracts
the arms are adducted and flexed, with the writs and fingers flexed on the chest. The legs are stiffly extended and internally rotated, with plantar flexion of the feet
Increased ICP dx studies
MRI, CT scan, cerebral angiography, EEG, ICP measurement
Increased ICP - nursing intervention
respiratory function - maintain airway
Fluid/electrolyte balance - daily weights, monitor BS, Na, K, Mg
Monitoring ICP - early s/s of intracranial HTN
Body position - HOB elevated
Protection from injury - confusion, agitation, possible seizures
Psychological considerations
Primary brain tumors
benign or malignant
gliomas - most common (astrocytoma, Glioblastoma multiforme)
More than half are malignant
Secondary brain tumors
metastasis from a malignant neoplasm (tumor)
brain tumor clinical manifestations
headache - common
seizures (common in gliomas and brain metastasis)
N/V
cognitive dysfunction (including memory problems and mood or personality changes)
Muscle weakness
Sensory Loss
Aphasia
Brain tumor complications
cerebral edema/inflammation increased ICP neurological deficiets hydrocephalus pituitary dysfunction
brain tumor dx studies
MRI, PET scan, CT scan
brain tumor collaborative tx
identifying the tumor type and location
removing or decreasing tumor mass
preventing or managing ICP
Surgical tx - preferred
Radiation/Chemo
Shunt
Stereotactic surgery
used with greater frequency to perform a biopsy and remove small brain tumors
bacterial meningitis
acute inflammation of the pia mater and arachnoid membrane surrounding the brain and spinal cord
Leading causes: Streptococcus pneumoniae and Neisseria meningitidis
bacterial meningitis clinical manifestations
fever, severe headache, N/V, nuchal rigidity photophobia, decreased LOC, s/s of increased ICP may be present Seizures in 1/3 of cases
Kernig’s Sign
physical symptom of meningitis
severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed at 90 degrees
Brudzinski’s Sign
physical symptom of meningitis
Severe neck stiffness causes a patient’s hip and knees to flex when the neck is flexed
Bacterial Meningitis Complications
Increased ICP - most common
meningoccemia
disseminated intravascular coagulation (DIC)
Residual neurological dysfunction: hemiparesis, dysphasia, hemianopais
cranial nerve dysfunction: CN lll, CN lV, CN Vl, CN Vll, CN Vlll
Cranial Nerve lll
oculomotor
Cranial Nerve lV
trochlear
Cranial Nerve Vl
Abducens
Cranial Nerve Vll
Facial
Cranial Nerve Vlll
vestibulocochlear
Hemianopsia
blindness in half of the visual field
Bacterial Meningitis Dx studies
blood culture, CT scan, lumbar puncture, CBC, sputum/throat/nasal culture
Skull x-rays
bacterial meningitis collaborative care
IV fluids, codeine, acetaminophen, Dexamethasone (decadron), Mannitol (osmitrol)
Antibiotics: penetrate blood-brain barrier: PCN, Cephalosporin
Bacterial Meningitis Nursing Dx
Acute confusion Disturbed sensory perception Acute Pain Hyperthermia Ineffective tissue perfusion (Cerebral)
Bacterial Meningitis Health Promotion
meningitis vaccine
pneumococcal vaccine
influenza vaccine
vigorous treatment of respiratory illness
Bacterial Meningitis acute interventions
pain relief position tx for photophobia seizure precautions tx of fever fluid replacement droplet precautions
Viral Meningitis
spread through direct contact w/ resp. secretions
Enteroviruses/arboviruses
Human immunodeficiency virus (HIV), Herpes Simplex Virus (HSV)
Prognosis: self-limiting
viral meningitis clinical manifestations
headache, fever, photophobia, stiff neck
viral meningitis dx studies
lumbar puncture
viral encephalitis
acute inflammation of the brain usually cause by viruses
transmitted through ticks, mosquitoes, west nile virus
Viral encephalitis clinical manifestations
fever, headache, N/V
alteration in mental status
symptoms of increased ICP
focal neurological deficits
viral encephalitis Dx studies
MRI, PET scan, Lumbar puncture
Viral encephalitis collaborative care
prevention mosquito control diuretics corticosteroids antiviral meds antiseizure meds
Brain Abscess
Accumulation of pus within the brain tissue by:
streptococci
staphylococcus aureus
Brain Abscess clinical manifestations
Headache
N/V
signs of increased ICP
focal symptoms
Brain Abscess Dx studies
CT scan, MRI
Brain Abscess collaborative tx
antimicrobial therapy
Surgical drainage
Surgical removal
