Acute Intracranial Problems

Question 1

Normal ICP

Answer 1

5-15

>20 is abnormal

Question 2

Risk Factors/Causes of increased ICP

Answer 2

Cerebral Edema
Tumors
Hemorrhaging
Cerebral embolism
Infection

Question 3

Nutritional Therapy

Answer 3

Increased need for glucose
Enteral/Parenteral nutrition
Early feeding within 3 days of injury
Keep patient normovolemic

Question 4

Pupillary Check Responses

Answer 4

Pupils equal and react normally
Pupils react to light slowly or briskly
Dilated pupils: compressed CN III
Bilateral dilated, fixed pupils: ominous sign
Pinpoint pupils (pons damage or drugs)

Question 5

Dolls reflex (oculocephalic)

Answer 5

Positive: eyes move in opposite direction of head
Negative: eyes move towards same direction of head

Question 6

Motor strength

Answer 6

Squeeze hands
Pronation drift test
Raise foot off bed or bend knees

Spontaneous or to pain

Question 7

Cheyenne-Stokes

Answer 7

Cycles of hyperventilation and apnea

Question 8

Central neurogenic hyperventilation

Answer 8

Sustained, regular rapid and deep breathing

Question 9

Apneustic breathing

Answer 9

Prolonged inspirations phase or pauses alternating with exploratory pauses

Question 10

Ataxic breathing

Answer 10

Completely irregular with some breaths deep and some shallow

Question 11

ICP acute care

Answer 11

Airway
Elevate HOB 30 degree
Suctioning needs
Minimize abdominal distention
Monitor ABGs
Maintain ventilatory support

Question 12

What should you monitor for in regards to F&E

Answer 12

DI and SIADH

Question 13

Interventions to optimize ICP and CPP

Answer 13

HOB elevated
Prevent extreme neck flexion
Turn slowly
Avoid coughing, straining, valsalva
Avoid hip flexion

Question 14

Head injury emergency care

Answer 14

Airway
Stabilize cervical spine
Oxygen
IV
Incubate if GCS <8
Control bleeding
Remove clothes

Question 15

Cushing triad

Answer 15

Signs of increased ICP

Bradycardia, high SBP, low respiration’s

Question 16

Head injury diagnoses

Answer 16

Risk for ineffective cerebral tissue perfusion
Hyperthermia
Impaired physical mobility
Complication: increased ICP

Question 17

Prevent leaking CSF

Answer 17

HOB elevated
Loose collection pad under nose/over ear
No sneezing/blowing nose
No NG tube 
No nasotracheal suctioning

Question 18

Bacterial meningitis

Answer 18

Rapid diagnosis crucial

• antibiotic therapy instituted before diagnosis confirmed
• encourage vaccinations
• fever, acute pain, phototopia
• darkened room, cool cloth, assess for dehydration, ROM

Question 19

Viral meningitis

Answer 19

Spread thru respiratory secretions

-headache, fever, phototopia, stiff neck

Question 20

Encephalitis

Answer 20

Mosquito control/prevention

Symptomatic management