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Critical Care Med Surg > Acute Intracranial Problems Notes > Flashcards

Acute Intracranial Problems Notes Flashcards

1
Q

3 essential volume components of the skull

A

Brain Tissue
Blood
Cerebrospinal Fluid (CSF)

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2
Q

Primary Injury

A

Occurs at the initial time of injury

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3
Q

Secondary Injury

A

Effects of the primary injury that can appear in a few hours to a few days.

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4
Q

Intracranial Pressure (ICP)

A

Pressure of CSF fluid within the brain.

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5
Q

Factors that influence ICP

A 
Arterial Pressure
Venous Pressure
Intraabdominal Pressure
Posture
Temperature
Blood Gases
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6
Q

Monro-Kellie Doctrine

A

The 3 components must stay in a constant volume overall.
Only affects when the skull is closed.
Brain compensates in any component if one component is displaced more than others.

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7
Q

Normal ICP ranges

A

5-15 mmHg

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8
Q

Cerebral Blood Flow (CBF)

A

Blood supply given to the brain in any given time period, usually 1 minute.

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9
Q

Cerebral Autoregulation

A

Automatic adjustment that the brain does to maintain a constant blood flow when arterial BP changes.

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10
Q

Normal MAP

A

60-100 mmHg
Most people have 70mmHg
Critical to maintain MAP when ICP is increased

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11
Q

Cerebral Perfusion Pressure (CPP)

A

Pressure needed to ensure blood flow to the brain.

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12
Q

Normal CPP

A

60-100 mmHg

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13
Q

How to calculate MAP

A

(SBP+2(DBP))/3

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14
Q

How to calculate CPP

A

CPP=MAP - ICP or

CPP= Flow x Resistance

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15
Q

Factors Affecting Cerebral Blood Flow

A

CO2
O2
Hydrogen ions (H+)

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16
Q

Why is it critical to maintain CBF?

A

To preserve tissue and minimize secondary injury.

Prevent brainstem compression and brain herniation.

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17
Q

3 Types of Cerebral Edema:

A

Vasogenic
Cytotoxic
Interstitial

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18
Q

Vasogenic Cerebral Edema

A

Most common type

Characterized by leakage of large molecules from capillaries into surrounding extracellular space.

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19
Q

Cytotoxic Cerebral Edema

A

The cell membrane breaks and moves fluids and proteins into cells.

20
Q

Interstitial Cerebral Edema

A

Result of hydrocephalus (buildup of brain fluid)

21
Q

C/M on Increased ICP

A

Changes in LOC - most reliable indicator of neuro status
Cushing’s Triad - MEDICAL EMERGENCY
Compression of Cranial Nerve III - fixed unilateral dilated pupils - MEDICAL EMERGENCY
Blurred vision, diplopia, and extraocular eye movements
Compression of Cranial Nerves II, IV, and VI.
Contralateral hemiparesis or hemiplegia
Decorticate or Decerebrate posturing
Headache
Unexpected vomiting
Projectile Vomiting

22
Q

Cushing’s Triad

A

MEDICAL EMERGENCY
Systolic HTN with widening pulse pressure
Bradycardia with bounding peripheral pulses
Irregular Respirations

23
Q

Which is worse: decorticate or decerebrate

A

Decerebrate

24
Q

Why do we have to monitor for headache?

A

Headache may appear benign but that’s an early symptom of cerebral edema and increase ICP that can lead to coma and death

25
Q

2 Major Complications:

A

Cerebral Perfusion

Cerebral Herniation

26
Q

Tentorial Herniation

A

Mass lesion in the cerebrum forces brain to herniate downwards

27
Q

Uncal Herniation

A

Lateral and downward herniation

28
Q

Cingulate Herniation

A

Lateral displacement of brain tissue under falx cerebri (dura wall that separate’s 2 cerebral hemispheres)

29
Q

Diagnostic Studies

A 
CT and MRI
Cerebral angiography
EEG
PET
Transcranial Doppler Studies 
Infrascanner - detects life-threatening intracranial bleeding
ECG
Lumbar Puncture (LP)
Lab Studies
30
Q

Why should you not perform a LP when an ICP is suspected?

A

Possible cerebral herniation can occur when the pressure is released during a LP.

31
Q

Indications for Intracranial Pressure Monitoring

A 
Hemorrhage
Stroke
Tumor
Infection
Traumatic Brain Injury (TBI)
Pts with GCS < 8 
Abnormal CT or MRI scan
32
Q

Ventriculostomy Nursing Management

A

Gold Standard for monitoring ICP
A specialized catheter is inserted into the lateral ventricle with an external transducer.
Make sure the transducer is in the same level as foramen of Monro
Document ICP every hour
Turn and reposition the patient every 2 hours.
Check capillary blood glucose level every 6 hours.
Monitor cerebrospinal fluid color and volume hourly.

33
Q

Fiberoptic Catheter

A

A sensory transducer is found within the catheter tip.
Sensor tip is placed within the brain tissue and ventricle.
It gives a direct measurement of brain pressure.

34
Q

Air pouch/Pneumatic technology

A

Air-filled pouch at the tip of the catheter that maintains a constant volume.

35
Q

How do you get an accurate reading of ICP with CSF device in place?

A

Close drain for 6 minutes

Monitor ICP waveform and mean ICP

36
Q

Major Complication for ICP monitoring?

A

Infection

37
Q

Intermittent Drainage

A

Open the system at indicated ICP and allow to drain for 2-3 minutes. Then close it after draining

38
Q

Continuous Drainage

A

Monitor for drained CSF volume

Strict aseptic technique

39
Q

LICOX and Neurovent catheters

A

Placed in healthy white matter of the brain

Measure brain oxygenation and temperature.

40
Q

Jugular Venous Bulb Oximetry

A

Measures oxygen in jugular vein using a catheter

SjvO2 should be 60-75%

41
Q

Mannitol (Osmitrol)

A

decreases ICP via plasma expansion and osmotic effect
Monitor fluid and electrolyte status
Contraindicated by renal disease

42
Q

Hypertonic Saline

A

Shifts fluids out of brain cells and into blood vessels.

Frequent monitoring of BP and serum sodium levels

43
Q

Corticosteroids

A

Treat vasogenic edema around tumors and abscess
Improves CBF and restores autoregulation.
Monitor fluid intake and sodium levels
Monitor blood glucose
Give antacids, histamine blockers or PPI to prevent GI ulcers and bleeding

44
Q

Barbituates

A

Reduces cerebral metabolism

Monitor pt’s ICP, blood flow and EEG

45
Q

Ventriculostomy Indications

A

Hydrocephalus
Cerebral Edema
Increased ICP

46
Q

Decorticate Posturing

A

Flexor position
Flexion position of arms, wrists, and fingers with adduction in upper extremities: extension, internal rotation and plantar flexion in lower extremities

47
Q

Nursing Management of ICP

A

GCS

Neuro Assessments include Assessing CN III, CN IV, and CN VI

Critical Care Med Surg (17 decks)

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