Altered LOC & ICP Flashcards
Frontal lobe
- speech
- thought
- emotion
- volunteer movement
- complicated cognitive process
- judgement reasoning
- concerns for others
Parietal lobe
- all sensory info
- shapes
- pain
- temperature
- 2 point discrimination (hot vs cold)
Occipital lobe
Process vision
Cerebellum
- control fine movement
- coordination
- balance position state
- awareness of position of body parts w/o looking at them
Brain stem
- controls reflexes
- influences all basic life function (breathing, HR, BP)
Temporal lobe
- stores memory
- interprets auditory stimuli
Consciousness-dynamic state
Being aware of oneself and the environment
Altered LOC causes
- lesions or injuries
- metabolic disorders (commonly hypoglycemia)
- meds
- direct or indirect pressure (masses, hematoma, cerebral edema)
- any systemic condition (usually impaired blood flow, hypoxemia, f/e imbalance, waste products and toxins d/t impaired hepatic or renal fxn)
Altered LOC manifestations
Changes in:
- pupillary response
- eye opening response
- verbal response
- motor response
- behavior (usually restlessness, increased anxiety)
Management of altered LOC
ABCs!!
- obtain/maintain patent airway
- monitor adequate perfusion
- IV access
- nutritional support
- med management
- prevention of complications
Normal ICP ranges
- infant: 1.5-6 mmHg
- children: 3-7 mmHg
- adults: 5-15 mmHg
How the brain compensates for increased ICP
- displacing or shifting CSF (increasing absorption, limiting production)
OR - decreasing cerebral blood volume
What ICP requires IMMEDIATE intervention?
> 20 mmHg
Increased ICP: causes
- head injuries
- infections
- tumors
- stroke
- seizures
- hydrocephalus
- hypoxemia
- meningitis
Increased ICP: manifestations
EARLY
- decreased LOC
- lethargy
- confusion
- abnormal behavior
- restlessness
Increased ICP: manifestations
LATE
- comatose
- impaired memory/judgement
- headache
- vision changes-inability to move eyes up or down
- pupillary changes-sluggish or fixed
- projectile vomiting
- change in speech pattern (slurred, doesn’t make sense)
- aphasia
- changes in sensorimotor and motor fxn
- cranial nerve dysfunction
- ataxia
- seizures
- HTN
- abnormal posturing
- altered respiratory pattern
Cushing’s Traid - a late sign of increased ICP
- HTN
- widened pulse pressure
- bradycardia
Intracranial surgery: nursing role
- pre-op baseline assessment
- post-op monitoring and assessments
- reducing cerebral edema (diuretics, corticosteroids)
- monitor ICP
Increased ICP: teaching
- avoid coughing, blowing nose, straining
- maintain head and neck alignment
- take rest periods
- encourage family to talk to pt but avoid distressing conversations
- maintain a quiet environment w/ minimal stimuli
Posturing: decorticate
- arms are like Cs, “moves in toward the cord”
- problems with cervical spinal tract or cerebral hemisphere
Posturing: decerebrate
- arms are like Es
- problems with midbrain or pons
