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z_MS1_Neuro Study > GF3: Neuro ICP > Flashcards

GF3: Neuro ICP Flashcards

1
Q

What are some s/s of increased ICP?

A
  • HA
  • Decreased LOC
  • Projectile vomiting
  • Cushings triad
    • bradycardia
    • irregular respirations
    • widened pulse pressure.
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2
Q

What are the factors that influence ICP?

A
  • Arterial pressure
  • Venous pressure
  • Intrabdominal pressure
  • Posture
  • Temperature
  • Blood gases (especially CO2 levels)
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3
Q

What is CPP?

A
  • Cerebral perfusion pressure
  • Pressure needed to ensure blood flow to the brain
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4
Q

What is the formula for MAP?

A

MAP = (SBP – DBP)/3+DBP

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5
Q

What is the formula for CPP?

A

CPP = MAP – ICP

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6
Q

What is MAP?

A
  • Mean Arterial Pressure
  • The average arterial pressure throughout one cardiac cycle, systole, and diastole.
  • MAP is influenced by cardiac output and systemic vascular resistance
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7
Q

What is the desired MAP range?

A

70-105 mmHg

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8
Q

What is considered normal ICP?

A

5-15 mmHg

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9
Q

What is the desired CPP range?

A

60-100

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10
Q

CPP <50 or >150 are associated with…

A

Ischemia and neuronal death

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11
Q

High ICP means _____ CPP

A

Decreased

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12
Q

How does a loss of cerebral autoregulation that results in high BP cause increased ICP?

A
  • High BP leads to increased cerebral blood volume
  • Increased cerebral blood volume leads to extravasation and edema
  • Extravasation increases ICP
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13
Q

How does a loss of cerebral autoregulation that results in low BP cause increased ICP?

A
  • Low BP leads to decreased cerebral blood volume
  • Decreased cerebral blood volume leads to hypoxia, hypercapnia and acidosis which lead to increased ICP
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14
Q

How does increased ICP manifest in the eyes?

A
  • Papilledema
  • Pupillary changes
  • Impaired eye movement
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15
Q

Headache and seizures are a risk w/ increased ICP due to…

A

Lack of oxygen to brain tissues

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16
Q

How does increased ICP affect VS?

A
  • Systolic BP rises due to resistance of increased ICP
  • This causes the HR to slow down to lower BP
  • Lower HR = lower diastolic pressure which widens pulse pressure
17
Q

What is pulse pressure?

A

The difference between systolic and diastolic pressures

18
Q

True or False

ICP will not change speech function or comprehension.

A

False, it can

19
Q

What are some causes of increased ICP?

A
  • Increased blood volume
  • Increased CSF
  • Brain tissue edema
  • Dilated cerebral arteries
20
Q

What are the risk factors for increased ICP?

A
  • Brain tumor
  • Closed head injury
  • Ruptured blood vessels
  • Embolism
  • Thrombosis and ischemia
  • Hydrocephalus
21
Q

Dx tests for ICP?

A
  • CAT scan (first)
  • MRI
  • PET (monitor glucose levels)
  • ICP monitoring
  • EEG
22
Q

What are some complications that occur due to increased ICP?

A
  • Herniation
  • SIADH
  • Diabetes insipidus
23
Q

What are the nursing interventions to ID and decreased ICP?

A
  • Neuro checks hourly
  • Elevated HOB
  • Change position slowly
  • Maintain hydration (w/ NS, NOT DM5)
  • Monitor I/O
  • No sedatives, narcotics or coughing
  • Hypothermia
24
Q

What are the nursing interventions regarding respiratory function with increased ICP?

A
  • Immobility
  • Maintain patent airway
  • Monitor PCO2 for acidosis
  • Suction GENTLY
  • Monitor ventilator if employed
25
Q

What are the nursing interventions regarding safety with increased ICP?

A
  • Seizure precautions
  • Monitor for CSF from ears/nose
  • Prevent aspiration
  • Provide quiet environment
  • Prevent eye damage
26
Q

What are the psychological nursing interventions with increased ICP?

A
  • Explain neuro checks
  • Encourage fear verbalization
  • Maintain reality orientation
  • Talk to unconscious pts
  • Work through feelings
27
Q

What are the nursing interventions regarding immobility with increased ICP?

A
  • ROM exercises
  • Monitor skin breakdown
  • Reposition
  • Assess motor responses and movement
  • Prevent foot drop
28
Q

What are the nursing interventions for elimination with increased ICP?

A
  • Monitor urinary and bowel function
  • Monitor for perineal excoriation
29
Q

What is ICP monitoring?

A

A device is inserted through skull and into a CSF space (ventricle, subarachnoid, epidural) to continually monitor ICP over time

30
Q

What are some methods of draining fluids causing increased ICP?

A
  • Burr holes
  • Laminectomy
  • Ommaya reservoir
  • VP/VA shunts
31
Q

What is an Ommaya Reservoir?

A
  • An intraventricular catheter system that can be used for the aspiration of cerebrospinal fluid or for the delivery of drugs into the cerebrospinal fluid.
  • It consists of a catheter in one lateral ventricle attached to a reservoir implanted under the scalp.
32
Q

What is a VP shunt?

A
  • A catheter is inserted into the cerebral ventricle with tubing tunnelled subcutaneously down the thorax and then further tunnelled into the peritoneal cavity where the CSF is absorbed
  • This is done to drain off extra CSF for a pt that continually produces excess amounts of it
33
Q

What is a VA shunt?

A
  • A catheter is inserted into the cerebral ventricle with tubing tunnelled subcutaneously down to the right atrium of the heart where excess CSF is drained and absorbed
  • This is done to drain off extra CSF for a pt that continually produces excess amounts of it
34
Q

What is a brain herniation?

A
  • A brain herniation, or cerebral herniation, occurs when brain tissue, blood, and cerebrospinal fluid (CSF) shifts from their normal position inside the skull.
  • The condition is usually caused by swelling from a head injury, stroke, bleeding, or brain tumor.
35
Q

What is a subfalcine herniation?

A

ICP pushes upper cerebrum from one side of the head to the other

36
Q

What is a central herniation?

A

ICP pushes central portion of cerebrum downward toward foramen magnum

37
Q

What is an uncal herniation?

A

ICP pushes the lower cerebrum inward and down toward foramen magnum

38
Q

What is a tonsillar herniation?

A
  • ICP pushes the cerebellum down through the foramen magnum
  • Instant death

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