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Med Surg IV > Head injuries & ICP > Flashcards

Head injuries & ICP Flashcards

1
Q

Normal range for ICP in the brain

A

5-15 mmHg

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2
Q

What is cerebral perfusion pressure (CPP)?

A

the pressure needed to ensure blood flow to the brain

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3
Q

Normal range for CPP

A

60-100 mmHg

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4
Q

Formula to calculate CPP

A

MAP - ICP= CPP

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5
Q

What is compliance?

A

the expandability of the brain

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6
Q

Most sensitive indicator for evaluating pt’s neuro state

A

Level of consciousness (LOC)

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7
Q

Oculomotor nerve

A

Cranial nerve III

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8
Q

What is the significance of the halo sign?

A

tests the fluid coming from nose or ear for CSF

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9
Q

How is halo sign tested?

A

have the fluid drip onto gauze.

If yellowish ring encircles the blood, CSF is present.

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10
Q

Purpose of the GCS

A

to assess LOC

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11
Q

3 areas assessed for GCS

A
  • speech
  • obey commands
  • open eyes
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12
Q

Craniectomy

A

excision to cut away bone flap from skull

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13
Q

Burr hole

A

hole drilled into skull to remove localized fluid and blood from under dura

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14
Q

Craniotomy

A

opening into skull with removal of bone flap and opening the dura

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15
Q

Autoregulation of cerebral blood flow

A

automatic adjustment in diameter of cerebral blood vessels by the brain to maintain constant blood flow during changes in arterial BP

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16
Q

What is stage 1 of cerebral blood flow (CBF)?

A

Stage 1

  • High compliance.
  • the brain is in total compensation, with accommodation and autoregulation intact.
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17
Q

True or False:

An increase in volume does NOT increase the ICP

A

True

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18
Q

What is stage 2 of CBF?

A

Stage 2

-the compliance is beginning to decrease, and increase in volume places the pt at risk for high ICP and secondary injury

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19
Q

What is stage 3 of CBF?

A

Stage 3
-significant reduction in compliance

  • any small addition to volume causes a great increase in ICP
  • compensatory mechanisms fail, there is a loss of autoregulation, and the pt exhibits manifestations of increased ICP
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20
Q

What is stage 4 of CBF?

A

Stage 4
-ICP rises to lethal levels with little increase in volume.

-herniation occurs as the brain tissue is forcibly shifted from the compartment of greater pressure to a compartment of lesser pressure

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21
Q

Can the brain stem die if herniation continues?

A

Yes, due to increased pressure on brain stem.

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22
Q

True or False:

Cushing’s triad is not an emergency

A

False. It is a neurological emergency

23
Q

What is Cushing’s triad?

A

when the autoregulation is lost, the body attempts to maintain cerebral perfusion by increasing systolic BP, but decomposition happens.

24
Q

Patient’s response to Cushing’s triad?

A
  • systolic HTN with widening pulse pressure
  • bradycardia
  • full bounding pulse
  • altered respirations
  • noticable change in body temp (can go up or down)
25
Q

True or False:

O2 and CO2 affect cerebral blood vessel tone

A

TRUE.

26
Q

High CO2 and cerebral blood flow

A
  • relaxes smooth muscles
  • dilates vessels
  • decreases cerebrovascular resistance
  • increases CBF
27
Q

Low CO2 and cerebral blood flow

A
  • constricts vessels
  • increases cerebrovascular resistance
  • decreases CBF
28
Q

What happens if cranial nerve III is compressed?

A
  • dilation of pupil on same side (ipsilateral) as mass or lesion
  • sluggish or no response to light
  • inability to move eye upward
  • ptosis of eyelid
29
Q

Decorticate posturing (flexor)

A

internal rotation and adduction of the arms

-result of interruption of voluntary motor tracts in cerebral cortex

30
Q

Decerebrate posturing (extensor)

A

arms are stiffly extended, adducted, and hyperpronated

  • result from disruption of motor fibers in mid-brain and brain stem
  • may indicate more serious damage
31
Q

Nursing interventions for ICP

A
  • HOB 30 degrees or higher
  • head in neutral position
  • intubation/mechanical ventilation
  • ICP and cerebral O2 monitoring
  • maintain > 100 mmHg PaO2
  • maintain fluid balance, assess osmolality
  • maintain systolic arterial pressure 100-160 mmHg
  • reduce cerebral metabolism (high dose barbiturates)
32
Q

Drug therapy for ICP

A
  • osmotic diuretic (mannitol)
  • hypertonic saline
  • antiseizure meds (phenytoin)
  • corticosteroids for brain tumors, bacterial meningitis
  • H2 receptor antagonist or proton pump inhibitors to prevent GI ulcers and bleeding
33
Q

Epidural hematoma

A
  • bleeding between dura and inner surface of skull
  • EMERGENCY!
  • venous or arterial
34
Q

Subdural hematoma

A
  • bleeding between dura and arachnoid layer of meninges

- results from injury to brain tissue and blood vessels

35
Q

Acute subdural hematoma

A

within 24-48 hours of injury

36
Q

Subacute subdural hematoma

A

within 48 hours-2 weeks of injury

37
Q

Chronic subdural hematoma

A

within weeks or months, usually >20 days

38
Q

Intracranial hematoma

A
  • occurs from bleeding within brain tissue
  • usually within frontal and temporal lobes

-approximately 16% of head injuries

39
Q

How much of the brain is made up of glucose and where does the glucose come from?

A

25% and cardiac output

40
Q

How much of the brain is made up of O2 and where does the O2 come from?

A

20% and cardiac output

41
Q

Is it better or worse for a patient with a head injury to have a high b/p?

A

Better! Increased b/p can help offset the ICP. Ideally you want the patient to have a MAP of 140-150. Increased b/p and increased ICP means the brain is getting blood flow.

42
Q

What MAP is too high and considered dangerous for a head injury patient?

A

165 and higher is TOO high

43
Q

If a patient with a head injury has a low ICP and a low b/p what should you do?

A

Notify the provider

44
Q

The brain can tolerate a low MAP until it reaches what value?

A

A MAP below 50 will cause ischemia

A MAP below 30 results in cell death

45
Q

The eyes are the _______ to the brain

A

Window

Checking the patient’s eyes is imperative if a patient comes in with a head injury. If a patient comes in with a head injury and their pupils are extremely dilated or non-responsive that is NOT good. This means the oculomotor nerve is compressed.

NOTE: Compression will happen on the same side as the injury.

46
Q

Increased CO2 causes what s/s?

A

Confusion and altered mental status

47
Q

What type of medication should be avoided in patients with head injuries?

A

Sedatives!

Sedatives cause a decrease in LOC and can impair ability to evaluate the patient

48
Q

What drug class is mannitol?

A

Osmotic diuretic

49
Q

How does mannitol work in the body?

A
  • Medication works via osmosis
  • The medication will pull fluid from the brain tissue and deposit the fluid into the bloodstream. This will help the ICP to decrease and the b/p to increase
50
Q

What IV fluid works like mannitol?

A

3% normal saline

51
Q

A patient with a head injury is at increased risk for what?

A

Seizures

52
Q

What are diagnostic tests for head injury patients?

A

CT scan

MRI

53
Q

What is a ventriculostomy?

A

The “gold standard” method used to measure ICP

A ventriculostomy also allows for CSF removal or sampling

Med Surg IV (12 decks)

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