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6200 Adult /Older Adult II > ICP > Flashcards

ICP Flashcards

1
Q

Factors that influence ICP?

A

BP, intrabd/intrathoracic pressure, posture, temp, blood gases (CO2 levels)

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2
Q

The Monro-Kellie Doctrine states?

A
  • If there is an increase in 1 of the 3 components total intracranial volume will not change
  • Ability to compensate is limited
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3
Q

How to calculate Cerebral Perfusion Pressure (CPP)?

A

MAP - ICP = CPP

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4
Q

What factors increase Cerebral Blood Flow and why?

A
  • ↑ CO2
  • ↑ H+
  • ↓ O2
  • cause vasodilation
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5
Q

What is normal CPP?

A

60-100 mmHg

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6
Q

At what CPP does ischemia occur?

A

< 50 mmHg

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7
Q

Sustained ↑ICP leads to?

A
  • brainstem compression

- herniation of brain from one compartment to another

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8
Q

Increased ICP Clinical Manifestations?

A
  • changes in LOC
  • Cushing’s triad
    • ↑BP and widening PP, ↓HR, Resp irreg
  • Ocular signs
    • Cranial Nerve III
  • Headache in AM
  • Vomiting (no nausea)
    • projectile in peds
  • Motor function ↓
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9
Q

type of decerbrate where the neck and back are arched?

A

Opisthotonic posturing

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10
Q

Increased ICP Diagnostic Imaging?

A

CT/MRI

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11
Q

What is the Cushing’s Triad?

A
  • late sign of ICP

- ↑BP and widening PP, ↓HR, Resp irregularites

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12
Q

Inaccurate ICP measurement readings are due to?

A

CSF leak, catheter obstruction, difference in HT of bolt/transducer, incorrect HT of drainage system relative to pt’s reference point

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13
Q

Major complications fo uncontrolled ICP?

A
  • inadequate cerebral perfusion leading to ischemia and infarction
  • Brain herniation which may result in resp arrest
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14
Q

Why is the optic nerve prone to herniation?

A

it is located at the base of the skull

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15
Q

Drug therapy ICP?

A
  • Osmotic therapy
  • Corticosteroids
  • Acetaminophen
  • Barbituates
  • Antiseizure meds
  • stool softeners
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16
Q

Osmotic therapy for ICP?

A
  • Mannitol to reduce fluid volume

- Hypertonic solution

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17
Q

What should be done prior to administering mannitol?

A

check for crystalization, warm and use filter if this occurs

18
Q

Corticosteroid therapy for ICP?

A
  • Dexamethasone (Decadron)
  • monitor blood glucose, infections,
  • prevent GI bleed-use H2 blocker or PPI
19
Q

Why are barbiturates given to tx ICP?

A
  • to decrease cerebral metabolism

- causes respiratory depression

20
Q

Antiseizure med of choice for ICP?

A

phenytoin - give loading dose followed by maintenance doses

21
Q

IV Dilantin (phenytoin) is only give with which soluntion?

A

Normal saline

22
Q

What is the max rate of administration for IV dilantin and what happens if given to quickly?

A
  • 50 mg/min or 1-3mg/kg/min whichever is slower

- to quick can cause decreased in BP

23
Q

Why is D5W not given to tx ICP?

A
  • it decreases serum osmolarity and could increase edema

- is an isotonic soln, but acts as a hypotonic soln in the body

24
Q

Fluid of choice to keep the ICP patient normovolemic?

A

IV 0.9% NaCl

25
Q

What to assess in the unconscious patient using the Glasgow Coma Scale?

A
  • opening eyes
  • verbal responses
  • motor responses
26
Q

Glasgow Coma Scale TBI classifications?

A

1) severe: 3-8
2) moderate: 9-12
3) slight: 13-15

27
Q

Unilaterally pupil dilation is indicative of?

A

compression of CN III

28
Q

Bilateral dilated, fixed pupils is indicative of?

A

ominous sign

29
Q

Pinpoint pupils are indicative of?

A

damage to pons or caused by drugs

30
Q

How to test for oculocephalic reflexes?

A

have pt fix eyes on one spot than passively rotate their head, eyes should not move with the head

31
Q

How to test for oculovestibular reflexes?

A
  • inject cold water into an ear
  • abnormal response i eyes turn towards the cold or eyes don’t move
  • normal response is quick/slow nystagmis where the eye quick movement is in the direction away from the cold
32
Q

Breathing pattern consisting of cycles of hyperventilation and apnea?

A

Cheyne-Stokes

33
Q

Breathing pattern consisting of sustained regular rapid and deep breathing?

A

central neurogenic hyperventilation

34
Q

Breathing pattern consisting of prolonged inspiratory phase or pauses alternating with expiratory pauses

A

apneustic breathing

35
Q

Breathing pattern consisting of clusters of breaths follow each other with irregular pauses between

A

cluster breathing

36
Q

Breathing pattern that is completely irregular with some breaths deep and some shallow, with random irregular pauses and slow rate?

A

ataxic breathing

37
Q

Body positioning to avoid in a patient with ICP?

A

neck flexion, head rotation, extreme hip flexion

38
Q

Normal ICP range?

A

5 - 15 mmhg

39
Q

What is the “gold standard” for monitoring ICP?

A

the ventriculostomy

40
Q

Decreased vision or blindness in half the visual field, usually on one side of the vertical midline?

A

Hemianopsia

6200 Adult /Older Adult II (17 decks)

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