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240 > ICP + TBIs > Flashcards

ICP + TBIs Flashcards

1
Q

brain metabolic activity

A

20% of cardiac output

25% of total body glucose

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2
Q

autoregulation

A

ability of brain to maintain a constant perfusion despite wide variations in blood pressures
ensures cerebral blood vessels dilate in response to a perceived increase in requirements

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3
Q

MonroKellie Hypothesis

A

intracranial volume (VIC) = brain volume + blood volume + CSF volume + lesion volume

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4
Q

cerebral perfusion pressure (CPP)

A

CPP = MAP-ICP

normal CPP = 50-60

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5
Q

normal MAP

A

60-90

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6
Q

normal ICP

A

5-15

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7
Q

low CPP

A

CPP < 40-50 leads to hypoxia of cerebral tissue and loss of autoregulation

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8
Q

increased ICP results in

A

decreased CPP

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9
Q

primary causes of IICP

A 
brain tumor
trauma
nontraumatic cerebral hemorrhage
ischemic stroke
hydrocephalus
post operative cerebral edema
meningitis
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10
Q

secondary causes of increased ICP

A 
airway obstruction
hypoxia/hypercarbia
HTN/hypotension
position
hyperthermia
seizures
metabolic disorders (hyponatremia)
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11
Q

hourly neuro assessment includes

A

GCS
pupillary response to light
motor function
vitals

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12
Q

GCS

A

assesses level of consciousness, motor response to stimulus

reliable if it has been obtained prior to intubation or sedating medications

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13
Q

GCS categories

A 
eye opening (4)
motor response (6)
verbal response (5)
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14
Q

GCS values

A

13-15 mild/no brain injury
9-12 moderate brain injury
< 8 severe brain injury

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15
Q

causes of small pupils

A

bright room
glaucoma meds
opiates
damaged pons

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16
Q

causes of dilated pupils

A

fear
anxiety
cocaine use
brainstem compression

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17
Q

blown pupil

A

> 4mm

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18
Q

3 types of downward herniation

A

uncal
central
tonsillar

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19
Q

Cushing response triad

A

bradycardia
hypertension (widened pulse pressure)
respiratory variation

suspected herniation requires immediate response

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20
Q

indications for ICP monitoring

A 
severe head injury with GCS 3-8
subarachnoid hemorrhage
hydrocephalus
brain tumor
stroke
meningitis
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21
Q

leading causes of TBI

A

falls
MVCs
assaults
sports related injury

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22
Q

TBI patho

A

direct damage to cerebral parenchyma and axonal injury 2/2 impact to the head

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23
Q

concussion

A

caused by sudden deceleration of brain against the skull

not associated with underlying parenchymal damage

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24
Q

MBI sx

A 
amnesia
headache
anxiety
dizziness
fatigue
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25
Q

cerebral contusions and diffuse axonal injuries

A

often result of acceleration/deceleration injuries

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26
Q

contusions

A

brain accelerates against fixed skull
disruption of underlying cerebral parenchyma and blood vessels
brain may recoil and impact skull on opposite side
coup/countercoup injury
cerebral edema develops in 24-72 hrs
may result in IICP

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27
Q

diffuse axonal injuries

A

deceleration and shearing between different densities of white and grey matter in the brain
graded from I-III

28
Q

linear skull fracture

A

nondisplaced

occur from low velocity impact

29
Q

depressed skull fracture

A

depression of bone at point of impact

may be closed or open

30
Q

basilar fractures

A

occur at base of skull

31
Q

vascular injuries

A

may result from bleeding of arteries and veins between the brain and the skull or in the brain tissue
bleeding that occurs between the brain and the skull is a surgical emergency !!!

32
Q

epidural hematoma

A 
bleeding between dura mater and skull
associated with skull fx
2/2 laceration in middle meningeal artery
develops rapidly
requires surgical evacuation
33
Q

epidural hematoma sx

A

initial LOC
lucid interval
sudden re-LOC
rapid deterioration in neurologic status

34
Q

subdural hematomas

A

usually 2/2 countercoup injuries and a venous bleed

classified as acute, subacute, and chronic

35
Q

acute subdural hematoma

A 
develops within 24-48 hrs of injury
initial LOC followed by deteriorating GCS
hemiparesis
dysphagia
IICP
requires evacuation
36
Q

subacute subdural hematoma

A

develops days-weeks following injury
clot usually liquefies
evacuation is on an elective basis

37
Q

chronic subdural hematoma

A

more common in older adults
develops weeks after injury
nonspecific sx (headache, confusion, speech deficits)
may require burr holes for drainage

38
Q

subarachnoid hemorrhage

A

bleeding between arachnoid and pia mater

can be traumatic or 2/2 preexisting aneurysm

39
Q

factors that predict death/disability for severe TBI

A 
age
GCS prior to intubation
pupillary size/reaction to light
presence of extracranial injury
CT findings
presence of hypotension
40
Q

severe TBI collaborative care

A 
early intubation
transport
fluid resuscitation
CT scan
immediate evacuation of mass/lesion
ICU care with ICP monitoring
41
Q

TBI oxygenation and perfusion

A 
maintain PaO2 >60, SpO2 >90
positioning, supplemental O2
avoid hypercarbia (increases ICP)
42
Q

TBI sedation and pain relief

A

agitation + pain increase BP and ICP
benzos (except midazolam) for sedation
propofol decreases ICP and can be titrated for neuro assessments
morphine for pain

43
Q

osmotherapy

A

can decrease ICP
mannitol (diuretic)
hypertonic saline

44
Q

CSF drainage

A

intraventricular catheter and a pressure transducer can drain
negligible effects on cerebral blood flow
should lower ICP immediately

45
Q

high dose barbiturate therapy nursing considerations

A 
used for refractory IICP
assess for:
hypotension
continuous ICP monitoring
mechanical ventilation
pneumonia
ileus
protect corneas
46
Q

therapeutic hypothermia

AKA target temperature mgmt

A

decreases ICP
prevent shivering
adverse effects: arrhythmias, coagulopathies, pulmonary infection, electrolyte imbalances, hypothermia induced diuresis

47
Q

decompressive craniectomy

A

may be used in conjunction with duroplasty
indicated if continuous deterioration and s/s herniation
maintain adequate cerebral perfusion and oxygenation

48
Q

TBIs and seizures

A 
risk factors:
GCS < 10
cortical contusion
depressed skull fx
subdural, epidural, or intracranial hematomas
penetrating head wounds
a seizure within 24 hrs post injury
49
Q

TBIs and nutrition

A

TBI pts have increased metabolic needs
TBI increases metabolic rate to 120-240% of expected
begin enteral feedings within 72 hrs
monitor blood glucose 80-120

50
Q

TBI complications

A

pneumonia
ARDS
DVT
sodium imbalance

51
Q

TBI recovery predictive factors

A

duration and severity of coma
duration of posttraumatic amnesia
location/size of contusions and hemorrhages in brain
other injuries

52
Q

earliest sign of increasing ICP

A

change in level of consciousness

slowed speech, delayed responses to verbal suggestions

53
Q

vitals changes with IICP

A 
increased systolic pressure
widened pulse pressure
decreasing HR
wide fluctuations in HR
hyperthermia
54
Q

late s/s IICP

A

Cushing triad (bradycardia, HTN, bradypnea)
projectile vomiting
deterioration of LOC
hemiplegia, decortication, decerebration, flaccidity
Cheyne-Strokes respirations
loss of reflexes (pupil, gag, corneal, swallowing)

55
Q

IICP nursing dx

A 
ineffective airway clearance
ineffective breathing pattern
ineffective cerebral perfusion
deficient fluid volume r/t fluid restriction
risk for infection r/t ICP monitoring
56
Q

IICP complications

A

brainstem herniation
diabetes insipidus
SIADH

57
Q

pt goals

A 
maintain patent airway
normalize respirations
adequate cerebral tissue perfusion
fluid balance
absence of infection
absence of complications
58
Q

IICP interventions

A

elevate HOB to 60 degrees to promote venous drainage
frequent respiratory assessment and maintain patent airway
maintain calm atmosphere
monitor fluid status every hour I&O
use strict aseptic technique for ICP monitoring system

59
Q

IICP things to avoid

A

hip flexion
valsalva maneuver
abdominal distention
any stimuli that may increase ICP

60
Q

craniotomy

A

opening of skull to remove tumor, relieve IICP, evacuate clot, control hemorrhage

61
Q

craniectomy

A

remove portion of skull

62
Q

cranioplasty

A

repair of cranial defect using a plastic or metal plate

63
Q

Burr holes

A

circular openings for exploration or diagnosis to provide access to ventricles or for shunting procedures , to aspirate a hematoma or abscess, or make a bone flapp

64
Q

preoperative care for cranial surgery

A

corticosteroids, fluid restriction, mannitol/diuretics to reduce cerebral edema
abx
diazepam

65
Q

pt care after cranial surgery

A 
monitoring of respiratory fxn
frequent vitals/LOC
assess dressing for bleeding/CSF drainage
monitor for potential seizures
monitor fluid status
66
Q

cranial surgery nursing dx

A 
ineffective cerebral tissue perfusion
risk for imbalanced body temperature
potential for impaired gas exchange
disturbed sensory perception
body image disturbance
impaired communication (aphasia)
risk for impaired skin integrity
impaired mobility
67
Q

maintaning cerebral perfusion actions

A

monitor respiratory status to prevent hypoxia/hypercapnia
vitals q15 min
strategies to reduce cerebral edema (peaks 24-36 hrs)
avoid extreme head rotation

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