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Intracranial Pressure Flashcards

1
Q

Normal ICP

A
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2
Q

Normal ICP

A
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3
Q

Cerebral Blood Flow

A

Brings oxygen and nutritious to the brain tissue for cellular energy production; Waste products removed
-Varies with changes in Cerebral perfusion pressure and diameter of cerebrovascular bed

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4
Q

Cerebral Perfusion Pressure (CPP) normal

A

60-100

CPP less than 50 indicated impaired neuronal functioning

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5
Q

Autoregulation

A

Ability of brain to alter the diameter of the arterioles to maintain cerebral blood flow at a constant level despite changes in CPP
-When ICP approaches MAP, CPP decreases to point where autoregulation is impaired and CBF decreases

  • CPP less than 50 causes HYPOFUSION causing anozic encephalopathy
  • CPP > 150 causes HYPERFUSION causing cerebral edema and hypertensive encephalopathy
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6
Q

Factors Affecting CBF:

Increase in CBF—> ^ICP

A

Hypercapnia: (vasodilation)
Hypoxemia: Increases initially then decreases
Decreased blood viscosity: Thinner blood easier to move
Hyperthermia: Increases oxygen demand
DRUGS: Vasodilation (Nitro- lightheadedness headache)

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7
Q

Factors Affecting CBF:

Decrease in CBF—-> decrease icp

A

Hypocapnia (constriction)
Hypoxemia: initially ^ b/c dilation but too much pressure on BV causes a decrease
Increased blood viscosity: thicker blood harder to move
Hypothermia
Intracranial hypertension?
DRUGS: Aesthetics, Barbiturates(induced coma to decrease metabolic needs

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8
Q

Patho state of ^ ICP

A 
Increased volume of the brain tissue: 
-Cerebral edema
-Tumor
-Abscess
Increased volume of blood:
-Hematoma
-Aneurysm with SAH
-Arterial venous malfunction
- Obstruction venous flow (PEEP)
Increased volume of CSF
-Decreased in csf absorption
-^ CSF production
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9
Q

Compensatory Mechanism

A 
Attempts to maintain a constant CBF
Types of compensatory mechanisms:
Displacement of CSF
Collapse of ventricles and cisterns
^ absorption of CSF in arachnoid villa and decrease secretion of CSF
-Autoregulation
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10
Q

Monrow compliance Curve

A

Body can compensate for so long but once it hits a certain pont it loses the ability to maintain pressure and goes sky high

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11
Q

Loss of Autoregulation

A 
Loss of cerebral autoregulation
1. ^ BP
^ Cerebral blood volume
^ Extravasation edema
2. decrease BP
Decrease Cerebral blood volume
^ Hypoxia, Hypercabia, Acidosis

All leads to ^ ICP

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12
Q

Decompensation- Herniation

A

Supratentorial
Infratentorial
Hernation into surgical site

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13
Q

Downward cerebellar herniation: Lumbar puncture, only if ICP isnt increased

A

Herniation of brainstem = Leads to death

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14
Q

Types of Herniations

A

Clingulate expanding lesion in ONE hemisphere
Central frontal, parental or occipital lesion
Transcalarial
**Uncal expanding lesion in middle fossa or temporal lobe causing lateral displacemnt
Unilateral- ipsilatera; pupil dilation ***** most common

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15
Q

Timeline of events to DEATH

A
  • Cranial insult
  • Tissue edema
  • ^ICP
  • Compression of arteries
  • Decreased CBF
  • Decrease o2 with death of brain cells
  • Edema around necrotic tissue
  • ^ ICP with compression of brainstem . resp center
  • CO2 accumulates causes vasodilation
  • ^ICP due to ^ blood volume
  • DEATH
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16
Q

Assessment of ^ ICP: over all

A 
Change in mental status ** LOC
Gross motor changes
Pupillary changes
Changes in V/s Cerebellar function
Psychological response of pt and fam
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17
Q

Assessment of ^ ICP:

  1. Early
  2. Late
  3. Terminal
A
  1. Able to compensate
    -Altered LOC (confusion and restless)
    -Unilateral pupil change in size, equality and or reaction7
    -Altered Resp (bradypnea or irregular rate)
    -Unilateral Hemiparesis
    v/s Focal (speech visual disturbances)
    -Papilledemia
    -Vomiting headache seziures
  2. Compensation failing
    Decrease LOC Stupor
    -Unilateral or bilateral change in pupils ect
    -Ineffective breathing patterns cheyne strokes resp
    -abnormal motor response
  3. Decompensation
    -Coma
    -Bilateral fixed pupils
    -Resp arrest
    -Absence of motor response- flaccid
    V/s for 2-3
    Hypertension with widened pulse pressure
    Bradycardia
    Hyperthermia
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18
Q

Papilledema

A

Edema of the optic disk (region where the optic nerve forms) often due to ^ICP

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19
Q

Therapeutic Management :

Prevent further ^ in ICP

A

Maintain airway
Mild hyperventilated
maintain BP
Prevent valsava (b/c it ^ICP)
IV fluid to maintain BP
Sedation and paralysis
Maintain normal temp
spacing nursing activites
Position- HOB ^ -promotes venous return to decrease ICP by sitting
Seizure activity- prevent it bc it ^ temp
DRUG therapy
Mannitol -Lasix pulls fluid from cerebral tissue
Decadron: Glucose corticosteroid - reduces inflammation

ICP monitoring
External ventricular draniage -drain from ventricle into bag keep at level of ventricles

20
Q

ICP surgical tx

A

Removal of the lesion
Burr holes
Lobtomy
Craniotomy with bone flap

21
Q

CSF

A

Normal is clear

22
Q

Internal drains

A

For ppl with perm ^ICP dumps to subclavian, peritoneal
Shunts: Pressure builds value open release of CSF then decrease pressure closes valve
Antiseptic technique

23
Q

ICP monitoring

Only one that can drain and monitor

A

intraventricular

24
Q

Intraventricular catheter with drainage

A

Keep collection system -zeroline at the level of the ear

25
Cerebral Blood Flow
Brings oxygen and nutritious to the brain tissue for cellular energy production; Waste products removed -Varies with changes in Cerebral perfusion pressure and diameter of cerebrovascular bed
26
Cerebral Perfusion Pressure (CPP) normal
60-100 CPP less than 50 indicated impaired neuronal functioning
27
Autoregulation
Ability of brain to alter the diameter of the arterioles to maintain cerebral blood flow at a constant level despite changes in CPP -When ICP approaches MAP, CPP decreases to point where autoregulation is impaired and CBF decreases - CPP less than 50 causes HYPOFUSION causing anozic encephalopathy - CPP > 150 causes HYPERFUSION causing cerebral edema and hypertensive encephalopathy
28
Factors Affecting CBF: | Increase in CBF---> ^ICP
Hypercapnia: (vasodilation) Hypoxemia: Increases initially then decreases Decreased blood viscosity: Thinner blood easier to move Hyperthermia: Increases oxygen demand DRUGS: Vasodilation (Nitro- lightheadedness headache)
29
Factors Affecting CBF: | Decrease in CBF----> decrease icp
Hypocapnia (constriction) Hypoxemia: initially ^ b/c dilation but too much pressure on BV causes a decrease Increased blood viscosity: thicker blood harder to move Hypothermia Intracranial hypertension? DRUGS: Aesthetics, Barbiturates(induced coma to decrease metabolic needs
30
Patho state of ^ ICP
``` Increased volume of the brain tissue: -Cerebral edema -Tumor -Abscess Increased volume of blood: -Hematoma -Aneurysm with SAH -Arterial venous malfunction - Obstruction venous flow (PEEP) Increased volume of CSF -Decreased in csf absorption -^ CSF production ```
31
Compensatory Mechanism
``` Attempts to maintain a constant CBF Types of compensatory mechanisms: Displacement of CSF Collapse of ventricles and cisterns ^ absorption of CSF in arachnoid villa and decrease secretion of CSF -Autoregulation ```
32
Monrow compliance Curve
Body can compensate for so long but once it hits a certain pont it loses the ability to maintain pressure and goes sky high
33
Loss of Autoregulation
``` Loss of cerebral autoregulation 1. ^ BP ^ Cerebral blood volume ^ Extravasation edema 2. decrease BP Decrease Cerebral blood volume ^ Hypoxia, Hypercabia, Acidosis ``` All leads to ^ ICP
34
Decompensation- Herniation
Supratentorial Infratentorial Hernation into surgical site
35
Downward cerebellar herniation: Lumbar puncture, only if ICP isnt increased
Herniation of brainstem = Leads to death
36
Types of Herniations
Clingulate expanding lesion in ONE hemisphere Central frontal, parental or occipital lesion Transcalarial ******Uncal expanding lesion in middle fossa or temporal lobe causing lateral displacemnt Unilateral- ipsilatera; pupil dilation ********* most common
37
Timeline of events to DEATH
- Cranial insult - Tissue edema - ^ICP - Compression of arteries - Decreased CBF - Decrease o2 with death of brain cells - Edema around necrotic tissue - ^ ICP with compression of brainstem . resp center - CO2 accumulates causes vasodilation - ^ICP due to ^ blood volume - DEATH
38
Assessment of ^ ICP: over all
``` Change in mental status ** LOC Gross motor changes Pupillary changes Changes in V/s Cerebellar function Psychological response of pt and fam ```
39
Assessment of ^ ICP: 1. Early 2. Late 3. Terminal
1. Able to compensate -Altered LOC (confusion and restless) -Unilateral pupil change in size, equality and or reaction7 -Altered Resp (bradypnea or irregular rate) -Unilateral Hemiparesis v/s Focal (speech visual disturbances) -Papilledemia -Vomiting headache seziures 2. Compensation failing Decrease LOC Stupor -Unilateral or bilateral change in pupils ect -Ineffective breathing patterns cheyne strokes resp -abnormal motor response 3. Decompensation -Coma -Bilateral fixed pupils -Resp arrest -Absence of motor response- flaccid V/s for 2-3 Hypertension with widened pulse pressure Bradycardia Hyperthermia
40
Papilledema
Edema of the optic disk (region where the optic nerve forms) often due to ^ICP
41
Therapeutic Management : | Prevent further ^ in ICP
Maintain airway Mild hyperventilated maintain BP Prevent valsava (b/c it ^ICP) IV fluid to maintain BP Sedation and paralysis Maintain normal temp spacing nursing activites Position- HOB ^ -promotes venous return to decrease ICP by sitting Seizure activity- prevent it bc it ^ temp DRUG therapy Mannitol -Lasix pulls fluid from cerebral tissue Decadron: Glucose corticosteroid - reduces inflammation ICP monitoring External ventricular draniage -drain from ventricle into bag keep at level of ventricles
42
ICP surgical tx
Removal of the lesion Burr holes Lobtomy Craniotomy with bone flap
43
CSF
Normal is clear
44
Internal drains
For ppl with perm ^ICP dumps to subclavian, peritoneal Shunts: Pressure builds value open release of CSF then decrease pressure closes valve Antiseptic technique
45
ICP monitoring | Only one that can drain and monitor
intraventricular
46
Intraventricular catheter with drainage
Keep collection system -zeroline at the level of the ear

Complex 2 (4 decks)

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