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Complex 2 > Intracranial Pressure > Flashcards

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
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

26
Q

Cerebral Perfusion Pressure (CPP) normal

A

60-100

CPP less than 50 indicated impaired neuronal functioning

27
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
28
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)

29
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

30
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
31
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
32
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

33
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

34
Q

Decompensation- Herniation

A

Supratentorial
Infratentorial
Hernation into surgical site

35
Q

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

A

Herniation of brainstem = Leads to death

36
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

37
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
38
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
39
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
40
Q

Papilledema

A

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

41
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

42
Q

ICP surgical tx

A

Removal of the lesion
Burr holes
Lobtomy
Craniotomy with bone flap

43
Q

CSF

A

Normal is clear

44
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

45
Q

ICP monitoring

Only one that can drain and monitor

A

intraventricular

46
Q

Intraventricular catheter with drainage

A

Keep collection system -zeroline at the level of the ear

Complex 2 (4 decks)

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