Intracranial regulation

Question 1

What is a normal ICP?

Answer 1

10-15 mmHg

Question 2

What is the normal CPP?

Answer 2

70-95 mmHg

Question 3

How do you calculate CPP?

Answer 3

MAP - ICP = CPP

Question 4

What happens when the CPP is too low?

Answer 4

The brain is not being perfused and the brain tissue will die

Question 5

What is the normal MAP?

Answer 5

70-100 mmHg

Question 6

How do you calculate MAP?

Answer 6

2 x DBP
+ SBP
divide by 3

Question 7

What are some things that increase ICP?

Answer 7

Hypercarbia
ET or oral tracheal suctioning
coughing
extreme neck or hip flexion/extension
HOB < 30 degrees
increasing intra-abdominal pressure (tight clothes, vomiting, sneezing)

Question 8

What are some things that decrease ICP?

Answer 8

HOB at least 30 degrees
maintain body midline
maintain patent airway
reduce stimuli
maintain c-spine until cleared

Question 9

What is the earliest s/sx of increased ICP?

Answer 9

alterations in LOC & respirations
confusion
cheyne stokes
apnea

Question 10

What are the other signs of increased ICP?

Answer 10

pupils uneven, blurry, double
weakness or paralysis on the opposite side (early)
posturing: decor or decere (late)
HA
N/V
fever
seizures
cushing’s triad (late)

Question 11

What precautions are patients with increased ICP on?

Answer 11

NPO
seizure
fall

Question 12

What can the nurse do to decrease the ICP?

Answer 12

ventriculostomy: cath in the brain to drain CSF and monitor ICP
neuro checks q15 min
give mannitol or hypertonic saline
vasopressors
manipulate CO2 (hyperventilate)
craniotomy
Prevent straining
decrease stimulation

Question 13

What is the function of mannitol?

Answer 13

Osmotic diuretic
pulls fluid off the brain & into the vascular system
increases cerebral O2 delivery

Question 14

What patients cannot receive mannitol?

Answer 14

renal disease patients

Question 15

What should be monitored while giving mannitol?

Answer 15

glucose bc its a concentrated sugar
monitor serum osmolality levels
-should be 265-295
-neuro defects can be seen at 315
-high is concentrated and low is diluted

Question 16

What is the function of hypertonic saline?

Answer 16

has the same action as mannitol but this is in a drip form
maintains the ICP level

Question 17

What should you monitor while giving hypertonic saline?

Answer 17

BP
NA level (watch for fluid overload)
give slowly

Question 18

What is the function of barbiturates (phenobarbital) for increased ICP?

Answer 18

to decrease brain metabolism
decreased ICP and cerebral edema
requires close monitoring

Question 19

What should be given as a prophylaxis for seizures when a patient has increased ICP?

Answer 19

Phenytoin
Fosphenytoin

Question 20

What should not be given when a patient has increased ICP with decreased LOC, and why?

Answer 20

Opioids
sedatives (promethazine)
because this will decrease their LOC (which is already low), and we will not be able to get an accurate neuro assessment

Question 21

What are the priority interventions for increased ICP?

Answer 21

assess ABCs
O2
ventriculostomy (constant ICP monitoring)
neuro checks w/ GCS
do not remove the c-collar
Head CT w/o contrast to see bleeding

Question 22

What is the major complication of increased ICP?

Answer 22

Brain Herniation
so much pressure that the brain is coming out of the bottom of the skull because there is nowhere to go
brain death will occur
prevent this by frequent neuro checks and craniotomy