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NSG 430 - Critical Care > T9: Intracranial Pressureand Brain Tumors > Flashcards

T9: Intracranial Pressureand Brain Tumors Flashcards

1
Q

coup-contrecoup injury

A

Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds.

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2
Q

what are the 3 essential components of the skull

A

1.Brain tissue
2.Blood
3.Cerebrospinal fluid (CSF)

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3
Q

factors that influence ICP

A

*Arterial pressure
*Venous pressure
*Intraabdominal and intrathoracic pressure-Valsalva-bearing down
*Posture
*Temperature (cold vasoconstricts and drops ICP, fever dialtes and can take up space in the head and cause seizures)
Blood gases (CO2 levels)

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4
Q

what does oxygen do to brain vessels

A

dilates

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5
Q

what does CO2 do to brain vessels

A

constricts

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6
Q

what are normal compensatory adaptation that change volume in the brain

A

*CSF
*intracranial blood volume
*tissue brain volume

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7
Q

if volume int he brain increases, then..

A

ICP rises and decompensation occurs resulting in compression and ischemia

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8
Q

how much of the body’s oxygen does the brain use

A

20%

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9
Q

how much of the body’s glucose does the brain use

A

25%

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10
Q

the brain does not store

A

glucose; this is why we need sugar to function

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11
Q

what is the mean arterial pressure for the brain

A

70-150mmHg

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12
Q

cerebral perfusion pressure (CPP)

A

is the pressure needed to ensure blood flow to the brain (what is needed to perfuse the brain tissue)

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13
Q

calculation for cerebral perfusion pressure (CPP)

A

CPP = MAP - ICP

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14
Q

what is normal cerebral perfusion pressure (CPP)

A

60 to 100 mm Hg.

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15
Q

cerebral perfusion pressure (CPP) <50mmHg means…

A

ischemia and neuronal death

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16
Q

HINT HINT we are in trouble if the lactic acid level is

A

> 4

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17
Q

with lactic acidosis the cerebral blood vessels

A

dilate more

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18
Q

what can be given for metabolic acidosis

A

bicarb

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19
Q

increase ICP is

A

life threatening

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20
Q

Common causes of increased ICP include

A

*a mass (e.g., hematoma, contusion, abscess, tumor) and cerebral edema (associated with brain tumors, hydrocephalus, head injury, or brain inflammation).

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21
Q

HINT HINT s/s of increase ICP

A

o Altered level of consciousness (earliest indicator)
o Headache, vomitting
o Abnormal respirations
o Rise in BP, slowing of pulse
o Pupil changes

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22
Q

hydrocephalus

A

accumulation of fluid in the spaces of the brain (can cause incresed ICP)

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23
Q

intervention for hydrocephalus

A

ventricularperitoneal shunt

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24
Q

cerebral edema

A

*increased accumulation of fluid in the extravascular spaces of brain tissue.

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25
Q

Causes of cerebral edema

A

*Brain tumor, abscess, toxins
*Fluid shift - extracellular/intracellular, SIADH, glucose shifting (HHS,DKA)
*Cerebral spinal fluid, hydrocephalus

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26
Q

what are the major complications of increased ICP

A

*inadequate cerebral perfusion and cerebral herniation.

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27
Q

HINT HINT cerebral herniation

A

a downward displacement of the brain into the brainstem

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28
Q

intervention for cerebral herniation n

A

OPEN UP THE SKULL and MEDICAL EMERGENCY

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29
Q

diagnostic studies for cerebral edema

A

*CT scan / MRI / PET
*EEG
*Cerebral angiography
*ICP and brain tissue oxygenation measurement
*Doppler and evoked potential studies

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30
Q

HINT HINT what diagnostic study CANNOT be done with increased ICP

A

NO lumbar puncture due to risk of herniation going from closed compartment to open compartment

31
Q

HINT HINTGlasgow Coma Scale (GCS)

A

scale used to assess the level of consciousness

eyes opening, verbal, motor

8 and less is considered coma

32
Q

how do we measure ICP

A

use pressure transducer (can be placed in various areas of the brain depending on where the bleed or excess CSF is )

33
Q

where is the pressure transducer placed when measuring ICP

A

placed mid ear

34
Q

what do we do when moving a patient with a pressure transducer

A

Be fore you change their position you turn OFF then re zero and calibrate

35
Q

HINT HINT what drug is given for cerebral edema

A

mannitol

36
Q

HINT HINT
Mannitol (Osmitrol)

A

Mannitol (Osmitrol)
Osmotic diuretics. Pull fluid from tissues into blood vessels
-Decrease intracranial pressure related to cerebral edema.

37
Q

HINT HINTwhat kind of solution is used to manage increased ICP

A

hypertonic solution

38
Q

HINT HINT hypertonic solution causes salt levels to…

A

RISE

Solute concentration is greater than that inside the cell; cell loses water

39
Q

HINT HINT what corticosteroid is used for cerebral edema

A

*Dexamethasone(decadron)

40
Q

what do we monitor with a patient on Dexamethasone(decadron)

A

*Monitor fluid intake, serum sodium and glucose levels

41
Q

what should be given with Dexamethasone(decadron)

A

antacids, H2 receptor blockers, proton pump inhibitors becuase corticosteroids can cause ulcers so we want to protect the gut

42
Q

anyone with head trauma/increased ICP should be on

A

antiseizure medications/seizure precautions

43
Q

medication for emergent seziure activity

A

*Benzodiazepines(Lorazepam)

44
Q

maintenance medication for seizure

A

*Phenytoin(Dilantin)

45
Q

ways to cool a client

A

alternate Tylenol and ibuprofen or sponge them and pack in ice or cooling blanket

46
Q

ways to warm a client

A

bear hugger or warm blanket, heating pad, warm IV fluids

47
Q

when a patient is on sedatives for increased ICP what should be done?

A

sedation vacation so that you can assess the neuro function

48
Q

scores for GSC

A

The highest GCS score is 15 for a fully alert person, and the lowest possible score is 3. A GCS score of less than or equal to 8 is generally indicative of coma, and mechanical ventilation should be considered.

49
Q

clinical manifestations of increased ICP

A

*Change in level of consciousness
*Flattening of affect → coma
*Change in vital signs
*Cushing’s triad
*Change in body temperature
*ocular changes
*↓ In motor function
* BADHeadache
* projectile Vomiting

50
Q

interventions for projectile vomiting

A

NPO, may need NG, antiemetics

51
Q

Ocular signs of increased ICP

A

*Unilateral pupil dilation
*Sluggish or no response to light
*Inability to move eye upward
*Eyelid ptosis
*Diploplia,
*blurred vision,
*EOM changes
*Pupillary reflex
*Corneal reflex

52
Q

Cushing’s triad

A

widened pulse pressure, hypertension, bradycardia, irregular respirations

53
Q

HINT HINT Decerebrate posturing

A

extensor posturing

54
Q

HINT HINT Decorticate posturing

A

flexor posturing extension of the legs and internal rotation and adduction of the arms with the elbows bent upward indicates damage to cortex

55
Q

Which posturing is worse?

A

decerebrate

56
Q

maintenance of airway for increased ICP

A

*Elevate head of bed 30 degrees
*Suctioning needs-Keep suctioning to a minimum
*Monitor ABGs-hypoxia-hypercapniaàvasoactive/constricts
*Maintain ventilatory support

57
Q

how do we determine if we need suction

A

Coughing, sats dropping, stuff is coming out of mouth, listen to breath sounds, you can feel it in the chest

58
Q

how to minimize abdominal distention

A

*NG tube for clients WITHOUT FACIAL OR BASAL skull fractures-use oral route instead

59
Q

*Pain and anxiety management

A

*Opioids-fentanyl less effect on brain perfusion/O2
*Propofol (Diprivan)-short duration, can assess
*Dexmedetomidine (Precedex)
*Neuromuscular blocking agents-paralyzers
*Benzodiazepines-avoided most times

60
Q

monitoring fluid and electrolyte balance

A

*Monitor IV fluids
*Daily electrolytes-
*Monitor for DI or SIADH (swelling pushed on pituitary gland)

61
Q

what are things that can increase ICP that need to me minimized

A

Valsalva maneuver, coughing, sneezing, suctioning, hypoxemia, and arousal from sleep

62
Q

Interventions to optimize ICP and CPP

A

*HOB elevated appropriately-30 degrees
*Prevent extreme neck flexion
*Turn SLOWLY
*Avoid coughing, straining, Valsalva
*Avoid hip flexion

63
Q

Protection from self-injury

A

*Seizure precautions
*Quiet, nonstimulating environment

64
Q

Benign brain tumors:

A

*Benign brain tumors do not contain cancer cells: usually, benign tumors can be removed, and they seldom grow back.
*
*The border or edge of a benign brain tumor can be clearly seen. Cells from benign tumors do not invade tissues around them or spread to other parts of the body.

65
Q

issue with brain tumors

A

benign tumors can press on sensitive areas of the brain and cause serious health problems.

66
Q

Malignant brain tumors:

A

*Malignant brain tumors are generally more serious and often is life threatening. It may be primary or secondary

*They are likely to grow rapidly and invade the surrounding healthy brain tissue.

67
Q

primary brain tumor

A

the tumor originate from the brain tissue

68
Q

Secondary brain tumors

A

metastasis from others tumor elsewhere in the body

69
Q

Risk factors of the brain tumor

A

*Being male
*Race
*Age
*Family history
*Being exposed to radiation or certain chemicals at work

70
Q

Signs and symptoms of brain tumor

A

*Decrease in level of consciousness such as confusion and lethargy.
*
*Headache most common in the early morning and made worse by coughing or strainingVomiting
*
*Papilledema ( edema of optic nerve) and visual disturbance
*
*Alteration in mental status.
*Vomiting
*
*Alteration in mental status.

71
Q

localized symptoms of brain tumor

A

*Aphasia
*Personality changes as in case of frontal lobe tumor
*Sensory defects ( smell, hearing).
*Seizures.
*Motor abnormalities

72
Q

HINT HINT when is a spinal tap used

A

use in diagnosis of brain tumor but NOT for increased ICP

73
Q

Treatment of brain tumor

A

*A variety of medical treatment modalities, including chemotherapy and radiotherapy, are used alone or in combination with surgical resection.
*Supportive care include:
*Steroids
*Anticonvulsant drugs

NSG 430 - Critical Care (42 decks)

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