Unit 7 Chaper 41 Increased Intracranial Pressure, Craniotomy Flashcards
Why is ICP detrimental?
Within this space, there is li ttle room for any of the components to expand or increase in volume.
With ICP it can shift lobes of the brain and also cause a CSF leak
Cranium is closed cavity, therefore does not allow for swelling
What is the normal ICP? Can Increased ICP cause death?
A normal level of intracranial pressure (ICP) is 10 to 15 mm Hg. Periodic increases in pressure occur with straining during defecation, coughing, or sneezing but do not harm the uninjured brain. A sustained ICP of greater than 20 mm Hg is considered detrimental to the brain because neurons begin to die.
What is the tx for ICP
Mannitol
If the brain swells, is there an increase in intracranial pressure?
A. Yes
B. No
A.YES
If any of these increase in size, there is an increase in pressure:
* If the brain swells
* If the tissues around the brain swells
* If there is too much CSF
* If the blood vessels vasodilate
Complication of ICP
If the pressure is too high – continuously gets worse if not treated:
Which causes cerebral edema
If too high, the brain herniates down through the hole at bottom of
skull (Foramen Magnum) and leads to brain stem dysfunction
* Brain stem controls vital signs
* Changes in HR, BP, respiration, and temperature
- Can cause hypoxia of brain
- Hypoxia can lead to brain tissue death
- Brain tissue death leads to increase in “clean up” via increase in WBC to site which leads to
further intracranial processes (more blood flow) * CO2 accumulation causes vasodilation, which leads to further intracranial processes
Increased ICP is the leading cause of death from head trauma in patients who reach the hospital alive.
Increased ICP is the leading cause of death from head trauma in patients who reach the hospital alive.
What is the main goal for ICP?
prevent ICP
Can ICP cause brain death?
YES
If edema remains untreated, the brainstem may herniate downward through the foramen of Monro or laterally from a unilateral lesion within one cerebral hemisphere,causing irreversible brain damage and possibly death (from brain herniation syndromes discussed later)
Causes of ICP
Trauma (Ex: falls, or MVA) – swelling and bruising
- Blood flow comes along to make the bruise and to take away the blood cells
as bruises go away (think about a bruise on your arm or leg where you can see it.) - Disease – infection
- Increase in WBC to site of infection
- Inflammation
- Hemorrhagic stroke – extra blood in area
S/S OF ICP
Initially: Altered LOC, restlessness, HA, confusion
- Vomiting—projectile or recurrent
- Unequal pupils and abnormal response
- Blown pupils—late sign of herniation
- Posturing—decorticate, decerebrate, flaccid
Is cushings triad an early or late sign of ICP?
A. early
B. late
B. late
What are the s/s of Cushing’s triad?
CHANGE IN VITAL SIGNS:
Cushing’s Triad
* Bradycardia
* Rising systolic BP (severe HTN)
* Widened pulse pressure
* Slow respiratory rate
*Cheyne stroke respirations
Decerebrate
A person whose limbs all extend away from their head has decerebrate posturing.
Decorticate
A person whose elbows bend and fold their arms up toward their chest has decorticate posturing. A
Which abnormal posturing is more severe?
Decorticate or Decerebrate
Decorticate or Decerebrate posturing develops when ICP is increased.
Decerebrate posturing means there is damage to the brainstem, which is
serious
What fluid and electrolyte balance requires immediate attention?
A. Potassium 4.9
B. Sodium 110.0
C. Calcium 10.0
D. magnesium 1.5
B. Sodium 110.0
Low sodium induces seizure
Monitor fluid and electrolyte imbalances
* Daily weights
* Accurate I&O’s
If there is trauma to the head what disease process should you monitor for that is associated with the anti diuretic hormone
(Diabetes insipidus/SIADH)
Nursing Intervention for Managing or preventing ICP
Elevate the HOB 30 degrees unless contraindicated by medical
condition and position in correct body alignment –
avoid flexion or extension of neck & maintain head in midline neutral position
Log roll patient & avoid hip flexion Decrease cerebral edema–osmotic diuretics like mannitol & possible
fluid restriction
* Lower CSF fluid–using an intraventricular drain system *
Maintain cerebral perfusion–monitor C.O., manage IV fluids carefully,
no cluster care
quiet environment
avoid flexion
inotropes if needed
MAP ATLEAST 65
Nursing Intervention for Managing ICP Continued
Controlling fever with antipyretics or gently cool with a cooling blanket – do not allow the patient to shiver – it will increase ICP
no cluster care
* Oxygenation–monitor ABG’s, pulse oximetry, Hgb levels and hyperventilate to decrease CO2 (increased PaCO2 causes
vasodilation)
Important to hyperoxygenate, not hyperventilate * Reduce cellular metabolic demands–barbiturates and/or sedation
quiet environment
Prior to suctioning what is the first intervention
(hyperoxygenatate 100%
Your patient with meningitis, has suddenly combative and irritable, what assessment should you initiate first?
A. Physical Assessment
B. Neurological Assessment
C. Respiratory assessment
D. Cardiovascular assessment
B. Neurological Assessment
Your patient with meningitis, suddenly exhibits. cheyne stroke respiration. What assessment should you initiate first?
A. Physical Assessment
B. Neurological Assessment
C. Respiratory assessment
D. Cardiovascular assessment
B. Neurological Assessment
Respiratory patterns can change with brain injuries
* Review respiratory patterns
* Cheyne stokes, Biot’s, et
What is the surgical management for Increased Cranial Pressure?
A. Thoracentesis
B. Paracentesis
C. Hyposphoectomy
D. Craniostomy
D. Craniotomy, usually used to remove tumors
What are the complications of craniotomy?
DI AND SIADH
