Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Increased ICP
K. Wolz podcast
| Question | Answer |
|---|---|
| What are the 3 constituents of the cranial vault? | Brain tissue, Intravascular blood, and CSF |
| If the brain swells, what must the body do to accommodate the loss of space within the cranial vault? | Shunt CSF away, and then, if necessary, shunt intravascular blood away. |
| What is a consequence of shunting intravascular blood out of the cranial vault? | Hypoxia. Cellular Damage and eventually brain death. |
| What happens if intravascular blood and/or CSF do NOT shunt away in the presence of brain swelling? | Increased intracranial pressure. |
| Why is it OK to shunt off CSF? | Because it is constantly being made. |
| What is the difference in the body's response to brain swelling in an infant and an adult? | In an infant, the cranium is not a closed vault, so the brain can swell up through the fontanelle. In an adult, the cranium is a closed vault and the tx would be to drill burr holes or do a craniotomy to allow room for the swelling. |
| In the case of a craniotomy, how long is the bone flap left OFF? | 12 months. |
| What precautions are taken while the bone flap is off? | Patient must wear a helmet. |
| What do they do with the bone flap in the meantime? | Insert it surgically under the skin in the abdomen to keep it alive. |
| Where do they place a shunt for CSF and what is it called? | It is called a Ventricular-Peritoneal Shunt & is placed on the non-dominant side of the brain. It goes under the skin and looks like a little worm and empties into the peritoneal cavity. That keeps the 9-10% volume of CSF out of the cranial to prevent ICP |
| What can be done to change the diameter of the cerebrovascular bed? | Hyperventilate to reduce diameter of bed; |
| What methods are there for determining the cerebral perfusion pressure? | The ONLY method for determining is placement of an Intracranial Perfusion Monitor. (Only in ICU) |
| What is the calculation for CPP? (Not on the test) | CPP = MSAP - ICP : mean systemic arterial pressure less the mean intracranial pressure equals the cerebral perfusion pressure. |
| What does the value for CPP need to be? | Between 80-90 mmHg |
| What are s/s of IICP in an infant? | Bulging fontanelle, suture separation, increased head size, high pitched cry |
| What type of subjective assessment data will we gather for IICP? | History, visual changes, pain, ADLs, headache |
| What type of objective assessment data will we gather for IICP? | Changes in LOC (subtle vs rapid), pupillary signs, VS changes, focal motor signs, sensory signs, vomiting, hiccups, papilledema, speech patterns |
| What is Papilledema? | Swelling in the back of the eye. This is a LATE sign!! |
| What is the Babinski sign? | The extension of the great toe with fanning when pressure is applied to the plantar foot laterally from the heel toward the toes. |
| When is Babinski present a normal finding? When is it an abnormal finding? | Babinski is present and normal in children up to the age of 2, when they are walking. Babinski present after the age of two is an abnormal finding. This is consistent with the idea that decompensating or insulted nervous mimic an immature nervous system. |
| What are the 3 signs of Meningimus (meningeal irritation)? | Nuchal rigidity, Brudzinski's sign, Kernig's sign. |
| What is Nuchal rigidity? | Marked resistance to flexion of the neck. |
| What is Brudzinski's sign? | When the neck is flexed, the hips and legs flex involuntarily. |
| What is Kernig's sign? | The examiner flexes one of the patient's thighs to a right angle and then attempts to extend the leg on the thigh. |
| What is Decorticate posturing (Flexor)? | The upper limbs are flexed and pronated and the lower limbs are extended. |
| What is Decerebrate posturing (Extensor)? | The upper limbs are extended. |
| How would you position the patient to check for the signs? | In a neutral position and look for subtle signs. Movements will not be great. |
| If a patient has an unstable fracture of C2-C4, what intervention will NOT be done? | We will NOT elevate the HOB 15-30 degrees. |
| What are things we can do to decrease ICP? | Elevate HOB 15-30 degrees, Avoid flexion of the hips, waist and neck, Avoid rotation of the head, especially to the right, space out nursing activities, avoid valsalva type mvmts, limit suctioning as necessary. |
| WHY do we avoid flexion of the hips, waist and neck? | Because if we increase intra-abdominal pressure, then we increase intra-thoracic pressure, and we increase ICP. |
| WHY do we avoid rotation of the head, especially to the right? | Because it interferes with drainage and perfusion. |
| How do we control B/P to keep systolic under 160? | For HTN, beta-blockers (labetalol). For HYPOtension, manipulate with fluids and meds. NOTE: Some HTN meds may cause increased ICP. |
| How are symptoms of shock and IICP compared? | IICP - Increased BP, Decreased Pulse & Resp SHOCK - Decreased BP, Increased Pulse & Resp, so these are OPPOSITE |
| What is Cushing's Triad? | Increased BP, Decreased Pulse, Decreased Respirations. This is a LATE sign of IICP. |
| If a patient presents with a DECREASED BP, what can you rule out? | Neurological bleeds. There is no way that a patient can be hypovolemic secondary to a bleed in the brain. If they bled that much, they would be dead. |
| What is the exception to the previous question? | Children with dog bites of the face and the head, because of the vascularity of the face and the scalp, a child can be mauled and present as a hypovolemia related to the head trauma. |
| How can we reduce metabolic demands? | Temperature control, sedation, analgesics, seizure prophylaxis, neuromuscular blockade, and barbituates; Aggressively manage hyperthermia; Benzodiazepines; |
| What is a nice fact about Benzodiazepines, as they relate to ICP? | They do NOT affect (CBF)Cerebral Blood Flow or ICP. |
| What is considered for patients nonresponsive to other treatments? | Neuromuscular blockade |
| If something we are doing is increasing ICP, what can we do? | Give Barbituates to reverse effect. |
| What is Pentobarbital used for? | To place the patient in a coma to reduce the metabolic demands and allow the brain to heal itself. |
| For IICP, what do we do to monitor fluid balance? | Restrict fluid to 2/3 normal, monitor urine output, use minidripper, give normotonic IV solutions, Include vomiting loss and/or losses due to IADH or DI. |
| For IICP, how do we maintain oxygenation? | Intubate, as necessary; Oxygenate before and after suctioning; Control respirations; Increase rate to keep PCO2 25-30; Use lidocaine to prevent coughing if intubated; Maintain H&H; |
| Why are these patients often intubated? | Because these patients can become hypoxic quickly and then we introduce a secondary injury. Intubation ensure oxygenation and prevents secondary hypoxia. |
| How do we oxygenate for suctioning on a patient not on a ventilator? | Bag 'em! |
| Why might we intentionally hyperventilate a patient with IICP? | Because when you hyperventilate and blow off too much CO2, it causes the diameter of the arterial vessels to constrict which decreases the arterial blood flow to the brain. |
| If we were to intentionally hyperventilate a patient with IICP, how long would we do that for? | SHORT TERM!! Some docs use this, some don't. |
| What happens if the patient coughs? | Increased intrathoracic pressure, increased ICP. |
| Long term management of IICP involves what? | Tracheostomy and PEG tube. |
| YOU NEED TO KNOW MANNITOL!! | . |
| Why do we administer Mannitol? | If the patient has a decreased intravascular volume, and we give a potent diuretic to pull that volume out, then the patient needs to have an adequate intravascular volume to prevent hypotension and secondary brain injury. |
| Precautions related to contraindications may not be followed if WHAT? | The benefits outweigh the risk. |
| What is the nice thing about giving a hypertonic solution of glucose (25-50%)? | They have a little bit of an anticoagulant property. |
| What is the down side of giving a hypertonic solution of glucose? | It can cause inflammation of the vessels, like hyperglycemia, and you run the risk of destroying the vessels. Again, do the benefits outweigh the risks. |
| LOTS OF QUESTIONS ON CORTICOSTEROID DECADRON, LOTS OF NURSING RESPONSIBILITIES, LOTS OF EDUCATION REQUIRED!! | . |
| Why would we give prophylactic Dilantin? | Anytime you have a change in the biochemistry in the brain, you have the potential for developing seizure activity. |
| VIEW ppt on TPN. I did. I thought we knew everything. Didn't think it was worth making flash cards for. | . |
| What are 3 possible surgical interventions for IICP? | Burr holes, removal of flap of skull, ventricular pressure monitoring. |
| What is the purpose of the ventricular pressure monitoring? | To drain off excess CSF. |
| What is the #1 complication of ventricular pressure monitoring? | INFECTION!! In an effort to prevent infection, it is a closed system and is always aseptic. |
| What will the waves shown on the Ventricular Pressure Monitor dictate? | Standing orders, ie. If the pressure is X, open up the free drain and drain off some CSF. OR Hyperventilate the patient. OR Give a dose of Mannitol. |
| What will be included in Patient and Family education? | Meds, s/s of ICP, follow-up care. |
| What is included in supportive care? | Listening skills, allowing family to spend time with the patient, explaining procedures, and talking to the patient. |
Created by:
Kitty Groebli
Popular Nursing sets