ICP Questions
Terms
undefined, object
copy deck
- Early sign of ICP
- Irritability
- What is the first thing to compensate when hyou have increased ICP
- Promotion and reabsorption of CSF
- A patietn presents with his arms rigid and flexed, he ahs hyperflexion ofhis upper extremities and hyperextension of his lower extremities. What kind of posture is this
- Decorticate
- A patient presents with BP of 137/90 and an ICP of 20 what is the patient's ICP
- 85.6
- A patient presents with increased ICP and has a widened pulse pressure, decreased HR and abnormal respirations. What interventions would the nurse anticiapte?
- Fluid restriction, mannitol, and intubtion
- What is a late indicator of increased ICP
- incrasing blood pressure and bradycardia
- What warly signs should the nurse observe as an early indicator of increasing ICP
- Declining level of consciousness
- A client is transferred to ICU after a craiotomy. What should the nurse do to reduce the client's risk of developing increased ICP?
- Administer stool softeners as prescribed
- What is not a nursing intervention to prevent an increase in ICP
- maintaining a well-lit room
- Drug of choice for decreasing ICP
- mannitol
- Early sign of serious impairment of brain circulaation related to increasing ICP
- lethargy and stupor
- Initial compensatory vital sign changes with increased ICP
- Respiratory rate irregularities, slow, bounding pulse, increased systemic blood pressure.
- For a steady state, an increase in one component must be compensated for by an equal decrease in the other components to maintain a constant volume and pressure in the box
- Monroe-Kellie doctrine
- Nursing care activities for a patient with increased ICP
-
use of a cervical collar
teach patietn to exhale when being turned to avoid valsalva maneuver
Avoid activities that interfere with venous drainage of blood from the head - How should mannitol be given
- give as a bolus
- How does mannitol work
- draws fluid from brain cells into the bloodstream promoting cerebral cell dehydration
- How does mannitol improve oxygen delivery
- it expands circulating volume and blood viscosity, and therefore increases CBF and O2 delivery
- A patient presents with transient symptoms of N/V and personality changes. What stage of intracrania hypertension would the nurse suspect the patient is in
- Stage 1
- A patient is to be on IV therapy for increased ICP. What solution should the nurse anticipate hanging
- Normal Saline
- Cushing's triad is a result of pressure on what area of the brain
- the brain stem
- An increase in ICP is critical at
- 30 mmHg
- Compensation for increases in ICP include
-
CFS regulation
Autoregulation of blood flow
Metabolic regulation fo blood flow - The nurse wants to keep a normovolemic state in the patient in order to
- increase CPP and decrease ICP
- You walk into a patients room and addess the following: a CPP between 60 - 100 mmHg, decrease cerebral oxygen, increase CO2, and hypothermia. You realize that the patient is
- metabolically regulating his blood volume
- What is a normal ICP value
- 0-20
- Longer term treatments of ICP include the following
-
Administration of NS
Admin of stool-softeners
Seizure precautions - Mannitol increases
- oxygen delivery to the brain
- Stage 1 of ICP
-
subtle changes in LOC
trouble remembering
personality changes
drowsiness
HA esp in AM
N/V - Stage 2 of ICP
-
present consisten s/s
systemic vasoconstriction to selevate systolic BP
Neuronal oxygenation compromised - Stage 3 of ICP
-
Compensatory mechanisms are exhausted
Dramatic increase in IPC
Changes are occuring rapidly - Stage 4 ICP
-
Brain herniation occurs
blood supply further compromised fcausing further ischemia and hypoxia in herniated tissue and displaced brain tissue. - Effects of Stage 4 ICP
-
Hemorrhages
obstructive hydrocephalus
Respiratory and or cardiac arrest due to brain stem herniation - How does brain herniate?
- Brain tissue is shifted from higher pressure to lower pressure compartment
- Types of Brain Herniation
-
Uncal is most common
Compression of CN III
Cerebral ischemia
Hemiparesis - Cheyne Stokes
- Cheyne Stokes - hyperventilation that graduallly diminishes to apneic periods followed by return to hyperventillation
- Late Symptoms of ICP
-
Rapid deterioration of condition
New onset of seizures
Decorticate or decerebrate posture
Glascow Coma Scale of < 8
Hypotension right before death
Respiratory changes - Ataxic breathing
- chaotic ventilations
- Central neurogenic hyperventilation
- Continuous rapid and deep breathing
- Apneustic Breathing
- prolonged inspiratory phase followed by apnea (intubate)
- What is CPP
- A measurement used to determine brain perfusion of cerebral blood flow and blood volume
- What is the range for CPP
- > or equal to 70 to maintain brain perfusion
- Calculation for CPP
- CPP = MAP - ICP
- Calculating MAP
- Diastolic + 1/3 (Systolic - diastolic)
- When chould ICP be controlled
- When CPP falls below 70 or ICP is greater than 20
- What is more important - maintenance of CPP or control of ICP
- Maintenance of CPP
- Fentenyl
- Opiate used to keep pts with increased ICP quiet so pressure is lower
- Methods ot decrease ICP
-
IV fluid therapy (fluid restriction)
Mannitol - shrink the cells
Ventilation (last resort and short term
Sedation and anesthesia - Changes in VS as ICP rises
-
Sysstolic BP increases
Pulse decreases
Temperature increases
Respirations abnormal - VS as client approaches brain death
-
hypotension
cardiac and ventilation collapse occurs - Cushings Triad
- Compensatory mechanism that tries to raise CPP even though ICP is increasing
- What is Cushings Triad
-
Widened pulse pressure
Decreased heart rate
abnormal respiration - What does Cushings triad reflect
-
apressure on the brain stem
Critical situation - Ventilation for ICP
-
Maybe venvilator to bring CO2 to normocapnia levels
Hyperventilation used for only a short time to lower pressure - Drawback of hyperventilation
- lowers ICP and CPP
- IV Fluid Therapy for ICP
-
NS or lactated ringers only.
Keeps up CPP and does not increase ICP - What does hypotonic solutions do for ICP
- Decreases plasma osmolality
- Mannitol for ICP
-
Effects immediatelya fter bolus administration (15-30 minutes)
Acute reduction of ICP - Why is it important to establish renal status before administering mannitol
- it is excreted in the urine
- NDX for ICP
-
Altered cerebral tissue perfusion
Ineffective respiratory function
Ineffective airway clearance
risk for aspiration
Risk for infection
Risk for injury
Hyperthermia
Total incontinence
Constipation - Artificial tears
- for absent corneal reflex
- Osmotic Diuretic
- mannitol
- Lasix
- to rid the body of extra fluid
- Decadron
-
decrease inflammation
4 mg IVP q6h - Dilantin
- prevent seizures
- Tylenol
- Fever - is it from infection or increased ICP
- Antibiotics
- Infection
- NI
-
seizure precations
Strict I/O
Restrict fluids
Mitts on hands to prevent IV pull out - Critical Care Monitoring
-
ICP monitoring
Barbituate Coma
Sedatives - Therapeutic endpoints
-
ICP <20
CPP 70-100
Stable VS
Resolution of intracranial mass effects or midline shifts - Failure of CARE
-
Uncontrolled ICP
Cushing's triad
CPP < 70
Brain Herniation
Hyperthermia
Respiration or cardiac irregularities
Sepsis
Progressive pulmonary dysfunction
Uncontrolled hypotension - ICP
- Increased BP, Decrease pulse, decreased respirations
- Shock
- Decreased BP, incrased pulse, increased Respirations
- S/s of ICP
-
Changes in LOC, unequal pupils
Papilledema (CNII)
HA upon waking
Vomiting
Decreased sensory/motor function - ICP pressure in the head from force of
-
Brain (tumor, edema, abscess)
CSF (flow, obstruction, hydrocephalus)
Blood (flow, bleeding, clots) - Monroe-Kellie Doctrine
- increase in one component must be compensated for an equal decrease in the other components to maintain a constant volume
- What temporarily increases ICP
- Coughing, sneezing, valsalva
- How can you measure ICP
- Transducer in lateral ventricle, subdurally or within brain tissue
- Compensatory mechanisms for ICP
-
CSF regluation
Autoregulation of blood flow
Metabolic regulation fo blood flow - CSF Regulation
- Compensates until the pressure gets too high and the compensations are no longer effective
- Autoregulation
- Decreased CPP with increased ICP. If ICP remains high then cerebral blood volume and CPP is reduced by vasoconstriction
- Metabolic regulation of blood volume
- Hyperventilation decreases metabolites and increases cerebral oxygen, no vasodialation, decreased CPP