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ICP
Neuro Exam
Question | Answer |
---|---|
Cranial vault contains what? | Brain tissue, blood, measured lateral ventricle |
Normal amount of blood is ____mL. Normal amount of CSF is _____ mL | 75 mL, 75 mL |
Normal ICP is up to how much mmHg? What is the upper limit? Treat if > ? | 10; 15; 20 |
What hypothesis states that an increase in any one of the components causes a change in the volume of others? | Monroe-Kellie Hypothesis |
According to Monroe-Kellie Hypothesis, compensation is accomplished by displacing or shifting _____; Increasing the absorption or diminishing production of ____; Decreasing cerebral blood volume | CSF; CSF |
Increased ICP may reduce CBF and result in _____ and cell ______ | Ischemia; cell death |
In early stages of cerebral ischemia, vasomotor centers are stimulated and systemic pressures rise to maintain CBF, accompanied by a ________, ______ pulse and RR ______. | slow, bounding; irregularities |
CO2 in blood also plays a role in regulation of CBF. Increase in PaCO2 causes _________. Decrease in PaCO2 causes _________. | Vasodilation; Vasoconstriction |
Body tries to compensate for ICP. Compensatory mechanisms include? | Autoregulation; decreased production and flow of CSF |
Term refers to the brain's ability to change the diameter of blood vessels to maintain a constant cerebral flow of blood during changes in systemic blood pressure | Autoregulation |
Autoregulation can be impaired in pts with sustained _____ | ICP |
Condition seen in pts with significantly decreased CBF. | Cushing's response |
What are the s/s of Cushing's Triad? | Bradypnea, HTN, Bradycardia |
Clinical manifestations of increased ICP depend on the rate of pressure increase and location in the brain. Changes in LOC indicates | Cerebral hypoxia |
An early sign (other than change in LOC) of ICP is changes in cranial nerve exam, especially slow-reacting ________ | Pupils |
First sign of ICP is | Vomiting without nausea |
Unrelieved ICP may result in pathologic ______ | posturing |
What are three complications of ICP? | Brain stem herniation, SIADH, DI |
Changes in VS with ICP can manifest as? | HR brady to tachy; Increase systemic BP with widening pulse pressure; T may rise; RR pattern irregular (may have Cheyne-Stokes) |
Medical management goal of ICP is the prevention of ______ _______ d/t _______ ______ and ____. | 2nd injury; cerebral edema and ICP |
Treatment of ICP may be medical or ________ | Surgical |
Procedure for ICP monitor: Catheter into the right lateral ventrical; facilitates intraventricular drug admin and facilitates removal and/or sampling of CSF | Ventriculostomy |
On ICP monitor A wave indicates | cerebral ischemia |
On ICP monitor B wave indicates | incracranial HTN and variations in RR cycle |
On ICP monitor C wave indicates | variations in systemic arterial pressure and RR |
What are three complications of ICP monitor device? | Ventricular infection, meningitis, occlusion of cath with brain tissue or blood |
What are three main interventions for decreasing cerebral edema? | Osmotic diuretic (Mannitol), Fluid restrictions, Hypothermia |
Osmotic diuretic (Mannitol) pulls fluids from brain tissue into _______ space | vascular |
Reduce CSF and intracranial blood volume by ______ CSF. PaCO2 should be brought to ____ to _____ | Draining; 30-34 |
Maintain oxygenation and decrease metabolic demands by obtaining ABGs and pulse ox, sedation with ________ and paralyzing agent such as ______ | Barbiturates, Propofol |