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NEURO
Head Injury and ICP
| Question | Answer |
|---|---|
| what are the three components that maintain ICP | brain tissue, blood, and CSF |
| factors that influence ICP | arterial / venous pressure, intra-abdominal and intrathoracic pressure, posture, temperature and blood gases (CO2) |
| what is the Monro-Kellie Hypothesis | if one of the three components increases, another must decrease to maintain ICP |
| what is normal ICP | 5-15 |
| if a persistent increase occurs more than 20 | abnormal and must be treated! |
| cerebral perfusion pressure | pressure needed to ensure blood flow to the brain |
| CPP | MAP-ICP MAP= 70-150 |
| normal CPP | 60-100 |
| if CPP < 50 | ischemia |
| If CPP < 30 | ischemia and incompatible with life |
| increased blood in brain is due to | increased CO2, decreased O2, stroke, decreased venous outflow |
| increased CSF is due to | increased production, obstruction of flow, inability to absorb CSF |
| increased brain tissue is due to | cerebral edema due to stroke, mass or tumor |
| increased ICP clinical manifestations | decrease in motor function, change in VS - cushing's triad, change in LOC, ocular sign --> body temp, dilation, sluggish/ no response to light, ptosis, headache, vomiting |
| diagnostic studies for ICP | CT scan / MRI / PET scan EEG ICP and brain tissue oxygenation measurement |
| nursing management of ICP | keep CPP > 60, maintain patent airway, suction, GCS, position to maximize CPP, HOB > 30 degrees and neutral position, periods of rest |
| medical management of ICP | treat cause, limit hyperventilation, adequate oxygenation, maintain state of euvolemia, Na and glucose monitoring - mannitol! use meds such as propfofol, anti-seizure, anti-pyretics, and barbituates |
| concern with barbituates | last resort due to it decreasing BP |
| nursing interventions for ICP | sedation, quiet and calm environment, manage BP, anti-seizure prophylaxis |
| surgical interventions for ICP | mass removal, hematoma removal, decompression hemicraniotomy, ventriculostomy |
| head injury | any trauma to skull, brain, or scalp |
| types of head injury | scalp laceration, skull fracture, head trauma - diffuse or focal |
| severe - TBI | GCS 3-8 |
| basilar skull fracture | linear fracture at base of skull into anterior, middle or posterior fossa not seen on a CT scan, raccoon eyes, rhinorrhea, otorrhea |
| primary brain injury | diffuse - concussion, no loss of consciousness, damage not localized to one area |
| diffuse axonal injury | 12-24 hours, decreased LOC, increased ICP, global cerebral edema |
| focal injury | damage is localized - contusion, laceration, hematoma |
| epidural hematoma | blood between dura and skull, frequently in temporal area laceration of middle meningeal, develops rapidly - EMERGENCY brief loss of consciousness, lucid interval then quick deterioration |
| subdural hematoma | blood within dura space, may be bilateral usually from torn cortical vein, may be multiple and associated with contusions |
| intracerebral hematoma | bleed in brain tissue, may occur from trauma, penetrating injury, GSW, depressed skull fracture |
| nonsurgical interventions | maintain ICP, maintain airway and oxygen, maintain BP, and use therapeutic hypothermia |
| post-operative craniotomy interventions | maintain ICP and airway, prevent fluid / electrolyte imbalances, prevent complications of immobility, avoid nutrition deficits, assess for infection and hemorrhage, assess surgical site |
| GCS scoring for eye opening response | 1- no response, 2- to pain 3- to speech 4- spontaneously |
| scoring verbal response for GCS | 1- no response 2- incomprehensible sounds 3-inappropriate words 4- confused 5- oriented to time, person and place |
| scoring for motor response for GCS | 1- no response 2- abnormal extension - decerebate posturing 3- abnormal flexion- bring to core- decorticate posturing 4- flex to withdraw from pain 5- flex towards pain 6- obeys commands |
Created by:
ebrewer12
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