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IICP 2040

Three components inside enclosed skull brain tissue, blood & CSF
What are the three compensatory measures to maintain cranial pressure CSF regulation, pressure auto regulation, metabolic regulation
What paths do the CSF take to regulate cranial pressure? Some is shunted from brain to spinal subarachnoid spaces, and the dura can expand and increase absorption
A bp of 108/98 with no chg in loc is a result of our blood vessels ability to do what? Vasoconstriction and vasodilation during chgs in systemic arterial pressures
PC02 increase will add to ICP because carbon dioxide is a ........ Potent vasodilator
An increase in temp can alter your loc r/t an..... Increase in ICP because hyperthermia increases use of oxygen and glucose
An increase in hydrogen ions will cause Acidosis which increases ICP (decrease in loc r/t acidosis; and DKA)
Norm ICP range is 5 to 15
Norm range for of CPP 60 - 100
What is the driving force that maintains cerebral blood flow? CPP
What will occur if the CPP is   < 40 mmHg Ischemia r/t decrease in blood circulation
SBP + 2DBP / 3= MAP
BP 122/84 = a MAP of .......... 97
The MAP is 97 and the ICP is 12 equals ______CPP 85
What has no valves, have thin walls and little muscle coat , drain into large venous sinuses , are Susceptible to compression, and an increases in intra-abd or thoracic can alter venous return in these..... Cerebral veins
Increases in intra-abd or thoracic alter_______ venous return
Anterior & posterior circulation function separately; Connection of anterior and posterior circulation by communicating arteries that can can shunt blood from anterior and posterior portions of brain is known as ___________ Circle of Willis (collateral circulation)
Increase in intrathoracic pressure can be caused by four things.... Coughing Straining Suctioning PEEP
Impairment of cerebral venous drainage can be caused by..... supine position, low/twisted neck
______ initial procedure of choice in acute head injury and most acute intracranial catastrophies, noninvasive, safe, anaphylaxis rare with contrast, rapidly available results on slide bone white, air black CT
Nursing mgt r/t trach Pre and post oxygenation Suction only as needed; 10 sec
Nursing mgt r/t coughing Lidocaine may help suppress coughing
Nursing mgt r/t increased CO2 Controlled hyperventilation with mechanical ventilation
Pt positioning r/t ICP HOB elevated Neutral alignment
Pt movement r/t ICP Prevent Valsalva TEDS and sequential air compression (pulmonary emboli)
CM of possible Pulmonary Emboli SOB, decreased BP, Chg on loc
What are four ways to F & E ASSESSMENT AND MANAGEMENT Fluid restriction Avoid hypotonic IV solutions Monitor output and specific gravity Monitor serum electrolytes (sodium) and osmolality
Name some ways you can avoid increasing ICP r/t NIC Control environment for noxious stimuli Provide undisturbed rest periods Avoid clustering nursing activities
What can be used to eliminate fluid from the vault? Osmotic diuresis – mannitol (Osmitrol) Hypertonic saline 2% or greater
What med would you use to control seizures Antiseizure – phenytoin (Dilantin)
A person with cardiac compromise should be monitored with what medication? Mannitol r/t increase fluid in vascular space (lasix can be used also)
What med is used r/t curlings stress ulcer prevention Protonix
What is the gold standard intervention for CSF edema removal within the vault intraventricular catheter
What would be used toput the brain at rest mannually induced coma with barbituate (pentobarbital)
Apnea is the most important CM r/t brain stem imjury and brain death
Mannitol 25% =_____g/100 mL 25
Doctor’s Order: Give Mannitol 50 g IV Give ____ mL 200
8 IICP TREATMENTS Body position in alignment Temperature control Seizure prevention Adequate oxygenation Osmotic diuretics Sedation Surgical intervention for hematoma Drainage of CSF
Subsequent Treatments for Refractory IICP Hyperventilation to decrease pCO2 Barbiturate coma (pentobarbital sodium) Propofol (Diprivan) shorter ½ life Decompressive craniectomy
For sedation short term <24 hrs use... midazolam (Versed); propofol (Diprivan); neuromm blockade pancuronium (Pavulon)
For pain use morphine, dilaudid
IV solutions with ________ should be avoided, hypotonic solutions can increase cerebral edema dextrose
What is the BRAIN DEATH CRITERIA Apnea most important brain stem sign Absent pupillary, extraocular, corneal, gag and cough reflexes (brainstem )Not a result of CNS depressant drug,alcohol,hypothermia (<32 degrees C or 90 F)Absence of cerebral blood flow
Some ND r/t ICP Decreased intracranial adaptive capacity Ineffective tissue perfusion, cerebral Ineffective breathing pattern Risk for disuse syndrome
Created by: troop27