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IICP 2040
| Question | Answer |
|---|---|
| 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 |
| MAP - ICP = | CPP |
| 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
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