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EXAM 2 2460
ICP/TBI Quizlet
| Question | Answer |
|---|---|
| ICP | Pressure inside the skull |
| What is ICP based on? | Balance of brain tissue, blood, and CSF |
| Monro-Kellie Doctrine | If one increases, the other must decrease to keep ICP stable |
| Autoregulation | Process that maintains the balance (if it fails, = increased ICP) |
| CPP | Pressure needed to ensure blood flow to brain |
| CPP equation | MAP - ICP |
| CPP normal range | 80-100 |
| What does a CPP < 60 mean? | Ischemia due to inadequate blood supply |
| What does a CPP < 50 mean? | Tissue death |
| What does a CPP < 30 mean? | Incompatible with life and brain damage |
| What does increased ICP mean? | ↑ ICP (more pressure, bad) = ↓ CPP (blood flow)*CRITICAL to maintain MAP when ICP ↑ |
| Normal ICP range | 5-15 |
| What does an ICP > 20 mean? | Abnormal AND NEEDS TREATMENT ASAP |
| Factors that influence ICP | - Arterial and venous pressure- Intra abdominal and intrathoracic pressure- Posture- Temperature- Blood gases |
| How is ICP measured? | Ventriculostomy- EVD |
| Causes for increased ICP | - Head trauma- Infections --> swelling of the brain*- Hydrocephalus- Brian tumor- Intracranial bleed- Too much CO2- Suctioning, coughing, tight clothing |
| - Abnormal CT/MRI- ICP monitoring | |
| Nursing assessment for increased ICP | Glascow coma scale --> used to assess LOC |
| Glasgow coma scale | |
| Assessment based on ability to open eyes, speak, and obey commands | |
| Low score = bad | |
| High GCS (13-15) | |
| Awake, normal (low concern) | |
| Moderate GCS (9-12) | |
| Impaired | |
| Low GCS (8 or less) | |
| Severe decreased consciousness | |
| Early s/s of increased ICP | - Decreased LOC- Headache --> worse in AM- Confusion, restlessness- Dizziness- Blurred or double vision- N/V |
| Late s/s of increased ICP | Cushings triad -> sign of impending brain herniation |
| Cushings triad | - Hypertension/widened pulse pressure --> systolic - diastolic = huge difference- Bradycardia- Irregular respirations |
| End-stage signs of increased ICP | - Cheyne Stokes respirations- Neck stiffness- Seizures/coma- Fixed pupils- Posturing |
| Decorticate posturing | |
| Decerebrate posturing | |
| How to decrease ICP --> nursing interventions | - Adequate oxygenation- Positioning- Temperature and environment- Avoid triggers- Meds and fluids |
| ICP oxygenation | -nABGs:--- PaO2: ≥ 100 mm Hg-- -PaCO2: 35-45 mm Hg- Intubation or tracheostomy- Mechanical ventilation:--- Keep PaCO₂: 30-35- Suction PRN: OVER suction ↑ ICP--- Hyperoxygenate before & after suctioning- Hyperoxygenate! |
| ICP positioning | - HOB 30-45- Keep head in midline--- Avoid flexion and/or rotation of the neck--- Avoid hip flexion |
| ICP temp/environment | - CORE temp (rectal, foley, esophageal probe)Quiet/Calm environment |
| ICP things to avoid | - Straining, vomiting, coughing, sneezing- Over suctioning b/c it makes you cough + sneeze--- Valsalva maneuver- Agitation |
| ICP meds and fluids | Mannitol and hypertonic/isotonic saline |
| ICP nursing interventions | - Seizure precautions (these pts are very likely to have)- Neuro checks- Calculate CCP hourly : MAP - ICP = CPP |
| ICP monitoring | - Assess for signs of ↑ ICP- Record ICP waveform changes- Monitor fluid and electrolytes |
| FRONT BACK | |
| What are the 2 major types of stroke? | Ischemic and hemorrhagic. |
| What percentage of strokes are ischemic in the lecture? | 87%. |
| What percentage are hemorrhagic? | 13%. |
| Primary problem in ischemic stroke | Vascular occlusion → decreased cerebral blood flow. |
| Primary problem in hemorrhagic stroke | Blood leaks into brain tissue or subarachnoid space. |
| Major ischemic stroke causes | Large-artery thrombosis, small penetrating artery thrombosis, cardiogenic embolism, cryptogenic embolism. |
| Major hemorrhagic causes | Cerebral aneurysm and AVM. |
| Common stroke manifestations | Unilateral weakness/numbness, aphasia, vision changes, gait problems, confusion, severe headache. |
| BE FAST: B | Balance loss. |
| BE FAST: E | Eye/vision changes. |
| BE FAST: F | Facial drooping. |
| BE FAST: A | Arm weakness. |
| BE FAST: S | Speech difficulty. |
| BE FAST: T | Time to call 911. |
| LEFT hemisphere stroke | RIGHT-sided weakness/paralysis, right visual deficit, aphasia, altered intellectual ability, slow/cautious behavior. |
| RIGHT hemisphere stroke | LEFT-sided weakness/paralysis, left visual deficit, spatial-perceptual problems, distractibility, impulsivity, poor judgment/lack of awareness. |
| Aphasia | Impairment of language. |
| Expressive aphasia | Unable/difficulty expressing oneself. |
| Receptive aphasia | Unable/difficulty understanding language. |
| Dysarthria | Difficulty speaking/articulating words. |
| Apraxia | Inability to perform a previously learned action. |
| First-line imaging for suspected acute stroke/bleeding | Noncontrast CT. |
| Why obtain CT before thrombolytic treatment | Must identify/exclude intracranial hemorrhage. |
| What does CTA evaluate? | Cerebral blood vessels/vascular abnormalities. |
| Why obtain ECG/telemetry after TIA/stroke? | Look for cardiac sources such as atrial fibrillation. |
| NIHSS purpose | Measures neurologic deficits/stroke severity and allows trends to be monitored. |
| NIHSS changes from 6 → 10 | Neurologic deterioration; requires prompt evaluation/provider notification. |
| Warfarin + AFib purpose | Prevent cardioembolic stroke. |
| Warfarin INR goal in today's lecture | 2–3. |
| Antiplatelet purpose | Reduce incidence of cerebral infarction when indicated. |
| Statin purpose | Reduce vascular/coronary events and ischemic stroke risk. |
| tPA purpose | Thrombolytic/clot-dissolving therapy for eligible ischemic stroke; time-sensitive. |
| What finding excludes tPA in the lecture question? | Intracranial hemorrhage on CT. |
| Carotid endarterectom | y Surgical removal of atherosclerotic plaque/thrombus from carotid artery. |
| Carotid artery stenting | Opens narrowed carotid artery. |
| Thrombectomy | Endovascular removal of a clot. |
| Intracerebral hemorrhage | Bleeding into brain tissue. |
| Important ICH risk factor | Hypertension. |
| Amyloid angiopathy | Beta-amyloid deposits in cerebral vessels; associated with older adults and hemorrhage. |
| AVM | Abnormal/tangled blood vessels that can rupture. |
| Subarachnoid hemorrhage | Bleeding into the subarachnoid space. |
| Classic SAH clue | Sudden severe/"worst headache of my life." |
| Other SAH findings | N/V, ↓LOC, seizures, neck pain/rigidity, visual disturbances. |
| Major hemorrhage complications | Cerebral hypoxia/decreased blood flow, vasospasm, increased ICP, rebleeding. |
| Stroke patient becomes increasingly drowsy and difficult to arouse S | uspect neurologic deterioration/increased ICP. |
| TIA | Temporary focal neurologic dysfunction from transient cerebral ischemia; warning for future stroke. |
| TIA symptoms resolve—is the emergency over? | No. It still requires urgent evaluation and secondary prevention. |
| Before giving food/fluid after acute neurologic symptoms | Assess swallowing/aspiration risk. |
| Most important concept with serial neuro assessments | TREND/change from baseline. |
Created by:
Anmag002