Increased Intracranial Pressure Monitoring
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Questions and Answers

What is the expected reference range for intracranial pressure (ICP)?

  • 15 to 20 mm Hg
  • 5 to 10 mm Hg
  • 10 to 15 mm Hg (correct)
  • 20 to 25 mm Hg

Which of the following actions can lead to an increase in ICP?

  • Administering oxygen therapy
  • Maintaining a calm environment
  • Performing endotracheal suctioning (correct)
  • Elevating the head of the bed

What position should the head be maintained to help decrease ICP?

  • Flat on the bed
  • At an angle less than 30°
  • At least 30° (correct)
  • In extreme flexion

Which measure should be avoided to prevent an increase in ICP?

<p>Implementing the Valsalva maneuver (D)</p> Signup and view all the answers

During the first 24 hours following a head injury, hyperventilation should be approached with caution because it can cause which condition?

<p>Cerebral ischemia (C)</p> Signup and view all the answers

What effect does hypercarbia have on intracranial pressure (ICP)?

<p>It leads to cerebral vasodilation. (A)</p> Signup and view all the answers

Which action should be implemented to promote venous drainage and reduce ICP?

<p>Elevate the head at least 30°. (A)</p> Signup and view all the answers

What is a recommended practice to maintain a patent airway in a client with increased ICP?

<p>Provide mechanical ventilation as indicated. (B)</p> Signup and view all the answers

Which patient care practice should be avoided in a patient with increased intracranial pressure?

<p>Allowing loud noises and multiple visitors. (C)</p> Signup and view all the answers

What should be considered during the first 24 hours following a head injury concerning hyperventilation?

<p>It can cause cerebral vasoconstriction. (A)</p> Signup and view all the answers

What is a primary purpose of performing a craniotomy?

<p>To remove nonviable brain tissue (B)</p> Signup and view all the answers

What is a critical nursing action after a supratentorial craniotomy?

<p>Keep the head of bed elevated at least 30° (C)</p> Signup and view all the answers

Which of the following conditions can arise from a brain herniation?

<p>Severe neurologic impairment (A)</p> Signup and view all the answers

Which medication can be used postoperatively to help prevent seizure activity?

<p>Phenytoin (A)</p> Signup and view all the answers

What role does interprofessional care play in the recovery of a patient after a craniotomy?

<p>It may involve physical and speech therapy (A)</p> Signup and view all the answers

What is associated with a craniotomy that may impact patient outcomes?

<p>Potential for severe neurologic impairment (B)</p> Signup and view all the answers

How can the risk of intracranial hemorrhages be managed during treatment?

<p>By surgical evacuation of hematomas (A)</p> Signup and view all the answers

What is the expected patient positioning following an infratentorial craniotomy?

<p>Lying flat and on either side for 24 to 48 hours (C)</p> Signup and view all the answers

What is the primary treatment for brain herniation if urgent medical intervention is required?

<p>Mannitol (A)</p> Signup and view all the answers

What sign indicates a deteriorating level of consciousness associated with brain herniation?

<p>Dilated pupils (B)</p> Signup and view all the answers

In managing a client with diabetes insipidus after brain surgery, which action is crucial for monitoring?

<p>Daily blood electrolytes and osmolality (B)</p> Signup and view all the answers

What is likely the most severe complication of mannitol treatment?

<p>Pulmonary edema (D)</p> Signup and view all the answers

Which nursing action is essential for family members of a client experiencing brain herniation?

<p>Frequent updates on health status (D)</p> Signup and view all the answers

What is a common symptom indicating the need for surgical intervention in cases of hematoma?

<p>Severe headache (D)</p> Signup and view all the answers

How should fluid balance be monitored in clients undergoing treatment for diabetes insipidus?

<p>Strict intake and output documentation (A)</p> Signup and view all the answers

Which abnormal respiratory pattern may be observed in patients experiencing brain herniation?

<p>Cheyne-Stokes respirations (A)</p> Signup and view all the answers

What is the primary action of mannitol in the treatment of cerebral edema?

<p>It draws fluid from the brain into the blood. (B)</p> Signup and view all the answers

What is a primary concern when using barbiturates for inducing a coma in patients with increased ICP?

<p>It may complicate the assessment of neurologic function. (A)</p> Signup and view all the answers

Which nursing action is essential when administering phenytoin?

<p>Check for medication interactions. (A)</p> Signup and view all the answers

What is a significant risk associated with the use of opioids in patients not on mechanical ventilation?

<p>Respiratory depression. (A)</p> Signup and view all the answers

What is the recommended action if a patient becomes overmedicated with opioids?

<p>Administer naloxone, the reversal agent. (D)</p> Signup and view all the answers

Flashcards

Increased Intracranial Pressure (ICP)

Elevated pressure inside the skull, potentially caused by various factors.

ICP Monitoring

Measuring ICP using a device placed in the brain's fluid-filled spaces.

ICP Elevation Causes

Increased pressure can be caused by things like hypercarbia, suctioning, or body positioning.

Decreasing ICP

Raising the head of the bed, avoiding extreme head/body movements help reduce pressure.

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Hyperventilation (after 24 hrs)

Controlled shallow breathing to lower ICP in the intubated client post-injury.

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Hypercarbia & ICP

High levels of carbon dioxide (hypercarbia) cause blood vessels in the brain to widen (vasodilate), increasing pressure inside the skull.

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ICP: What to avoid

Actions that increase pressure inside the skull include: suctioning, coughing, neck flexion/extension, and Valsalva maneuver.

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ICP: Head of the bed

Elevating the head of the bed at least 30 degrees helps reduce ICP and promotes drainage of blood from the brain.

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ICP: Quiet environment

A calm and quiet environment helps reduce stress and anxiety, which can lower ICP.

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Hyperventilation & ICP

Controlled shallow breathing (hyperventilation) can help lower ICP in intubated patients after 24 hours. This helps reduce blood flow to the brain, lowering pressure.

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Craniotomy

Surgical procedure to remove nonviable brain tissue, hematomas, or tumors to relieve pressure and improve brain function.

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Burr Hole

A small circular hole drilled into the skull to access the brain during a craniotomy.

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Supratentorial Craniotomy

Surgery performed above the tentorium cerebelli, a membrane separating the cerebrum from the cerebellum.

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Infratentorial Craniotomy

Surgery performed below the tentorium cerebelli, accessing the brain stem and cerebellum.

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Transsphenoidal Craniotomy

Surgery accessing the pituitary gland through the nose and sinuses.

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Brain Herniation

Downward shift of brain tissue due to swelling, causing pressure on vital areas.

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ICP Management

Strategies to reduce heightened pressure in the skull, like medication, HOB elevation, and positioning.

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Postoperative Care: Supratentorial

Patient positioned with head elevated at least 30 degrees to reduce intracranial pressure.

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Brain herniation symptoms

Fixed, dilated pupils, decreasing consciousness, abnormal breathing, unstable blood pressure, and abnormal body positioning.

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Brain herniation treatment

Mannitol (medicine) and/or surgery to remove pressure.

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Brain herniation outcome

Recovery is rare, severe neurological problems usually persist.

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Hematoma and intracranial hemorrhage

Bleeding inside the skull, requiring surgery.

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Pulmonary edema

Fluid buildup in the lungs, a possible side effect of mannitol.

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Diabetes insipidus

A condition where the body produces too much urine.

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SIADH

A condition where the body retains too much water.

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What does Mannitol do for ICP?

Mannitol, an osmotic diuretic, pulls fluid from the brain into the bloodstream, reducing cerebral edema and lowering intracranial pressure.

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Barbiturate Coma for ICP

A barbiturate coma is induced to suppress brain activity and decrease metabolic demands, lowering ICP. Commonly used medications include pentobarbital and thiopental.

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Phenytoin's Role in ICP

Phenytoin is used prophylactically to prevent or treat seizures in patients with ICP, as seizures can significantly raise pressure.

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Opioid Caution with ICP

Opioids (morphine or fentanyl) are used for pain, but they can worsen ICP and respiratory depression. Only use in mechanically ventilated patients.

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Naloxone: Opioid Reversal

Naloxone is an antidote for opioid overdose, reversing the effects of morphine or fentanyl, vital for ICP monitoring.

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Study Notes

Increased Intracranial Pressure (ICP) Monitoring

  • ICP is monitored by placing a device (screw, catheter, or sensor) through a burr hole into the ventricle or a surrounding space (subarachnoid, epidural, or subdural).
  • Normal ICP is 10-15 mm Hg.

ICP-Increasing Factors

  • Hypercarbia (increased CO2) causing cerebral vasodilation
  • Endotracheal or oral suctioning
  • Coughing
  • Extreme neck or hip flexion/extension
  • Head of bed less than 30°
  • Increased intra-abdominal pressure (e.g., tight clothing, Valsalva maneuver)

Decreasing ICP

  • Elevate the head of the bed at least 30 degrees. This reduces ICP and promotes venous drainage.
  • Avoid extreme head movements (flexion, extension, or rotation). Maintain the body in a neutral midline position.
  • Maintain a clear airway. Mechanical ventilation might be needed.
  • Administer oxygen to keep PaO2 above 60 mm Hg.
  • Provide stool softeners and discourage the Valsalva maneuver.
  • Maintain a calm, quiet environment. (Limit visitors, minimize noise).

Hyperventilation and ICP

  • Brief periods of hyperventilation may lower ICP after the first 24 hours post-injury for intubated clients.
  • During the first 24 hours, hyperventilation can cause cerebral vasoconstriction, potentially leading to ischemia if not monitored carefully.

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Description

This quiz covers the essentials of monitoring increased intracranial pressure (ICP), including normal ranges and factors that can affect ICP. It also addresses methods for decreasing ICP effectively. Learn the best practices and interventions for managing this critical condition.

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