Podcast
Questions and Answers
A nurse is assessing a patient with increased intracranial pressure (ICP). Which of the following is an early sign of increased ICP?
A nurse is assessing a patient with increased intracranial pressure (ICP). Which of the following is an early sign of increased ICP?
- Bradycardia
- Widened pulse pressure
- Restlessness and confusion (correct)
- Irregular respirations
The nurse is caring for a patient with a head injury. The patient's ICP is 22 mmHg. What is the nurse's priority action?
The nurse is caring for a patient with a head injury. The patient's ICP is 22 mmHg. What is the nurse's priority action?
- Elevate the head of the bed to 30 degrees (correct)
- Administer a bolus of IV fluids
- Encourage coughing and deep breathing
- Place the patient in Trendelenburg position
A patient with a traumatic brain injury is exhibiting decerebrate posturing. The nurse recognizes this indicates:
A patient with a traumatic brain injury is exhibiting decerebrate posturing. The nurse recognizes this indicates:
- Recovery from a prior coma
- A normal response to painful stimuli
- Damage to the brainstem, indicating a poor prognosis (correct)
- A mild brain injury with good prognosis
Which diagnostic tool is most appropriate for assessing a patient's level of consciousness with increased ICP?
Which diagnostic tool is most appropriate for assessing a patient's level of consciousness with increased ICP?
A patient with increased ICP is prescribed mannitol. What is the primary goal of this medication?
A patient with increased ICP is prescribed mannitol. What is the primary goal of this medication?
The nurse is monitoring a patient with increased ICP. Which of the following interventions are appropriate? (Select all that apply.)
The nurse is monitoring a patient with increased ICP. Which of the following interventions are appropriate? (Select all that apply.)
A nurse is caring for a patient with a ventriculoperitoneal (VP) shunt. What complications should the nurse monitor for? (Select all that apply.)
A nurse is caring for a patient with a ventriculoperitoneal (VP) shunt. What complications should the nurse monitor for? (Select all that apply.)
A patient with a head injury is exhibiting signs of Cushing's Triad. What are the classic signs? (Select all that apply.)
A patient with a head injury is exhibiting signs of Cushing's Triad. What are the classic signs? (Select all that apply.)
A patient with hydrocephalus is scheduled for a ventriculostomy. What should the nurse include in post-procedure care? (Select all that apply.)
A patient with hydrocephalus is scheduled for a ventriculostomy. What should the nurse include in post-procedure care? (Select all that apply.)
Which conditions can lead to increased intracranial pressure? (Select all that apply.)
Which conditions can lead to increased intracranial pressure? (Select all that apply.)
The nurse is reviewing arterial blood gas results for a patient with increased ICP. Which of the following values should the nurse be most concerned about?
The nurse is reviewing arterial blood gas results for a patient with increased ICP. Which of the following values should the nurse be most concerned about?
A patient with increased ICP is receiving mechanical ventilation. Which setting is most important for the nurse to monitor?
A patient with increased ICP is receiving mechanical ventilation. Which setting is most important for the nurse to monitor?
Which of the following medications is contraindicated in a patient with increased ICP?
Which of the following medications is contraindicated in a patient with increased ICP?
A nurse is monitoring a patient with a ventriculostomy for ICP monitoring. Which of the following findings requires immediate intervention?
A nurse is monitoring a patient with a ventriculostomy for ICP monitoring. Which of the following findings requires immediate intervention?
Which of the following activities should be avoided in a patient with increased ICP?
Which of the following activities should be avoided in a patient with increased ICP?
A nurse is teaching a family about Cushing's triad in increased ICP. Which signs should be included? (Select all that apply.)
A nurse is teaching a family about Cushing's triad in increased ICP. Which signs should be included? (Select all that apply.)
A patient with increased ICP is prescribed mannitol. What are important nursing considerations? (Select all that apply.)
A patient with increased ICP is prescribed mannitol. What are important nursing considerations? (Select all that apply.)
The nurse is teaching a patient with a ventriculoperitoneal (VP) shunt. Which complications should be reported immediately? (Select all that apply.)
The nurse is teaching a patient with a ventriculoperitoneal (VP) shunt. Which complications should be reported immediately? (Select all that apply.)
A patient with a head injury is being monitored for signs of increased ICP. Which findings indicate worsening condition? (Select all that apply.)
A patient with a head injury is being monitored for signs of increased ICP. Which findings indicate worsening condition? (Select all that apply.)
The nurse is caring for a patient with an epidural hematoma. Which interventions are appropriate? (Select all that apply.)
The nurse is caring for a patient with an epidural hematoma. Which interventions are appropriate? (Select all that apply.)
A nurse is assessing a patient with suspected increased ICP. Which of the following is a late sign?
A nurse is assessing a patient with suspected increased ICP. Which of the following is a late sign?
The nurse is evaluating a patient with increased ICP who has a Glasgow Coma Scale (GCS) score of 6. What does this indicate?
The nurse is evaluating a patient with increased ICP who has a Glasgow Coma Scale (GCS) score of 6. What does this indicate?
A patient with increased ICP is prescribed dexamethasone. The nurse explains that this medication is used to:
A patient with increased ICP is prescribed dexamethasone. The nurse explains that this medication is used to:
Which of the following findings would indicate a potential complication in a patient with a ventriculostomy?
Which of the following findings would indicate a potential complication in a patient with a ventriculostomy?
The nurse is monitoring a patient with increased ICP. Which intervention is most appropriate to minimize further increases in ICP?
The nurse is monitoring a patient with increased ICP. Which intervention is most appropriate to minimize further increases in ICP?
The nurse is caring for a patient with increased ICP. Which non-pharmacological interventions can help lower ICP? (Select all that apply.)
The nurse is caring for a patient with increased ICP. Which non-pharmacological interventions can help lower ICP? (Select all that apply.)
A patient with increased ICP is receiving mechanical ventilation. The nurse should ensure which of the following ventilator settings are appropriate? (Select all that apply.)
A patient with increased ICP is receiving mechanical ventilation. The nurse should ensure which of the following ventilator settings are appropriate? (Select all that apply.)
A nurse is assessing a patient with suspected meningitis. Which findings support this diagnosis? (Select all that apply.)
A nurse is assessing a patient with suspected meningitis. Which findings support this diagnosis? (Select all that apply.)
A patient is admitted with an ischemic stroke and increased ICP. Which interventions should the nurse anticipate? (Select all that apply.)
A patient is admitted with an ischemic stroke and increased ICP. Which interventions should the nurse anticipate? (Select all that apply.)
The nurse is teaching a patient about post-craniotomy care. What instructions should be included? (Select all that apply.)
The nurse is teaching a patient about post-craniotomy care. What instructions should be included? (Select all that apply.)
The nurse is monitoring a patient with a basilar skull fracture. Which finding requires immediate intervention?
The nurse is monitoring a patient with a basilar skull fracture. Which finding requires immediate intervention?
Which patient is at the highest risk of developing increased ICP?
Which patient is at the highest risk of developing increased ICP?
The nurse is caring for a patient with increased ICP. Which of the following positions is contraindicated?
The nurse is caring for a patient with increased ICP. Which of the following positions is contraindicated?
A patient with increased ICP is receiving IV fluids. Which type of fluid should the nurse question?
A patient with increased ICP is receiving IV fluids. Which type of fluid should the nurse question?
The nurse is assessing a patient with a traumatic brain injury (TBI). The patient suddenly develops irregular breathing, bradycardia, and hypertension. What should the nurse suspect?
The nurse is assessing a patient with a traumatic brain injury (TBI). The patient suddenly develops irregular breathing, bradycardia, and hypertension. What should the nurse suspect?
The nurse is preparing discharge teaching for a patient with mild traumatic brain injury. Which instructions should be included? (Select all that apply.)
The nurse is preparing discharge teaching for a patient with mild traumatic brain injury. Which instructions should be included? (Select all that apply.)
A patient with increased ICP is prescribed neuromuscular blocking agents (e.g., vecuronium). What are the primary reasons for this therapy? (Select all that apply.)
A patient with increased ICP is prescribed neuromuscular blocking agents (e.g., vecuronium). What are the primary reasons for this therapy? (Select all that apply.)
A nurse is educating a patient with hydrocephalus about VP shunt placement. Which points should be included? (Select all that apply.)
A nurse is educating a patient with hydrocephalus about VP shunt placement. Which points should be included? (Select all that apply.)
The nurse is caring for a patient with a suspected brain herniation. Which symptoms require immediate intervention? (Select all that apply.)
The nurse is caring for a patient with a suspected brain herniation. Which symptoms require immediate intervention? (Select all that apply.)
A nurse is educating a patient with a history of transient ischemic attacks (TIAs) about stroke prevention. Which recommendations should be included? (Select all that apply.)
A nurse is educating a patient with a history of transient ischemic attacks (TIAs) about stroke prevention. Which recommendations should be included? (Select all that apply.)
Flashcards
Early signs of increased ICP
Early signs of increased ICP
Changes in mental status (restlessness, confusion) due to decreased cerebral perfusion.
Priority action for ICP of 22 mmHg?
Priority action for ICP of 22 mmHg?
Elevating the head promotes venous drainage, reducing intracranial pressure.
Decerebrate Posturing
Decerebrate Posturing
Rigid extension of arms/legs, pronation, plantar flexion. Indicates severe brainstem injury and a poor prognosis.
Glasgow Coma Scale (GCS)
Glasgow Coma Scale (GCS)
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Mannitol's Primary Goal
Mannitol's Primary Goal
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Appropriate interventions for increased ICP
Appropriate interventions for increased ICP
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VP Shunt Complications
VP Shunt Complications
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Cushing's Triad
Cushing's Triad
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Post-Ventriculostomy Care
Post-Ventriculostomy Care
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Conditions causing increased ICP
Conditions causing increased ICP
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Concerning Arterial Blood Gas Value
Concerning Arterial Blood Gas Value
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Ventilator Setting to Monitor
Ventilator Setting to Monitor
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Basilar Skull Fracture Finding Requiring Intervention
Basilar Skull Fracture Finding Requiring Intervention
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Patient at highest risk of developing increased ICP?
Patient at highest risk of developing increased ICP?
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IV Fluid to Question
IV Fluid to Question
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Neuromuscular Blocking Agents
Neuromuscular Blocking Agents
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Facts about VP shunt placement
Facts about VP shunt placement
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Indicating Brain Herniation
Indicating Brain Herniation
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Post-Craniotomy Instructions
Post-Craniotomy Instructions
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Mild traumatic brain injury discharge instructions
Mild traumatic brain injury discharge instructions
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Study Notes
Increased Intracranial Pressure (ICP) Early Signs & Interventions
- Early signs of increased ICP include restlessness and confusion due to decreased cerebral perfusion.
- Elevate the head of the bed to 30 degrees to promote venous drainage and reduce ICP.
- Trendelenburg position increases ICP.
- Coughing can increase ICP.
- IV fluid boluses can lead to cerebral edema.
Decerebrate Posturing
- Decerebrate posturing (rigid extension of arms and legs, pronation of arms, plantar flexion) indicates severe brainstem injury and is associated with a poor prognosis.
Assessing Consciousness & Neurological Function
- The Glasgow Coma Scale (GCS) is a standardized tool to assess consciousness and neurological function in patients with brain injuries or increased ICP.
Mannitol
- Mannitol, an osmotic diuretic, reduces cerebral edema by drawing fluid out of the brain tissue, lowering ICP.
Nursing Interventions for Increased ICP
- Appropriate interventions include maintaining the head of the bed at 30 degrees, monitoring for Cushing's Triad, and administering IV mannitol as prescribed.
- Elevating the HOB to 30 degrees promotes venous drainage.
- Monitoring for Cushing's Triad (hypertension, bradycardia, irregular respirations) is critical for assessing worsening ICP.
- Clustering care increases ICP due to excessive stimulation.
- The Valsalva maneuver increases ICP and should be avoided.
Ventriculoperitoneal (VP) Shunt Complications
- Monitor for infection (e.g., meningitis), seizures, and shunt malfunction.
- VP shunts increase the risk of infection.
- Seizures may occur due to alterations in brain function.
- Shunt malfunction can lead to increased ICP.
- VP shunts drain excess CSF but do not decrease ICP below normal levels.
Cushing's Triad
- Cushing's Triad includes hypertension with widening pulse pressure, bradycardia, and irregular respirations.
- Increased ICP, brainstem herniation.
Post-Ventriculostomy Care
- Drainage output must be monitored to prevent over-drainage or under-drainage.
- The drainage system should be below head level to promote CSF drainage.
- Infection risk is high due to an invasive procedure.
- Lying flat can increase ICP.
- Rapid IV fluids can worsen cerebral edema.
Conditions Leading to Increased ICP
- Traumatic brain injury, brain tumors, meningitis, and hydrocephalus can all lead to increased ICP due to swelling or obstruction of CSF flow.
Arterial Blood Gas & Mechanical Ventilation
- A PaCO2 of 50 mmHg indicates hypercapnia, which leads to cerebral vasodilation and increased ICP. The normal range is 35-45 mmHg.
- End-tidal CO2 (ETCO2) should be maintained between 30-35 mmHg to prevent hypercapnia, which increases ICP by causing cerebral vasodilation.
Contraindicated Medications in Increased ICP
- Opioids like morphine can cause respiratory depression, leading to increased CO2 retention and subsequent cerebral vasodilation, worsening ICP.
Ventriculostomy Monitoring
- An ICP > 40 mmHg is life-threatening, indicating severe cerebral hypertension, requiring immediate intervention.
Activities to Avoid in Increased ICP
- Suctioning increases ICP by stimulating the cough reflex and should be limited to only when necessary.
Cushing's Triad Teaching
- Cushing's Triad consists of hypertension (widened pulse pressure), bradycardia, and irregular respirations (bradypnea).
- Tachycardia and hypotension are not part of Cushing's Triad.
Nursing Considerations for Mannitol
- Mannitol increases serum osmolality, so levels must be monitored.
- It must be given through a filtered IV set to prevent crystallization.
- Diuresis can cause dehydration and electrolyte imbalances.
- Urine output increases, not decreases, as fluid shifts from the brain into circulation.
Ventriculoperitoneal (VP) Shunt Teaching
- Signs of VP shunt malfunction include headache, vomiting, and bulging fontanel in infants.
- CSF leakage suggests a shunt infection or malfunction.
Signs of Worsening ICP
- Projectile vomiting, altered LOC, pupil changes, and Cushing's Triad (HTN + bradycardia) indicate worsening ICP.
- Hyperactive reflexes are not specific to increased ICP.
Epidural Hematoma Interventions
- Epidural hematomas require emergency surgery.
- Neurological function can deteriorate quickly.
- Pupillary changes indicate worsening condition.
- Mannitol reduces cerebral edema.
- Trendelenburg increases ICP and is contraindicated.
Late Signs of Increased ICP
- Fixed, dilated ("blown") pupils are a late and ominous sign of brainstem herniation. Early signs include headache, nausea, and altered LOC.
Glasgow Coma Scale (GCS) Interpretation
- A GCS score of 3-8 indicates severe brain injury, 9-12 indicates moderate injury, and 13-15 indicates mild injury.
Dexamethasone
- Dexamethasone is a corticosteroid used to reduce cerebral edema, particularly in brain tumors and inflammatory conditions.
Ventriculostomy Complications
- A sudden spike in ICP and decreased LOC indicate possible obstruction, infection, or worsening brain swelling, requiring immediate intervention.
Interventions to Minimize Further Increases in ICP
- A neutral head position promotes venous drainage and prevents increased ICP.
- Coughing, excessive fluids, and frequent suctioning increase ICP.
Non-Pharmacological Interventions to Lower ICP
- HOB elevation promotes venous drainage.
- A quiet environment reduces stimulation.
- Stool softeners prevent straining, which can increase ICP.
- Coughing increases ICP.
- Neck flexion impairs venous return and worsens ICP.
Mechanical Ventilation Settings for Increased ICP
- A PaCO2 of 30-35 mmHg prevents cerebral vasodilation.
- Excessive PEEP increases intrathoracic pressure, reducing venous return and raising ICP.
- Hyperthermia increases metabolic demands and ICP.
- Controlled hyperventilation (temporary) may reduce ICP in emergencies.
- FiO2 should be titrated to oxygenation needs, not kept "as high as possible."
Meningitis Diagnosis
- Nuchal rigidity (neck stiffness) and Kernig's sign (pain on knee extension) suggest meningeal irritation.
- Photophobia and fever are common symptoms.
- Meningitis increases ICP, not decreases it.
Ischemic Stroke and Increased ICP Management
- Mannitol reduces cerebral edema.
- Monitoring for deterioration is crucial.
- Adequate oxygenation prevents further ischemia.
- The HOB should be at 30 degrees, not 10 degrees.
- Thrombolytics are only for eligible ischemic stroke patients (not those with high ICP).
Post-Craniotomy Care Instructions
- Avoiding straining prevents increased ICP.
- Signs of infection, like fever, should be reported.
- Mild headaches and swelling are normal, but worsening symptoms are not.
- Vision changes or confusion can indicate complications.
- A flat position is discouraged; slight elevation is better for ICP management.
Basilar Skull Fracture Intervention
- Clear fluid from the nose (CSF rhinorrhea) suggests a dural tear and increases the risk of infection (e.g., meningitis).
Risk of Increased ICP
- Brain tumors can increase ICP, and persistent vomiting suggests worsening cerebral pressure.
Contraindicated Positions
- Turning the head can obstruct venous outflow, increasing ICP. Keeping the head in a neutral position is essential for proper drainage.
IV Fluids in Increased ICP
- Hypotonic fluids like 0.45% NS cause fluid shifts into brain cells, worsening cerebral edema. Hypertonic solutions (e.g., 3% NS) help pull fluid out of brain cells, reducing ICP.
Traumatic Brain Injury (TBI) Assessment
- Cushing's Triad (hypertension, bradycardia, irregular respirations) is a late sign of increased ICP and indicates brainstem herniation.
Mild Traumatic Brain Injury Discharge Teaching
- Driving and contact sports should be avoided until a doctor gives clearance.
- Vomiting can indicate worsening ICP and requires medical attention.
- Memory issues may improve in weeks, not necessarily months.
- Opioids should be avoided as they can mask worsening symptoms.
Neuromuscular Blocking Agents
- Neuromuscular blocking agents reduce cerebral oxygen demand and prevent ICP spikes from movement.
Hydrocephalus Education
- VP shunts drain CSF into the peritoneal cavity.
- Infection and obstruction are possible complications.
- Shunts often need replacement as the patient grows or if malfunction occurs.
- Temporary swelling is common postoperatively.
Brain Herniation
- A fixed, dilated pupil suggests brainstem compression.
- Severe headaches, posturing, and Cushing's Triad (bradycardia + HTN) indicate herniation.
Transient Ischemic Attacks (TIAs)
- Managing BP, taking prescribed medications, avoiding smoking, and staying active all reduce stroke risk.
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