NR 341 EDAPT Week 6 Notes (2026) PDF | Neurological Alterations | Complex Adult Health

NR 341
(EDAPT WEEK 6 NOTES)
COMPLEX INTRACRANIAL –
NEUROLOGICAL ALTERATIONS

Complex Adult Health

,WEEK 6 EDAPT NOTES COMPLEX CARE NR 341
COMPLEX INTRACRANIAL – NEUROLOGICAL ALTERATIONS
Intracranial regulation is the body’s ability to control blood and cerebral spinal fluid flow
throughout the brain and spinal cord. A delicate system of nerve fibers senses the
increases and decreases in pressure and flow and adjusts to maintain homeostasis.

Any type of injury or abnormality can cause an imbalance, requiring the nervous system to
adjust. In some cases, adjustment isn’t possible, and the body requires outside intervention
to bring the body back to its normal state.

A client has a mean arterial pressure of 120 mm Hg with an intracranial pressure of
42 mm Hg. What is the calculated cerebral perfusion pressure?

Cerebral perfusion pressure is the mean arterial pressure minus the intracranial pressure.
For this client, the answer is 78 mm Hg.

When intracranial pressure is significantly elevated, what symptoms might the nurse
expect?

Significantly elevated intracranial pressure leads to bradycardia, irregular respirations, and
widening blood pressure measurements. This is also known as Cushing’s triad, and an
indication of impending cerebral herniation. Bloody ear drainage suggests a skull fracture.
Cold and clammy skin below the neck suggests symptoms of autonomic dysreflexia.

The nurse reports that the client is experiencing a reduced level of consciousness.
Which tool is used to measure and record the level of consciousness?

The best tool to measure and record a client’s level of consciousness is the Glasgow coma
scale (GCS).

The balance of cerebral spinal fluid and blood:

Intracranial pressure changes whenever brain tissue, cerebrospinal fluid, or blood
pressures change. For small changes resulting from the changes of brain tissue,
cerebrospinal fluid, or blood pressure, the body can compensate by increasing or
decreasing blood pressure or changing the amount of flowing cerebral spinal fluid. This
process is called intracranial regulation.

Altered Intracranial Regulation

When there are unexpected changes in mass, either due to space occupying tissue, or
increased swelling from inflammatory response, the body can fail at intracranial regulation.
This can occur slowly with a brain tumor, or quickly with cerebral edema from
inflammatory response or bleeding.

,Changes in the amount of brain tissue, cerebrospinal fluid, or blood can increase or
decrease the intracranial pressure in the brain. When intracranial pressure goes up or
down, the client can develop signs or symptoms of decreased brain perfusion, measured
by cerebral perfusion pressure (CPP).

In caring for clients with complex health:

 Advanced monitoring is used to closely measure intracranial pressures.
 Drains and other devices may be used to reduce this pressure through the drainage
of cerebral spinal fluid.
 Intracranial pressure may be further reduced through the induction of a coma and
artificial ventilation as well.

Intracranial pressure:
In complex health care environments, intracranial monitoring can be done with a catheter
placed inside the skull. The continuous measurement determines possible elevated
pressures or changes in brain temperature.

NOTE:

Because the brain is a closed container, the worst complication of altered intracranial
regulation is herniation. Herniation occurs when the pressure inside the skull is so severe it
forces the brain stem through the hole in the bottom of the skull.

This results in death or severe brain damage.

Remember the following normal range:

 Mean arterial pressure (MAP) is 70 to 100 mm Hg
 Intracranial pressure (ICP) is 5 to 15 mm Hg
 Cerebral perfusion pressure (CPP) is 60 to 80 mm Hg

 Intraventricular Catheter:
 This is the most accurate and is done with a flexible tube inserted into the lateral
ventricle in the brain. This device can also be used to remove excess cerebral spinal
fluid (CSF) to lower Intracranial pressure (ICP).

 Subdural Screw (or Bolt)

 This device can be inserted quickly and is composed of a hollow screw inserted
through a hole drilled into the skull. The sensor reads the pressure in the subdural
space.

 Epidural Sensor

,  This is inserted between the skull and dural tissue. This is the least invasive way to
measure, but it cannot be used to drain excess CSF fluid.

Intracranial monitor:
Along with monitoring intracranial pressure, other measurements that may be used in
complex environments measure brain information including:

 blood flow
 oxygenation
 metabolism
 continuous electroencephalographic monitoring

Research to discover how the different types of monitoring can impact survival and
minimize damage in any client with altered intracranial regulation continues to bring new
evidence to the bedside.




Spinal cord injury:
Injury to the spinal cord is another important neurological alteration addressed acutely in a
complex health environment.

The spinal cord can be bruised, punctured, or severed. Because the spinal cord runs from
the top of the neck and ends between the first and second lumbar vertebrae, with further
nerve roots going out to the ends of the extremities, any damage at any point of the
spinal cause’s symptoms beyond the point of damage.

 If the spinal injury is in the neck, the respiratory system is affected.