1
Exam 1: Neurological
Chapters 57: Acute Intracranial Problems
Increased Intracranial Pressure Lewis 1357
Etiology Diagnostic Causes/Risk Manifestations Nursing Medical
indicators Factors interventions Treatment
Any patient who -CT scan -mass -Change in level of -It is critical to -identify &
becomes -MRI (hematoma, consciousness maintain CBF to treat the
unconscious -PET scan contusion, -Cushing’s triad preserve tissue and underlying
acutely, regardless -EEG abscess, tumor) (systolic thus minimize cause
of the cause, -Cerebral -cerebral edema hypertension with a secondary injury -Intubation &
should be angiography (associated with widening pulse -HOB to 30 degrees mechanical
suspected of -ICP & brain tissue brain tumors, pressure, with head in a ventilation
having increased oxygenation hydrocephalus, bradycardia with a neutral position -Maintenance of
ICP. Increased ICP measurement head injury, or full -ICP monitoring arterial pressure
is a potentially (LICOX catheter) brain -maintain adequate btw 100-160
& bounding pulse,
life- threatening -Doppler & evoked inflammation) oxygenation to mmHg
situation that potential studies and irregular support brain -Drug therapy
results from an **NO lumbar respirations) function • Osmotic diuretic
increase in any or puncture (cerebral -Change in body -The goal is to (mannitol)
all of the three herniation could temperature maintain the PaO2 • Hypertonic saline
components (brain occur from the Headache (Often at greater than or • Antiseizure drugs
tissue, blood, CSF) sudden release of equal to 100 mm Hg (phenytoin
continuous & worse
within the skull. the pressure in the and to keep PaCO2 [Dilantin])
Elevated ICP is skull from the area in the morning) in normal range at • Corticosteroids
clinically above the lumbar -Vomiting (not 35 to 45 mm Hg (dexamethasone
significant puncture) preceded by -monitor pt using [Decadron]) for
because it nausea & can be the Glasgow brain tumors,
diminishes CPP, projectile) coma scale bacterial
increases risks of -ocular signs -compare pupils meningitis
brain ischemia and with each other for • Histamine (H2)-
• Diplopia
infarction, and is size, shape, receptor
• Blurred
associated with a movement antagonist
poor prognosis. vision &reactivity (cimetidine
Can result in an • Unilateral -test motor strength [Tagamet]) or
Page 1 of 80
,2
cerebral edema pupil dilation when pts is awake & proton pump
(increased • Sluggish or cooperative by inhibitor
accumulation of having them (pantoprazole
[Protonix]) to
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, 3
fluid in the no response squeeze your hands prevent GI ulcers
extravascular to light to compare strength and bleeding
spaces of brain in the hands
• Inability to
tissue). There are -palmar drift test to
three types of move eye measure upper
cerebral edema: upward extremity strength
vasogenic, • Eyelid ptosis (The patient raises
cytotoxic, and -decrease in motor the arms in front of
interstitial. The function the body with the
same patient may palms facing
(hemiparesis
have more than upward, if there is
one type. -decerebrate any weakness in the
posturing upper extremity, the
(extensor) palmar surface turns
-decorticate downward and the
posturing (flexor) arm drifts down)
-Assess the motor
response of the
unconscious or
uncooperative pt by
observation of
spontaneous
movement. If no
spontaneous
movement is
possible, apply a
pain stimulus to
the patient, and
note the response.
Head Injury Lewis 1369
Etiology Diagnostic Causes/Risk Manifestations Nursing Medical
indicators Factors interventions Treatment
Page 3 of 80
, 4
Head injury -CT scan (best -Motor vehicle The location of -observation & the principal
includes any injury diagnostic test to collisions & falls the head injury management of treatment of head
or trauma to the evaluate head are the most injuries is timely
determines the increased ICP
scalp, skull, or trauma) common causes diagnosis and
brain. A serious -MRI & PET scan of head injury clinical -teach the use of surgery (if
form of head injury -C spine x-rays -firearms manifestations helmets when riding necessary)
is traumatic brain -Glasgow coma -assaults a motorcycle or a -skull fractures
injury (TBI). Head scale -sports-related bike, use car seats conservative tx,
trauma has a high -transcranial trauma with children, avoid surgery if
Page 4 of 80
Exam 1: Neurological
Chapters 57: Acute Intracranial Problems
Increased Intracranial Pressure Lewis 1357
Etiology Diagnostic Causes/Risk Manifestations Nursing Medical
indicators Factors interventions Treatment
Any patient who -CT scan -mass -Change in level of -It is critical to -identify &
becomes -MRI (hematoma, consciousness maintain CBF to treat the
unconscious -PET scan contusion, -Cushing’s triad preserve tissue and underlying
acutely, regardless -EEG abscess, tumor) (systolic thus minimize cause
of the cause, -Cerebral -cerebral edema hypertension with a secondary injury -Intubation &
should be angiography (associated with widening pulse -HOB to 30 degrees mechanical
suspected of -ICP & brain tissue brain tumors, pressure, with head in a ventilation
having increased oxygenation hydrocephalus, bradycardia with a neutral position -Maintenance of
ICP. Increased ICP measurement head injury, or full -ICP monitoring arterial pressure
is a potentially (LICOX catheter) brain -maintain adequate btw 100-160
& bounding pulse,
life- threatening -Doppler & evoked inflammation) oxygenation to mmHg
situation that potential studies and irregular support brain -Drug therapy
results from an **NO lumbar respirations) function • Osmotic diuretic
increase in any or puncture (cerebral -Change in body -The goal is to (mannitol)
all of the three herniation could temperature maintain the PaO2 • Hypertonic saline
components (brain occur from the Headache (Often at greater than or • Antiseizure drugs
tissue, blood, CSF) sudden release of equal to 100 mm Hg (phenytoin
continuous & worse
within the skull. the pressure in the and to keep PaCO2 [Dilantin])
Elevated ICP is skull from the area in the morning) in normal range at • Corticosteroids
clinically above the lumbar -Vomiting (not 35 to 45 mm Hg (dexamethasone
significant puncture) preceded by -monitor pt using [Decadron]) for
because it nausea & can be the Glasgow brain tumors,
diminishes CPP, projectile) coma scale bacterial
increases risks of -ocular signs -compare pupils meningitis
brain ischemia and with each other for • Histamine (H2)-
• Diplopia
infarction, and is size, shape, receptor
• Blurred
associated with a movement antagonist
poor prognosis. vision &reactivity (cimetidine
Can result in an • Unilateral -test motor strength [Tagamet]) or
Page 1 of 80
,2
cerebral edema pupil dilation when pts is awake & proton pump
(increased • Sluggish or cooperative by inhibitor
accumulation of having them (pantoprazole
[Protonix]) to
Page 2 of 80
, 3
fluid in the no response squeeze your hands prevent GI ulcers
extravascular to light to compare strength and bleeding
spaces of brain in the hands
• Inability to
tissue). There are -palmar drift test to
three types of move eye measure upper
cerebral edema: upward extremity strength
vasogenic, • Eyelid ptosis (The patient raises
cytotoxic, and -decrease in motor the arms in front of
interstitial. The function the body with the
same patient may palms facing
(hemiparesis
have more than upward, if there is
one type. -decerebrate any weakness in the
posturing upper extremity, the
(extensor) palmar surface turns
-decorticate downward and the
posturing (flexor) arm drifts down)
-Assess the motor
response of the
unconscious or
uncooperative pt by
observation of
spontaneous
movement. If no
spontaneous
movement is
possible, apply a
pain stimulus to
the patient, and
note the response.
Head Injury Lewis 1369
Etiology Diagnostic Causes/Risk Manifestations Nursing Medical
indicators Factors interventions Treatment
Page 3 of 80
, 4
Head injury -CT scan (best -Motor vehicle The location of -observation & the principal
includes any injury diagnostic test to collisions & falls the head injury management of treatment of head
or trauma to the evaluate head are the most injuries is timely
determines the increased ICP
scalp, skull, or trauma) common causes diagnosis and
brain. A serious -MRI & PET scan of head injury clinical -teach the use of surgery (if
form of head injury -C spine x-rays -firearms manifestations helmets when riding necessary)
is traumatic brain -Glasgow coma -assaults a motorcycle or a -skull fractures
injury (TBI). Head scale -sports-related bike, use car seats conservative tx,
trauma has a high -transcranial trauma with children, avoid surgery if
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