Neuro (Cerebral Perfusion Pressure)
Card Set Information
Neuro (Cerebral Perfusion Pressure)
Adult MedSurg 2
How do you calculate Cerebral Perfusion Pressure? (CPP)
MAP= (1 systolic + 2 diastolic)/3
MAP-ICP (monitor surgically placed in head)=CPP
CPP>50 is normal
Measured in mm Mercury
If BP 145/90 and ICP is 18, what is CCP?
Nursing care plans for craniotomy pt.
Risk for altered tissue perfusion related to:
Ineffective individual coping related to:
The client will have decreased anxiety related to:
Risk for altered thought process related to:
Anticipatory grief related to:
Risk for safety related to:
Risk for discomfort related to:
Come up with some interventions...
What is subarachnoid hemorrage?
Most commonly caused by TBI, intracranial aneurysms and AVMs
Saccular (berry) aneurysms are most common & development
--hastens with HTN, atherosclerosis, aging and stress
--usually found in anterior circle of willis
Pathophys of SAH
Media thins and connective tissue replaces smooth muscles
Vasospasm causes ischemia and infarction seems related to volume of blood degradation
SnSs of SAH?
Usual very sudden onset with sudden
, projectile vomiting, then loss of consciousness
Generalized seizures may occur
S&S of meningeal irritation (nuchal rigidity [whole spine goes stiff when lifted by head], photophobia, back pain)
S&S relate to the artery in spasm
: hemiparesis, dysphagia
: incontinence, faulty problem solving
Review ignoral (neglect of a side of body or limb) and heminopsia (part of visual field is completely ignored.
How do you diagnose SAH?
Best diagnostic is CT angiography
Blood in CSF
Most frequently seen at 7th day post hemorrhage
80% have enough blood to be appreciated with non-contrast CT. Other 20% will not, so might be missed.
Therapeutic goas for SAH?
Maintain CPP (vasopressors, hemodynamics monitored, prevent ischemias from hypotension)
Minimize vasospasm (treat HTN,Hypervolemia and Hemodilution)
Manage hydrocephalus (drains may be placed)
Manage arrhythmias (monitor electrolytes and rhythm)
What treatments are available for SAH?
--Aneurysm clip (“time bomb”)
: tangle of arteries/veins malformation. Impossible to detangle. Present like SAH when it bleeds.
--Massive lesions that tangle veins and arteries
--Usually in brain or spinal column
--When bleeds, present like SAH
--Can present with “circulatory steal”
--Usually require surgical resection, now developing radiographic approaches to controlling AVMs
--Care is similar to SAH with outcomes, interventions
What are some etiologies of Neurotraumas?
Associated with space occupying lesion, infarction, CSF flow issue, abscess,elevated pCO2,decreased pO2
SnSs of neurotrauma
Subtle change in LOC (restlessness,confusion, irritability)
Change in GCS
HA, N/V, Diplopia, changes in PERRLA
: massive increased SBP, widened pulse pressure, bradycardia
Cheyne stokes respirations, apneustic (loss of respirations) or ataxic breathing (labored, uncoordinated breathing). Messy breathing.
What should you know about cranial herniation?
Always a medical emergency
Herniation through open skull fractures
Central herniation (rapid change in LOC with hyperventilation (early))
Uncal herniation (lateral pressure on temporal lobe) has pupils that are unreactive to light with stupor and resp changes
Infratentorial (Tonsillar) herniation is classic foramen magnum herniation with Cushing's triad and change in LOC
Outcomes and nursing interventions for cranial trauma/hemorrhage?
Mannitol (review this one)
Barbiturate coma combined with...
...NMB (neuromuscular blockage) agents. Done to preserve the brain and to slow blood flow to smooth muscle.
Assessments for neuro/trauma?
RR and pattern
Independent nursing interventions for neuro/trauma pt.
: with szr, may want to place pt on floor because they'll end up there anyway.
F&E/I&O (DI, then you're dry)
Monitor VS, LOC, ICP, CPP
: becomes a problem when pt cannot feed themselves or loses gag reflex-->npo.