Neuro (Cerebral Perfusion Pressure)

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Author:
alyn217
ID:
201756
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Neuro (Cerebral Perfusion Pressure)
Updated:
2013-02-21 08:08:53
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AMS2T2
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Adult MedSurg 2
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  1. 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? 
    • Answer: 60
  2. 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...
  3. 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
  4. Pathophys of SAH
    • Media thins and connective tissue replaces smooth muscles
    • Vasospasm causes ischemia and infarction seems related to volume of blood degradation
  5. SnSs of SAH?
    • Usual very sudden onset with sudden severe HA, 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
    • MCA: hemiparesis, dysphagia
    • ACA: incontinence, faulty problem solving
    • PCA: hemianopia
    • Review ignoral (neglect of a side of body or limb) and heminopsia (part of visual field is completely ignored.
  6. 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. 


  7. Therapeutic goas for SAH?
    • Maintain CPP (vasopressors, hemodynamics monitored, prevent ischemias from hypotension)
    • Control ICP
    • Minimize vasospasm  (treat HTN,Hypervolemia and Hemodilution)
    • Manage hydrocephalus (drains may be placed)
    • Manage arrhythmias (monitor electrolytes and rhythm)
    • Prevent re-bleeding
  8. What treatments are available for SAH?
    • Possible surgeries:
    • --Endovascular therapies
    • --Aneurysm clip (“time bomb”)
    • AVMs: 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
  9. What are some etiologies of Neurotraumas?
    Associated with space occupying lesion, infarction, CSF flow issue, abscess,elevated pCO2,decreased pO2
  10. SnSs of neurotrauma
    • Subtle change in LOC (restlessness,confusion, irritability)
    • Change in GCS
    • HA, N/V, Diplopia, changes in PERRLA
    • Papilledema
    • Cushing's triad: massive increased SBP, widened pulse pressure, bradycardia
    • Cheyne stokes respirations, apneustic (loss of respirations)  or ataxic breathing (labored, uncoordinated breathing). Messy breathing.
  11. 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
  12. Outcomes and nursing interventions for cranial trauma/hemorrhage?
    • Decrease ICP
    • Mannitol (review this one)
    • CPP/ICP monitoring
    • Prevent complications
    • Barbiturate coma combined with...
    • ...NMB (neuromuscular blockage) agents. Done to preserve the brain and to slow blood flow to smooth muscle. 
    • Nursing Care
  13. Assessments for neuro/trauma?
    • LOC
    • VS, especially RR and pattern
    • Pupils
    • --Equal
    • --Size
    • --Position
    • --Reactivity
    • --Shape
    • --EOM
    • --Accommodation
    • --Nystagmus
  14. Independent nursing interventions for neuro/trauma pt.
    • Airway
    • Positioning: 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)
    • Body Temp
    • Monitor VS, LOC, ICP, CPP
    • Nutrition: becomes a problem when pt cannot feed themselves or loses gag reflex-->npo. 
    • Elimination
    • Prevent complications

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