ch57 Acute Intracranial Problems
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Normal intracranial pressure (ICP) range is:
0-15 mm Hg
Autoregulation to maintain constant blood flow to the brain becomes ineffective when the MAP is below _______ and ischemia occurs.
50 mm Hg
Autoregulation becomes ineffective when the MAP is greater than ______ due to maximal vasoconstriction.
150 mm Hg
Normal cranial perfusion pressure (CPP) is:
70-100 mm Hg
Cranial perfusion pressure (CPP) calculation:
- CPP = MAP - ICP
- Cranial perfusion pressure = mean arterial pressure - intracranial pressure
Mean arterial pressure (MAP) calculation:
- MAP = (SBP - DBP)/3 + DBP
- Mean arterial pressure = (systolic blood pressure - diastolic blood pressure)/3 + diastolic blood pressure
Earliest sign of increased intracranial pressure (ICP):
Decreasing level of consciousness (LOC)
Cushing's triad is a late sign of increased intracranial pressure (ICP). The signs are:
- Increased pulse pressure (increased systolic BP with unchanged to slightly elevated diastolic BP)
- Irregular respirations
- Decreased pulse (bradycardia)
Define the following herniations:
- Uncal - lateral and downward herniation toward brainstem
- Tentorial - downward herniation toward brainstem
- Cingulate - lateral displacement beneath falx cerebri
- Temporal lobe - brain herniates through a fracture or surgical site (external hernia)
Priority nursing interventions for a patient post cranial surgery are to prevent:
Increased intracranial pressure (ICP) and infection
Meningitis vs. Encephalitis:
Common cause: Bacterial vs. viral
Increased ICP from: Increased CSF vs. cerebral edema
Onset: Rapid vs. slow
Inflammation of: Pia & arachnoid maters vs. brain
Source: Respiratory infection vs. insect bite
- Most commonly bacterial
- Increased CSF
- Rapid onset
- Inflammation of pia & arachnoid maters
- Commonly from a respiratory infection
- Most commonly viral
- Increased cerebral edema
- Slow onset
- Inflammation of brain
- Commonly from insect bite (e.g. West Nile)
A patient is admitted to the ER with a large laceration on the forearm as a result of a dog bite. A pack of dogs on the edge of town attacked him, but scattered when another person intervened with a stick. The nurse informs the patient that the incident will be reported to the public health officials and adds that:
A. If the dog cannot be identified, caught, and observed for 10 days, he must have the series of rabies vaccine.
B. If he develops symptoms such as tingling and numbness at the bite site with fever, headache, and malaise, he should get the full rabies immunization series.
C. Because he was not immunized for rabies before the bite, his protection against rabies will only involve the administration of rabies immune globulin (RIG).
D. If the wound is cleaned well with soap and water with an antiseptic applied, the chance of developing rabies is small.
A. Rationale: The priority in treatment is to determine whether the animal is rabid. No treatment is required if a domestic animal can be caught and develops no symptoms of rabies for 10 days or if a wild animal can be killed and the brain has no evidence of rabies. In all other cases, full rabies immunization is required. The initial immunization is a rabies immune globulin followed by active immunization. If immunization is delayed until symptoms develop, rabies infection is ultimately fatal.
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