ch57 Acute Intracranial Problems

  1. Normal intracranial pressure (ICP) range is:
    0-15 mm Hg
  2. Autoregulation to maintain constant blood flow to the brain becomes ineffective when the MAP is below _______ and ischemia occurs.
    50 mm Hg
  3. Autoregulation becomes ineffective when the MAP is greater than ______ due to maximal vasoconstriction.
    150 mm Hg
  4. Normal cranial perfusion pressure (CPP) is:
    70-100 mm Hg
  5. Cranial perfusion pressure (CPP) calculation:
    • CPP = MAP - ICP
    • Cranial perfusion pressure = mean arterial pressure - intracranial pressure
  6. Mean arterial pressure (MAP) calculation:
    • MAP = (SBP - DBP)/3 + DBP
    • Mean arterial pressure = (systolic blood pressure - diastolic blood pressure)/3 + diastolic blood pressure
  7. Earliest sign of increased intracranial pressure (ICP):
    Decreasing level of consciousness (LOC)
  8. 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)
  9. Define the following herniations:
    Temporal lobe
    • 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)
  10. Priority nursing interventions for a patient post cranial surgery are to prevent:
    Increased intracranial pressure (ICP) and infection
  11. 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
    • Meningitis:
    • Most commonly bacterial
    • Increased CSF
    • Rapid onset
    • Inflammation of pia & arachnoid maters
    • Commonly from a respiratory infection

    • Encephalitis:
    • Most commonly viral
    • Increased cerebral edema
    • Slow onset
    • Inflammation of brain
    • Commonly from insect bite (e.g. West Nile)
  12. 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. 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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ch57 Acute Intracranial Problems
Chapter 57 Acute Intracranial Problems