Intracranial pressure
What is the Monroe-Kellie Hypothesis?
A change in volume of CSF, blood volume, or intracellular/extracellular fluids must be accompanied by a reciprocal change in one or both of the other components or else there will be ↑ Intracranial pressure (ICP)
What is an early sign of increased ICP?
A. Cushing’s triad
B. Decerebrate posturing
C. Irritability and headache
D. Fixed and dilated pupils
C. Early signs of increased ICP include irritability, headache, and vomiting. Cushing’s triad and fixed pupils are late signs.
What three time periods is death most common following a head injury?
Immediately after the injury
Within 2 hours after the injury- progressive worsening of the brain or internal bleeding
3 weeks after the injury-multisystem failure
Which of the following signs is most concerning in a patient with head trauma and suggests brain herniation?
A. Bilateral pupil constriction.
B. Fixed, unilateral, dilated pupil.
C. Bilateral hand tremors.
D. Generalized muscle weakness.
B. Fixed, unilateral, dilated pupil.
A fixed, unilateral, dilated pupil indicates cranial nerve III compression and is a critical sign of brain herniation.
What do you use to treat meningitis
broad spectrum abx that cross the BBB for 14-21 days
What is a normal ICP?
5-15 mmHg
What is the most appropriate head positioning to reduce ICP?
A. Flat with the neck extended
B. High Fowler’s position
C. 30 degrees elevation with the neck midline
D. Side-lying with the head turned
C. Elevating the head to 30 degrees and maintaining the neck midline promotes venous drainage and reduces ICP.
What are signs and symptoms of a basilar fracture?
Halo sign – sign of CSF leakage
otorrhea & rhinorrhea
“Raccoon eyes”- periorbital ecchymosis
“Battle sign” – mastoid ecchymosis
A patient with a suspected basilar skull fracture presents with clear fluid draining from the nose. Which test can confirm cerebrospinal fluid (CSF) leakage?
A. Glucose testing of the fluid.
B. Testing for blood type.
C. Testing for the presence of albumin.
D. Serum sodium testing.
A. Glucose testing of the fluid.
CSF contains glucose, and its presence in nasal or ear drainage indicates a possible basilar skull fracture.
What are the goals of seizure management?
prevention of secondary brain injury, maintain a patent airway, and administration of anticonvulsants in a timely manner
What are the causes of increased blood volume that lead to increased ICP?
obstruction of venous outflow via positioning of the head or neck, c-collars, using PEEP (positive end-expiratory pressure), Valsalva maneuvers
What is a classic sign of an epidural hematoma?
A. Gradual onset of symptoms
B. "Worst headache of life"
C. Lucid interval followed by unconsciousness
D. Hemiparesis on the contralateral side
C. Lucid interval followed by unconsciousness
Epidural hematomas often present with a brief period of lucidity before rapid neurological decline.
what is a patient at risk for with an open or depressed skull fracture?
meningitis
Which nursing intervention is most effective in preventing secondary brain injury in a patient with a traumatic brain injury?
A. Administering sedatives to maintain coma.
B. Monitoring and controlling blood glucose levels.
C. Ensuring oxygen saturation remains above 90%.
D. Restricting fluids to prevent cerebral edema.
C. Ensuring oxygen saturation remains above 90%.
Maintaining adequate oxygenation prevents hypoxia, a major cause of secondary brain injury.
What location should the external ventricular drain be leveled at?
Bonus 100: What is it cleaned with?
The tragus
CHG
A patient's MAP is 56 and their ICP is 20. What is their Cerebral Perfusion Pressure?
Bonus 100: What level of CPP is incompatible with life?
36
under 30 is incompatible
Which intervention is appropriate for a patient with a cerebrospinal fluid (CSF) leak?
A. Insert an NG tube for feeding.
B. Elevate the head of the bed.
C. Perform frequent nasopharyngeal suctioning.
D. Apply tight dressings to stop leakage.
B. Elevate the head of the bed.
Elevating the head helps reduce ICP and facilitates CSF drainage while minimizing risks of infection.
What are the acute symptoms of a subdural hematoma?
Occur within 48 hours.
drowsiness, coma, headache, confusion, unilateral headache, slowed thinking, agitation
Symptoms may progress rapidly
A patient presents with signs of increased intracranial pressure (ICP). Which of the following interventions should the nurse prioritize?
A. Lowering the head of the bed to 10 degrees.
B. Administering IV mannitol as prescribed.
C. Encouraging the patient to perform Valsalva maneuvers to reduce ICP.
D. Maintaining a dark room with minimal stimulation.
B. Administering IV mannitol as prescribed.
Mannitol is an osmotic diuretic that reduces ICP by drawing fluid out of the brain tissue. Other interventions like positioning the head at 30 degrees (not 10) and avoiding Valsalva maneuvers are also crucial. Minimizing stimulation is supportive but not a direct priority for reducing ICP.
What should you assess for when giving IV mannitol?
Bonus 100: what kind of fluid is mannitol?
Crystals - send back to pharmacy, and the use of a filter
osmotic diuretic
What are 5 s/s of increased ICP?
Irritability, HA, projectile vomiting, alterations in LOC, decrease in motor function (stroke-like s/s), ipsilateral pupil dilation
What is the definitive diagnostic test for meningitis?
A. Blood cultures
B. CT scan
C. Lumbar puncture
D. MRI
C. Lumbar puncture
Rationale: A lumbar puncture is performed to analyze CSF for signs of infection and confirm meningitis.
How is chronic traumatic encephalopathy diagnosed?
can only be diagnosed on autopsy, permanent changes in brain due to repeated concussions
A patient with increased ICP exhibits Cushing's triad. What findings would the nurse expect?
A. Tachycardia, narrowed pulse pressure, and irregular breathing.
B. Bradycardia, widened pulse pressure, and irregular breathing.
C. Tachycardia, hypotension, and shallow breathing.
D. Hypertension, bradycardia, and rapid respirations.
B. Bradycardia, widened pulse pressure, and irregular breathing.
Cushing's triad is a late sign of increased ICP indicating brainstem compression and impending herniation.
How do you treat an Intraparenchymal hematoma?
Supportive measures, decreasing ICP