Intracranial Pressure
the earliest symptom reported by a client with increasing ICP
what is headache
signs and symptoms specific to later stages of SIADH
what is weight gain, confusion, personality changes, extreme muscle weakness and hyponatremia
*early s/s include weakness and muscle cramps*
signs and symptoms associated with DI
what is polyuria, polydipsia and hypernatremia
dehydration
signs and symptoms associated with AD
what is severe hypertension, bradycardia and pounding headache.
*pale/cool skin below area of injury and diaphoresis/flushed skin above the level of injury
*"severe HTN"- over 150mmHg or 20-40mmHg above the client's normal*
a medication used to prevent seizures in a client who has a history of a TBI
what is Phenytoin
the earliest sign of a client with increasing ICP
what is decreased LOC
causes of SIADH
what is pressure on the pituitary gland, tumors
*pressure increases ADH release*
*tumors can produce, secrete or stimulate an ADH-like substance*
causes of DI
what is pressure on the pituitary causing a decrease of ADH, a complication of pituitary surgery (Sublabial Transsphenoidal)
*stroke, trauma, surgery, idiopathic*
causes of AD
what is noxious stimuli- most often bladder, but can also be bowels, pressure injury/pressure on skin.
could also be extreme temperatures, trauma or sexual activity
*bladder, bowels and breakdown- 3Bs*
a medication administered to a client with a TBI and the nurse reports 9L urine output over the past 24-hours
what is desmopressin (DDAVP)
*often administered as nasal spray and is first line treatment*
What is the primary pathophysiological mechanism behind increased intracranial pressure?
What is an increase in the volume of brain tissue, blood, or cerebrospinal fluid within the skull, leading to elevated pressure
*CSF (10%), brain (80%) and blood (10%).
icp- *what is <15 mmHg
*prolonged and over 20 is not good!*
nursing interventions for a client with SIADH
what is fluid restrictions, increase sodium intake
*administer meds as prescribed, monitor Na, treat underlying cause- chemo or XRT (radiation treatment)*
the difference between central and nephrogenic DI
what is decreased ADH production (central) vs unresponsive kidneys in presence of adequate ADH (nephrogenic)
nursing interventions to prevent AD
what is:
- straight catheterization Q4-6H/ check indwelling for kinks
- maintaining wrinkle free linens and clothes
- T&P Q2H
- maintain a regular bowel routine
the specific assessment that may prompt the nurse to administer Hydralazine over Labetalol for a stroke client who is hypertensive.
what is heart rate
*"lol" are beta blockers, if HR is low choose the hydralazine*
widening pulse pressure (increasing BP), decreasing HR and decreasing RR, also often involves increased temperature
what is Cushing's Triad
*normal pulse pressure is 40-60 mmHg*
*may see Cheyne stokes- rhythmic, periods of apnea*
Regular monitoring of this blood component is crucial in managing SIADH to avoid rapid changes that can be dangerous.
what is sodium
nursing interventions for a client with DI
what is administration of desmopressin, hypotonic NS can replace fluids (0.45% NS), monitor neuro and CVS, monitor electrolytes (Na, K, Ca), maintain adequate fluid intake, avoid diuretics/foods that cause such,
first intervention for a client with a T4 spinal cord injury who reports a sudden headache and has excessive hypertension
what is to elevate the HOB to high fowlers
*prevent hypertensive stroke*
*next- loosen tight clothing and check for noxious stimuli to eliminate it*
a hypertonic intravenous fluid administered to treat increased ICP
what is 3% NS
*if Na is <120mmol/L*
What advice should be given to a patient to help manage increased intracranial pressure at home?
What is to avoid activities that increase intracranial pressure, such as straining during bowel movements or heavy lifting
These medications, such as conivaptan and tolvaptan, are used to block the action of antidiuretic hormone in SIADH patients.
What are vasopressin receptor antagonists.
*so it blocks the receptor so the kidneys will not reabsorb water.
Diuretic such as Furosemide can work as well.*
What is a severe complication that can arise from untreated Diabetes Insipidus
What is severe dehydration leading to hypovolemic shock.
*early signs- restless, decreased BP, increased HR*
*later- increased depth of respirations*
What is an important piece of advice you would give to a patient with a spinal cord injury to prevent Autonomic Dysreflexia?
What is to regularly empty the bladder and bowel, and to check for any skin irritations or pressure sores.
Which medication is commonly used to reduce intracranial pressure by drawing fluid out of the brain?
What is mannitol
*osmotic diuretic*