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ATI RN VCS Safety Dosage Calculation of Critical Care Medication 3.0 with verified solutions
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ATI RN VCS Safety Dosage Calculation of Critical Care Medication 3.0 with verified solutions
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Critical Care- Neuro EXAM fullyupdated 2024-2025 with
verified solutions
Normal ICP - answer 0-15mm/hg
Increased ICP - answer 20mm/hg or greater, persisting for 5 minutes or
longer
Monroe-Kellie Hypothesis - answer Calls for a balance between blood, csf,
and brain tissue; cranial cavity is a closed cavity (no place for expansion),
so this says if one of these three components increases, the others are
going to have to decrease to maintain cerebral perfusion
Risk Factors for Increased ICP - answer 1. Increased Brain Volume
2. Increased Cerebral Blood Flow
3. Increased Cerebrospinal Fluid
Increased Brain Volume typical causes - answer tumors, edema (swelling
from trauma)
Increased Cerebral Blood Flow typical causes - answer trauma (rupture of
vessel), stroke (ruptured aneurysm)
Increased Cerebrospinal Fluid typical causes - answer hydrocephalus
What are factors that can temporarily increase ICP - answer Anything that
increases intrathoracic pressure increases intracranial pressure; therefore
sneezing, valsalva maneuver (straining), suctioning, pain, physical
activity, excessive stimulation can all temporarily increase ICP
,What are nursing interventions to avoid things that temporarily increase
ICP - answer stool softeners, adequate rest, low lights, suction
intermittently
S/S of IICP - answer Earliest: subtle change in LOC / confusion
Others: HA, blurred vision, pupil changes, motor/sensory changes
Cushing's Triad: bradycardia, change in respiratory pattern, wide pulse
pressure (170/40) --> not good!
Glascow Coma Scale - answer Rates the eyes 1-4, motor 1-6, verbal 1-5
How to perform hourly "neuro checks" - answer Don't test pain response
unless decreasing LOC
Appropriate: sternal rub, squeeze shoulders, press on nail beds
What is a late sign of IICP - answer Posturing
Decorticate posturing - answer Flexion = 3 under motor response
Decerebrate posturing - answer Extension = 2 under motor response
What should a full neuro assessment include - answer s/s, glascow coma,
dtr, babinski reflex, posturing, hourly neuro checks
Indications for ICP Monitoring - answer 1. Glascow Coma Scale of 3-8
2. To treat IICP: use a system that treats both monitors and treats ICP
3. Patients with risk of IICP
,4. To assess response to therapy
Cerebral perfusion pressure - answer The pressure it takes to perfuse the
brain
Cerebral perfusion pressure formula and normal values - answer MAP-ICP;
60-100mm/hg
When does cerebral perfusion stop - answer When MAP (drops) and ICP
(rises), because it makes them begin to equalize
Nursing Interventions for patients at risk for CPP problems - answer
Patient with high ICP may be able to tolerate a blood pressure higher than
normal --> we may not be as aggressive with HTN treatment
ICP monitoring insertion procedure - answer Explain/consent
Sterile: in OR
Head shaved
Local anesthetic; sedatives if indicated
Scalp incised
Placed through a burr hole (hole is skull)
Device inserted
Connect equipment
Note waveform/pressures
Suture, dress
Most devices have direct contact with CSF, so sterile/aseptic technique is
critical!
Methods to Invasively Measure ICP - answer 1. Intraventricular
2. Subarachnoid Screw
3. Epidural
4. Fiberoptic Catheter'
, *All of these will be set up to a saline solution that is pressurized (same as
pulmonary artery catheter monitoring) and a transducer (gives us
waveforms/numbers)
Intraventricular insertion - answer Catheter is introduced via burr hole,
and placed into the ventricle of the brain
Advantages of intraventricular insertion - answer 1. May be placed with a
ventriculostomy, which allows us to drain CSF to decrease the ICP
2. We can monitor and treat IICP
Disadvantages of intraventricular insertion - answer 1. Possibility of
causing brain damage due to difficulty of placement
2. Risk of infection
Subarachnoid screw insertion - answer Screw is introduced via burr hole,
and the tip rests in the subarachnoid space
Advantages of subarachnoid screw - answer 1. Insertion is easier
2. Lower risk of infection
Disadvantages of subarachonid screw - answer 1. Able to become occluded
with tissue/clots
2. Not possible to drain CSF
Fiberoptic catheter insertion - answer Catheter with light that can be
placed anywhere (subdural, subarachnoid, or intraparenchymal), and the
monitor gives a second to second read-out of brain activity
Advantages of fiberoptic catheter - answer Accurate/reliable
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