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NUR 376- EXAM 3 with complete verified solutions
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NUR 376- EXAM 3 with complete verified solutions
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NUR 376- EXAM 3 with completeverified solutions
ICP
intracranial pressure = balance of pressure of the brain tissue,
blood, and CSF.
(normal pressure is 5 to 15 mm Hg)
Changes to ICP
brain tissue, cerebral blood flow (hypertension), or CSF
Brainpower
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Monroe-Kellie hypothesis*
increase in one compartment of the brain is compensated by a
decrease in the other compartments of the brain
Increased ICP patho
initially compressing blood vessels in the brian = less blood = less
O2 = cerebral hypoxia
If ICP continues to increase and cause more pressure on the brain
stem, Cushing’s triad- hypertension with wide pulse pressure, low
HR (bradycardia), and low RR (bradypnea)
early clinical manifestations pt suspected increased ICP*
reduced LOC (irritability or restlessness), decreased mental status*-
earliest sign, sleepiness, flat affect & drowsiness
moderate signs pt suspected increased ICP
headache- constant (patho: stretching of meninges), sudden
vomiting “emisis) without nausea!- report (patho- pressure on
medulla)
late- clinical manifestations pt suspected increased ICP*
Brain stem affected: extra pressure on the brian, eventually
squashing the brian stem which controls breathing & heart = kills pt
,Eyes: pupils fixed & dilated (8 mm, normal 2-6mm) , sometimes
unequal- pressure on cranial nerve 3 (oculomotor nerve)
We want dolls eyes- meaning the eyes move in opposite direct of
head movement = brain stem is in tact!!
Papilledema- swelling around the optic disk caused by increased
pressure of CSF
lungs: irregular respirations, cheyne stroke respirations (apnea)
Neck: nuchal rigidity (stiff neck)- can not FLEX chin towards chest
crushing triad
Cushing’s triad
hypertension with wide pulse pressure, slowed heart rate
(bradycardia), and slowed respirations (bradypnea)
Intracranial hypertension*
increased ICP)- Mechanisms that increase the volume of one or more
of three compartments—circulation, brain tissue, and CSF—will
increase ICP
Mechanisms that decrease ICP*
decreasing volume of any one of the three compartments- brain
tissue, CSF, or circulation- will decrease the ICP
Causes:
-Externally draining CSF via a catheter placed in the ventricles will
lower ICP.
-Blood volume can also be reduced by lowering blood pressure
-Infusing a hypertonic solution such as IV mannitol can rapidly
decrease intracellular pressure and lower cerebral edema.
-A low carbon dioxide level will vasoconstrict cerebral arteries,
reducing the volume of blood delivered to the brain.
-Removing brain tissue, such as occurs in a lobectomy, will likewise
decrease volume and ICP.
decompressive craniectomy, in which a section of the skull is
removed, creating an opening in the closed space of the skull and
allowing expansion of the brain.
-This allows the ICP to increase without the danger of compressing
brain tissue
what is a stroke?
, inability of O2 rich blood to reach the brain due to blockage or
bleeding in a vessel
Types of stroke
ischemic, transient ischemic, and hemorrhagic
Ischemic Stroke- Risk factors:
Hypertension (over 140 systolic), smoking, hyperlipidemia (high
cholesterol- adds fatty build up under scarred vessels to form
plaque), and uncontrolled diabetes (thick syrupy blood- putting
loads of pressure on the vessels), sickle cell disease, age, race,
ethnicity
Ischemic Stroke- patho
NARROWING of blood vessels in the brain that leads to blood
clotting, blockage, & severely reduced blood flow to the brain
(ischemia)
Ischemic Stroke S/S
Hemiparesis- unilateral weakness, one-sided weakness- new,
sudden “arm drift”
FAST: Facial & smile droop, arm drift, speech impairment, time to
call 9-1-1 ( get CT scan immediately)
GOLDEN HOUR: only have 1 hour to get medical attention bc the
brain can't go long without bloodflow
Transient Ischemic Attack (TIA) patho
mini-stroke, partial occlusion of an artery
Resolves in 24-72 hours
Transient Ischemic Attack (TIA) risk factors
hypertension, smoking, diabetes —> can cause lacunar
infarcts, occluded tiny blood vessels in brain.
Probably has DVT
Transient Ischemic Attack (TIA) S/S
confusion, disorientation, inability to communicate, and memory
impairment
Hemorrhagic Stroke- risk factors
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