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NUR 405 ( LATEST 2024 / 2025 ) UNIT 2 | QUESTIONS & ANSWERS (SOLVED)
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NUR 405 ( LATEST 2024 / 2025 ) UNIT 2 | QUESTIONS & ANSWERS (SOLVED)
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NUR 405 Unit 21. Causes of increased ICP
Answer
temperature, arterial & Venous pressure, position, aneurysms, hydrocephalus, head trauma,
meningitis, tumors
2. what is the earliest sign of increased ICP
Answer
Change in LOC, decreased mental status
3. what is cerebral perfusion pressure (CPP)
Answer
pressure needed to ensure blood flow to the brain.
the difference between ICP and MAP
4. Early signs of increased ICP
Answer
Altered LOC, irritability, restlessness, decreased mental status, sleepiness, flat affect,
drowsiness
5. what is the calculation for CPP
Answer
,MAP - ICP (Normal 70/80; less than 60 = tissue death)
6. what is the calculation for MAP
Answer
SBP+2(DBP)/3
7. Moderate signs of increased ICP
Answer
headache, vomiting,
8. what are late signs of increased ICP
Answer
Cushing's triad nuchal rigidity
fixed & dilated pupils babinski reflex seizures & coma
Decorticate and decerebrate posturing
9. Signs of Cushing's triad
Answer
Systolic hypertension bradycardia
irregular respirations
10. what medication is given to reduce cerebral edema
Answer
, mannitol. - osmotic diuretic
11. Key points for Mannitol
Answer
- IV admin
-causes peripheral edema
-increased UO and can affect electrolytes
12. Nursing interventions for increased ICP
Answer
-Hourly VS and neuro checks
-HOB @ 30 degrees
-Do not cluster care
-Decrease stimuli
-Temperature control
-Hyperoxygenate
-Don't suction often
-No valsalva
13. Eye Opening Response scoring on GCS
Answer
4 - spontaneously 3- to speech
2 - to pain
1 - no response
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