Intracranial Regulation

An 86-year-old patient looks at you when you speak to her. When you ask her the date, she says "Purple". You note left-sided weakness when she grips your fingers. What is her GCS?

13 (Eye: 4, Verbal: 3, Motor: 6)

A trauma patient moans, bends her arms towards her chest, and points her toes when you attempt to start an IV. What is her GCS?

6. (Eye: 1, Verbal: 2, Motor: 3)

A nurse is assigned to care for an 8-year-old child with a diagnosis of a basilar skull fracture. The nurse reviews the physician's prescriptions and contacts the physician to question which prescription? a) suction as needed b) obtain daily weight c) provide clear liquid intake d) maintain a patent intravenous line

A. A basilar skull fracture is a type of head injury. Nasotracheal suctioning is contraindicated in a child w/ a basilar skull fracture. B/C of the nature of the injury, there is a high risk of secondary infection and the probability of the catheter entering the brain through the fracture. Fluid balance is monitored closely by daily weight, I&O measurement, & serum osmolality determination to detect early signs of water retention, excessive dehydration, and states of hypertonicity or hypotonicity. The child is maintained on NPO status or restricted to clear liquids until it is determined that vomiting will not occur. An IV line is maintained to administer fluids or meds if necessary.

A mother arrives at an emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected, and a nurse checks the child's airway status and assess the child for signs of increased intracranial pressure (ICP). Which of the following is a late sign of increased ICP in this child? a) nausea b) bradycardia c) bulging fontanel d) dilated scalp veins

B. Head injury is the pathological result of any mechanical force to the skull, scalp, meninges, or brain. A head injury can cause bleeding in the brain and result in increased intracranial pressure (ICP). Late signs of increased ICP include a significant decrease in LOC, bradycardia, decreased motor and sensory responses, alterations in pupil size and reactivity, posturing, Cheyne-Stokes respirations, and coma. A bulging fontanel and dilated scalp veins are EARLY signs of increased ICP and would be noted in an infant, NOT a 5-year old. Nausea is an early sign of increased ICP.

A nurse is caring for an infant with a diagnosis of hydrocephalus. Preoperatively, a priority nursing intervention is to: a) test the urine for protein b) reposition the infant frequently c) provide a stimulating environment d) assess blood pressure every 15 minutes

B. Hydrocephalus occurs as a result of imbalance of cerebrospinal fluid absorption or production that is caused by malformations, tumors, hemorrhage, infections, or trauma. It results in head enlargement and increased intracranial pressure. In infants w/ hydrocephalus, the head grows at an abnormal rate, and if infant is not repositioned frequently, pressure ulcers can occur on the back & side of the head. An egg crate mattress under the head is also a nursing intervention. Stimulus should be kept at a minimum b/c of the increase in ICP. It is not necessary to check the BP every 15mins.

When obtaining the signs of a client with multiple traumatic injuries, a nurse detects bradycardia, bradypnea, and systolic hypertension. The nurse must notify the physician immediately because these findings may reflect which complication? a) shock b) encephalitis c) increased intracranial pressure d) status epilepticus

C - ICP. When ICP increases, Cushing's triad may develop, which involves decreased heart & respiratory rates & increased systolic BP. Shock typically causes tachycardia, tachypnea, & hypotension. In encephalitis, the temp rises & the heart & respiratory rates may increase from the effects of fever on the metabolic rate. (If the client doesn't adequate hydration, hypotension may occur.) Status epilepticus causes unceasing seizures, not changes in vital signs.

A nurse is reviewing the record of a child with increased intracranial pressure and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which of the following if this type of posturing is present? a) flaccid paralysis of all extremities b) adduction of the arms at the shoulders c) rigid extension and pronation of the arms and legs d) abnormal flexion of the upper extremities and extension and adduction of the lower extremities

C. Decerebrate (extension) posturing is characterized by rigid extension and pronation of the arms and legs. A is incorrect. B and C describe decorticate (flexion) posturing. Focus on the data in the question. Recalling the clinical manifestations associated with decerebrate posturing will direct you to the correct option.

how do you figure out the CPP

CPP = MAP - ICP

A nurse is caring for a child recently diagnosed with cerebral palsy, and the parents of the child ask the nurse about the disorder. The nurse bases her response on the understanding that cerebral palsy is: a) An infectious disease of the central nervous system b) An inflammation of the brain as a result of a viral illness c) A congenital condition that results in moderately to severe retardation d) A chronic disability characterized by impaired muscle movement and posture

D. Cerebral palsy is a chronic disability characterized by impaired movement and posture resulting from an abnormality in the extrapyramidal or pyramidal motor system. Meningitis is an infection process of the CNS. Encephalitis is an inflammation of the brain that occurs as a result of a viral illness or CNS infection. Down syndrome is an example of a congenital condition that results in moderate to severe retardation. Use the process of elimination. Eliminate options 1&2 first, noting that they are comparable or alike. Next, note the relationship between the words "palsy" in the question and "impaired muscle movement" in D.

At what stage in the intracranial volume-pressure curve is the brain in total compensation?

Stage 1

If an increase in volume does not increase the intracranial pressure, what stage in the intracranial volume-pressure curve is the patient at?

Stage 1

At what stage in the intracranial volume-pressure curve is the patient at risk for increased intracranial pressure?

Stage 2

At what stage of the intracranial volume-pressure curve does any small addition of volume cause a great increase in intracranial pressure?

Stage 3

At what stage of the intracranial volume-pressure curve is there a loss of autoregulation?

Stage 3

At what stage of the intracranial volume-pressure curve will the patient start exhibiting manifestations of increased intracranial pressure?

Stage 3

At which stage of the intracranial volume-pressure curve do compensatory mechanisms fail?

Stage 3

noninvasive technique used to monitor changes in cerebrovascular resistance in ICUs

Transcranial Doppler

the pressure needed to ensure blood flow to the brain

cerebral perfusion pressure

the expandability of the brain

compliance

Equation for compliance

compliance = volume/pressure

What clinical manifestations can occur during stage 3 of the intracranial volume-pressure curve?

headache, loss of consciousness or pupil responsiveness