nursing management: acute intracranial problems chapter 57 overview copyright © 2011, 2007 by...

Nursing Management:

Acute Intracranial Problems

Chapter 57 Overview

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Intracranial Pressure (ICP)

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.2

Fig. 57-1. Components of the brain.


Regulation and Maintenance of ICP Normal ICP Normal compensatory adaptations

Cerebral Blood Flow Autoregulation of cerebral blood flow




Table 57-1. Calculation of Cerebral Perfusion Pressure


Cerebral Blood Flow, continued Pressure changes




Fig. 57-2. Intracranial pressure-volume curve. (See text for descriptions of 1, 2, 3, and 4.)


Cerebral Blood Flow, continued Factors affecting cerebral blood flow

Mechanisms of Increased ICP




Fig. 57-3. Progression of increased intracranial pressure (ICP).



Fig. 57-4. Herniation. A, Normal relationship of intracranial structures. B, Shift of intracranial structures.


Cerebral Edema Vasogenic cerebral edema Cytotoxic cerebral edema Interstitial cerebral edema


Increased Intracranial Pressure (ICP)

Clinical Manifestations Change in level of consciousness

Changes in vital signs Ocular signs Decrease in motor function




Fig. 57-5. Decorticate and decerebrate posturing. A, Decorticate response. Flexion of arms, wrists, andfingers with adduction in upper extremities. Extension, internal rotation, and plantar flexion in lower extremities. B, Decerebrate response. All four extremities in rigid extension, with hyperpronation of forearms and plantar flexion of feet. C, Decorticate response on right side of body and decerebrate response on left side of body. D, Opisthotonic posturing.


Clinical Manifestations, continued Headache Vomiting



Complications Diagnostic Studies Monitoring of ICP and

Cerebral Oxygenation Indications for ICP monitoring Methods of measuring ICP




Fig. 57-6. Coronal section of brain showing potential sites for placement of ICP monitoring devices.



Fig. 57-7. Intracranial pressure monitoring can be used to continuously measure ICP. The ICP tracingshows normal, elevated, and plateau waves. At high ICP the P2 peak is higher than the P1 peak, and the peaks become less distinct and plateau.



Fig. 57-8. Ventriculostomy in place. CSF can be drained via a ventriculostomy when ICP exceeds the upper pressure parameter set by the physician. Intermittent drainage involves opening the three-way stopcock to allow CSF to flow into the drainage bag for brief periods (30 to 120 seconds) until the pressure is below the upper pressure parameters. ICP, Intracranial pressure.



Fig. 57-9. A, Leveling a ventriculostomy. B, CSF is drained into a drainage system.



Table 57-4. Normal ICP Waveforms*.


Monitoring of ICP and Cerebral Oxygenation, continued CSF drainage Cerebral oxygenation monitoring




Fig. 57-10. The LICOX brain tissue oxygen system involves a catheter inserted through an intracranial bolt (A). The system measures oxygen in the brain (PbtO2), brain tissue temperature, and intracranial pressure (ICP) (B).


Collaborative Care Drug therapy Nutritional therapy


Nursing Management: Increased Intracranial

Pressure (ICP) Nursing Assessment

Glasgow coma scale Neurologic assessment



Pressure (ICP)


Fig. 57-11. Pupillary check for size and response.


Pressure (ICP)


Fig. 57-12. Common abnormal respiratory patterns associated with coma.


Pressure (ICP) Nursing Diagnoses Planning



Pressure (ICP) Nursing Implementation

Acute intervention Respiratory function Fluid and electrolyte balance Monitoring ICP Body position Protection from injury Psychologic considerations

Evaluation


Head Injury

Types of Head Injuries Scalp lacerations Skull fractures


Head Injury


Fig. 57-13. A, Raccoon eyes and rhinorrhea. B, Battle’s sign (postauricular ecchymosis) with otorrhea. C, Battle’s sign. D, Halo or ring sign (see text).

Head Injury

Types of Head Injuries, continued Head trauma

Diffuse injury Diffuse axonal injury

Focal injury


Head Injury


Fig. 57-14. Coup-contrecoup injury. After the head strikes the wall, a coup injury occursas the brain strikes the skull (primary impact). The contrecoup injury (the secondary impact)occurs when the brain strikes the skull surface opposite of the site from the original impact.

Head Injury

Complications Epidural hematoma


Head Injury


Fig. 57-16. Epidural hematoma covering a portion of the dura. Multiple small contusionsare seen in the temporal lobe.

Head Injury

Complications, continued Subdural hematoma


Head Injury


Fig. 57-15. Locations of epidural, subdural, and subarachnoid hematomas.

Head Injury

Complications, continued Intracerebral hematoma

Diagnostic Studies and Collaborative Care


Nursing Management: Head Injury

Nursing Assessment Nursing Diagnoses Planning Nursing Implementation

Health promotion Acute intervention Ambulatory and home care

Evaluation


Brain Tumors

Types


Brain Tumors


Fig. 57-17. A, Glioblastoma. A large glioblastoma (G) arises from one cerebral hemisphere andhas grown to fill the ventricular system. B, Meningioma. These two different sections from different levels in the same brain show a meningioma (M) compressing the frontal lobe and distorting underlying brain.

Brain Tumors

Clinical Manifestations and Complications


Brain Tumors


Fig. 57-18. Each area of the brain controls a particular activity.

Brain Tumors

Diagnostic Studies


Brain Tumors

Collaborative Care Surgical therapy Ventricular shunts Radiation therapy and stereotactic radiosurgery

Chemotherapy


Nursing Management: Brain Tumors

Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation


Cranial Surgery

Types Sterotactic surgery


Cranial Surgery


Fig. 57-19. Stereotactic frame.

Cranial Surgery

Types, continued Craniotomy


Nursing Management: Cranial Surgery


Acute intervention Ambulatory and home care

Evaluation


Inflammatory Conditions of the Brain


Brain Abscess


Bacterial Meningitis

Etiology and Pathophysiology

Clinical Manifestations Complications Diagnostic Studies Collaborative Care


Nursing Management: Bacterial Meningitis


Health promotion Acute intervention Ambulatory and home care

Evaluation


Viral Meningitis


Encephalitis

Clinical Manifestations and Diagnostic Studies


Nursing and Collaborative Management: Encephalitis


Rabies


nursing management: acute intracranial problems chapter 57 overview copyright © 2011, 2007 by...

Documents

affiliate of elsevier

overview copyright

motor function copyright

decerebrate response

decerebrate posturing

continued factors

plantar flexion of feet

flexion of arms