nursing management: acute intracranial problems chapter 57 overview copyright © 2011, 2007 by...
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Nursing Management:
Acute Intracranial Problems
Chapter 57 Overview
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Intracranial Pressure (ICP)
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Fig. 57-1. Components of the brain.
Intracranial Pressure (ICP)
Regulation and Maintenance of ICP Normal ICP Normal compensatory adaptations
Cerebral Blood Flow Autoregulation of cerebral blood flow
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Intracranial Pressure (ICP)
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Table 57-1. Calculation of Cerebral Perfusion Pressure
Intracranial Pressure (ICP)
Cerebral Blood Flow, continued Pressure changes
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Intracranial Pressure (ICP)
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Fig. 57-2. Intracranial pressure-volume curve. (See text for descriptions of 1, 2, 3, and 4.)
Intracranial Pressure (ICP)
Cerebral Blood Flow, continued Factors affecting cerebral blood flow
Mechanisms of Increased ICP
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Intracranial Pressure (ICP)
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Fig. 57-3. Progression of increased intracranial pressure (ICP).
Intracranial Pressure (ICP)
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Fig. 57-4. Herniation. A, Normal relationship of intracranial structures. B, Shift of intracranial structures.
Intracranial Pressure (ICP)
Cerebral Edema Vasogenic cerebral edema Cytotoxic cerebral edema Interstitial cerebral edema
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Increased Intracranial Pressure (ICP)
Clinical Manifestations Change in level of consciousness
Changes in vital signs Ocular signs Decrease in motor function
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Increased Intracranial Pressure (ICP)
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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.
Increased Intracranial Pressure (ICP)
Clinical Manifestations, continued Headache Vomiting
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Increased Intracranial Pressure (ICP)
Complications Diagnostic Studies Monitoring of ICP and
Cerebral Oxygenation Indications for ICP monitoring Methods of measuring ICP
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Increased Intracranial Pressure (ICP)
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Fig. 57-6. Coronal section of brain showing potential sites for placement of ICP monitoring devices.
Increased Intracranial Pressure (ICP)
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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.
Increased Intracranial Pressure (ICP)
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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.
Increased Intracranial Pressure (ICP)
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Fig. 57-9. A, Leveling a ventriculostomy. B, CSF is drained into a drainage system.
Increased Intracranial Pressure (ICP)
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Table 57-4. Normal ICP Waveforms*.
Increased Intracranial Pressure (ICP)
Monitoring of ICP and Cerebral Oxygenation, continued CSF drainage Cerebral oxygenation monitoring
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Increased Intracranial Pressure (ICP)
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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).
Increased Intracranial Pressure (ICP)
Collaborative Care Drug therapy Nutritional therapy
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Nursing Management: Increased Intracranial
Pressure (ICP) Nursing Assessment
Glasgow coma scale Neurologic assessment
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Nursing Management: Increased Intracranial
Pressure (ICP)
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Fig. 57-11. Pupillary check for size and response.
Nursing Management: Increased Intracranial
Pressure (ICP)
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Fig. 57-12. Common abnormal respiratory patterns associated with coma.
Nursing Management: Increased Intracranial
Pressure (ICP) Nursing Diagnoses Planning
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Nursing Management: Increased Intracranial
Pressure (ICP) Nursing Implementation
Acute intervention Respiratory function Fluid and electrolyte balance Monitoring ICP Body position Protection from injury Psychologic considerations
Evaluation
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Head Injury
Types of Head Injuries Scalp lacerations Skull fractures
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Head Injury
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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
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Head Injury
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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
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Head Injury
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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
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Head Injury
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Fig. 57-15. Locations of epidural, subdural, and subarachnoid hematomas.
Head Injury
Complications, continued Intracerebral hematoma
Diagnostic Studies and Collaborative Care
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Nursing Management: Head Injury
Nursing Assessment Nursing Diagnoses Planning Nursing Implementation
Health promotion Acute intervention Ambulatory and home care
Evaluation
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Brain Tumors
Types
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Brain Tumors
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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
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Brain Tumors
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Fig. 57-18. Each area of the brain controls a particular activity.
Brain Tumors
Diagnostic Studies
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Brain Tumors
Collaborative Care Surgical therapy Ventricular shunts Radiation therapy and stereotactic radiosurgery
Chemotherapy
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Nursing Management: Brain Tumors
Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Evaluation
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Cranial Surgery
Types Sterotactic surgery
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Cranial Surgery
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Fig. 57-19. Stereotactic frame.
Cranial Surgery
Types, continued Craniotomy
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Nursing Management: Cranial Surgery
Nursing Assessment Nursing Diagnoses Planning Nursing Implementation
Acute intervention Ambulatory and home care
Evaluation
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Inflammatory Conditions of the Brain
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Brain Abscess
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Bacterial Meningitis
Etiology and Pathophysiology
Clinical Manifestations Complications Diagnostic Studies Collaborative Care
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Nursing Management: Bacterial Meningitis
Nursing Assessment Nursing Diagnoses Planning Nursing Implementation
Health promotion Acute intervention Ambulatory and home care
Evaluation
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Viral Meningitis
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Encephalitis
Clinical Manifestations and Diagnostic Studies
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Nursing and Collaborative Management: Encephalitis
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Rabies
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