1. Nursing Management: Acute Intracranial Problems
Chapter 57 Overview
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2. Intracranial Pressure (ICP)
Fig Components of the brain.
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3. 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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4. Intracranial Pressure (ICP)
Table Calculation of Cerebral Perfusion Pressure
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5. Intracranial Pressure (ICP)
Cerebral Blood Flow, continued
Pressure changes
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6. Intracranial Pressure (ICP)
Fig Intracranial pressure-volume curve. (See text for descriptions of 1, 2, 3, and 4.)
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7. Intracranial Pressure (ICP)
Cerebral Blood Flow, continued
Factors affecting cerebral blood flow
Mechanisms of Increased ICP
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8. Intracranial Pressure (ICP)
Fig Progression of increased intracranial pressure (ICP).
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9. Intracranial Pressure (ICP)
Fig Herniation. A, Normal relationship of intracranial structures. B, Shift of intracranial structures.
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10. Intracranial Pressure (ICP)
Cerebral Edema
Vasogenic cerebral edema
Cytotoxic cerebral edema
Interstitial cerebral edema
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11. 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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12. Increased Intracranial Pressure (ICP)
Fig Decorticate and decerebrate posturing. A, Decorticate response. Flexion of arms, wrists, and
fingers 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.
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13. Increased Intracranial Pressure (ICP)
Clinical Manifestations, continued
Headache
Vomiting
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14. 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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15. Increased Intracranial Pressure (ICP)
Fig Coronal section of brain showing potential sites for placement of ICP monitoring devices.
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16. Increased Intracranial Pressure (ICP)
Fig Intracranial pressure monitoring can be used to continuously measure ICP. The ICP tracing
shows 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.
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17. Increased Intracranial Pressure (ICP)
Fig 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.
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18. Increased Intracranial Pressure (ICP)
Fig A, Leveling a ventriculostomy. B, CSF is drained into a drainage system.
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19. Increased Intracranial Pressure (ICP)
Table Normal ICP Waveforms*.
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20. Increased Intracranial Pressure (ICP)
Monitoring of ICP and Cerebral Oxygenation, continued
CSF drainage
Cerebral oxygenation monitoring
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21. Increased Intracranial Pressure (ICP)
Fig 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).
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22. Increased Intracranial Pressure (ICP)
Collaborative Care
Drug therapy
Nutritional therapy
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23. Nursing Management: Increased Intracranial Pressure (ICP)
Nursing Assessment
Glasgow coma scale
Neurologic assessment
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24. Nursing Management: Increased Intracranial Pressure (ICP)
Fig Pupillary check for size and response.
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25. Nursing Management: Increased Intracranial Pressure (ICP)
Fig Common abnormal respiratory patterns associated with coma.
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26. Nursing Management: Increased Intracranial Pressure (ICP)
Nursing Diagnoses
Planning
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27. 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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28. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Head Injury
Types of Head Injuries
Scalp lacerations
Skull fractures
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29. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Head Injury
Fig A, Raccoon eyes and rhinorrhea. B, Battle’s sign (postauricular
ecchymosis) with otorrhea. C, Battle’s sign. D, Halo or ring sign (see text).
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30. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Head Injury
Types of Head Injuries, continued
Head trauma
Diffuse injury
Diffuse axonal injury
Focal injury
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31. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Head Injury
Fig Coup-contrecoup injury. After the head strikes the wall, a coup injury occurs
as 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.
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32. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Head Injury
Complications
Epidural hematoma
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33. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Head Injury
Fig Epidural hematoma covering a portion of the dura. Multiple small contusions
are seen in the temporal lobe.
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34. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Head Injury
Complications, continued
Subdural hematoma
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35. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Head Injury
Fig Locations of epidural, subdural, and subarachnoid hematomas.
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36. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Head Injury
Complications, continued
Intracerebral hematoma
Diagnostic Studies and Collaborative Care
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37. Nursing Management: Head Injury
Nursing Assessment
Nursing Diagnoses
Planning
Nursing Implementation
Health promotion
Acute intervention
Ambulatory and home care
Evaluation
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38. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Brain Tumors
Types
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39. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Brain Tumors
Fig A, Glioblastoma. A large glioblastoma (G) arises from one cerebral hemisphere and
has 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.
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40. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Brain Tumors
Clinical Manifestations and Complications
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41. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Brain Tumors
Fig Each area of the brain controls a particular activity.
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42. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Brain Tumors
Diagnostic Studies
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43. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Brain Tumors
Collaborative Care
Surgical therapy
Ventricular shunts
Radiation therapy and stereotactic radiosurgery
Chemotherapy
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44. Nursing Management: Brain Tumors
Nursing Assessment
Nursing Diagnoses
Planning
Nursing Implementation
Evaluation
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45. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Cranial Surgery
Types
Sterotactic surgery
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46. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Cranial Surgery
Fig Stereotactic frame.
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47. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Cranial Surgery
Types, continued
Craniotomy
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48. Nursing Management: Cranial Surgery
Nursing Assessment
Nursing Diagnoses
Planning
Nursing Implementation
Acute intervention
Ambulatory and home care
Evaluation
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49. Inflammatory Conditions of the Brain
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50. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Brain Abscess
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51. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Bacterial Meningitis
Etiology and Pathophysiology
Clinical Manifestations
Complications
Diagnostic Studies
Collaborative Care
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52. Nursing Management: Bacterial Meningitis
Nursing Assessment
Nursing Diagnoses
Planning
Nursing Implementation
Health promotion
Acute intervention
Ambulatory and home care
Evaluation
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53. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Viral Meningitis
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54. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Encephalitis
Clinical Manifestations and Diagnostic Studies
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55. Nursing and Collaborative Management: Encephalitis
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56. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Rabies
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