Neurology Critical Care NUR 351/352 Diane E. White RN CCRN PhD

Terminology  Intracranial Pressure – 0-15mm; as less compliance and cerebral blood flow occurs leading to hypoxia and cerebral edema  Cerebral Perfusion Pressure – mm estimate of level of cellular perfusion; calculation = MAP – ICP; as ICP CPP  PaCO2- most potent vasodilator which aid cerebral blood flow; fine balance b/t need for and too much CO2

Terminology  PaO2 – cerebral arteries less sensitive to changes  Cerebral Edema - water content of brain tissue  Herniation – mass effect

Nursing Care  Complete Neuro Assessment – frequent and ANY change report to MD. Glasgow Coma Scale (GCS) of 3-15 is normal  Vital Signs – late sign of changes

Monitoring Techniques  ICP- measure intraparenchymal, intraventricular, subarachnoid, and epidural  Advantages and Disadvantages of each  All types allow for waveform monitoring  Assisting neurosurgeon with insertion at bedside

Parts of the ICP Waveform  A waves – mm  B waves – less than 50mm  C waves – 16-20mm

Patient Outcomes  Maintain normal ICP  Maintain adequate Cerebral perfusion  Maintain fluid and electrolyte balance  Minimize hyper metabolic state  Minimal or no mobility hazards  No infections  Minimal if any impaired thought processes  No injuries  Optimal self-care  Effective family coping

Nursing Interventions  HOB degrees  Strict intake and output  Fluid restriction  Neuro checks  Vital Signs/Hemodynamic monitoring  Oxygenation  stimulus  Nutrition  Infection

Medical Interventions  Hyperventilation  Diuretic Therapy  Corticosteroids  Oxygen  Inotropes  Seizure prevention