Section 3: IICP Clinical Manifestations - Stroke & Increased Intracranial Pressure

NUR 433: Adult Chronic Health; MCUSON; Mrs. Cooper

the earliest sign of rising ICP is a change in _____

LOC (level of consciousness)

*i.e. restlessness, confusion, or new drowsiness

Cushing’s triad and a fixed, dilated pupil are _____ signs of rising ICP and by then damage may be irreversible

late

_____ _____ means the brainstem is being compressed and herniation is imminent

Cushing’s triad

*priority: notify the provider immediately

Cushing’s triad: blood pressure - systolic hypertension with a _____ pulse pressure (increased SBP, decreased or stable DBP)

widening

Cushing’s triad: heart rate - _____, full and bounding

bradycardia

Cushing’s triad: respirations - _____, slowed, Cheyne-Stokes, or apneic periods

irregular

***Practice it: a patient’s BP goes from 150/86 to 166/74, HR from 84 to 54, and respirations become irregular at 10–16/min. Pulse pressure widened from 64 to 92, the heart slowed, and breathing became irregular. That is Cushing’s triad.

_____ _____ _____(oculomotor) compression causes a dilated, sluggish or nonreactive pupil on the same side as the lesion, plus ptosis.

cranial nerve III

A fixed, unilateral, dilated (“blown”) pupil is a neurologic emergency that signals _____

herniation

Hemiparesis or hemiplegia appears on the _____ side of the lesion

opposite

_____ changes occur when pressure affects the hypothalamus

temperature

_____ (swollen optic disc) is a nonspecific sign of persistently high ICP

papilledema

Uncontrolled ICP forces brain tissue across the rigid _____ folds (the falx cerebri between the hemispheres and the tentorium over the cerebellum).

dural

what type of herniation syndrome shifts sideways under the falx cerebri and often has no specific early sign

cingulate

what type of herniation syndrome is when the temporal lobe shifts sideways and down across the tentorium and results in a unilateral dilated pupil (CN III)

uncal

what type of herniation syndrome is when the brain pushed straight down toward the foramen magnum and results in sluggish but equal pupils early —→ Cushing’s triad and respiratory arrest

central (tentorial)

preventing herniation: drain CSF through a _____ (external ventricular drain)

ventriculostomy

preventing herniation: Give _____ therapy (mannitol or hypertonic saline) to pull fluid from brain tissue

osmotic

preventing herniation: _____ (dexamethasone) only for vasogenic edema around tumors or abscesses, and in bacterial meningitis. They are not used for traumatic brain injury.

corticosteroids

preventing herniation: _____: hematoma evacuation or decompressive craniectomy to give the brain room to swell

surgery