Intracranial Regulation

CSF is clear and colorless, with a similar composition to other ___. It has a specific gravity of 1.00_ and minimal ____ and no ____

ecf. 7, wbc, rbc

CSF is produced in choroid plexus of ____ and circulates around brain and spinal cord surface. It is drained by the ___ ventricle

ventricles, fourth

obstructive hydrocephalus is a blockage of CSF flow in the ____ system

ventricular

CSF produced at ____ml/day rate, ventricle and subarachnoid space has about _____ fluid

500, 125-150

brain doesnt store ___ so it requires a constant supply of ____

nutrients, oxygen

Brain receives around ___% of cardiac output, which is ___mL per minute of blood flow

15, 750

arterial and venous vessels are ___ parallel in the brain. The blood vessels have ___ layers instead of 3, which make them more prone to rupture

not, 2

In the brain veins dont follow ____ ___ and also don’t have ____

arterial circulation, valves

BBB is formed by ____ cells of the brains capillaries that form ___ __

endothelial, tight junctions

disorders affecting LOC

IICP patho

brain swelling, increased icp, hypoxia, further secondary injury, more swelling, more icp

IICP causes

HTN, strokes

IICP infant manifestations

bulging fontanelles, separated sutures, downward deviation of eyes, cushings triad, sensitive to stimuli, fixed and dilated pupils

cushings triad

increased systolic and pulse pressure, bradycardia, decrease respirations

IICP adult clinical manifestations

ams, incontinent, change in pupil size and light reaction, cushings, unilateral weakness, posturing, meningeal irritation

decorticate is arms ____ and indicates issue with ____ ____

in, cerebral cortex

decerebrate is arms ___ and indicates issue with ____. its the worst

out, midbrain

meningeal irritation clinicals

kernigs, brudzinskis

kernigs is pain and jerking when ____ raised. Brudzinskis is ____ rigidity so entire upper region moves with it

legs.nuchal

GCS grid

early IICP ss

Late ss of IICP

IICP Dx

ABGs, ICP monitoring, lumbar puncture

Increased ___ and ___ will vaso ____ and increase ___ bc more acidity

co2, h, dilate, icp

lumbar puncture isnt common because it can ____ the brain

herniate

IICP complications

herniation, DI, SIADH, hyponatremia

IICP medical tx

diuretics, hypertonic saline, corticosteroids for cerebral edema , antiseizure, NM blocking agents, Ca blockers, vasopressors, mannitol

mannitol role to reduce ICP

pulls water out of brain tissue and diuresis

IICP interventions table

IN IICP, BP, pulse, LOC, pupils, and motor function are checked

hourly

Aneurysm precautions

bed rest, HOB up, constipation, DVT

Vasospasm ss

headache, decreased response, aphasia or partial paralysis

vasospasm tx

ca blocker

hydrocephalus is blood in subarachnoid space. ss is x3. Tx with a _____ shunt

drowsiness, behavior change, ataxic gait. Ventriculoperitoneal

IICP positioning

HOB up, neutral head and neck, no flexion, log roll

IICP oxygenation nursing cares

suction 15s2m, auscultate q8h, TBI mgmt

PaCO2 should be under ___mmHg after hyperventilation

30

IICP GI nursing care

stool softeners, bowel protocol, no coughing or enemas/cathartics

IICP temperature nursing cares

acetaminophen, cooling blankets. Shivering means increase metabolic rate and ICP

rotation/flexion of neck or hip causes intraabdominal and intrathoracic _____ ____ which means ICP increase

pressure increase

Before suctioning IICP should _____ with 100 o2 before and limit to 15 secs

hyperventilate

neutral/midline position of head promotes

venous drainage

IICP fluid balance nursing cares

diuretics, corticosteroids for edema, hypertonics, slow IVs, oral hygiene

hyperhypoiso

if UO is GREATER than 200/mL for 2+ hrs this indicates

diabetes insipidus

TIA is early warning signs of a ____ stroke, lasts from a few mins up to 24 hrs

ischemic

TIA Tx

carotid endardectomy, stenosis

TIA complications

stroke, CN injury, infection/hematoma, carotid artery disruption, hypotension to ischemia

Stroke dx

noncontrast CT, ECG afib, ultrasound

Stroke prevention

antithrombotics, anticoagulation, BP control, statins

Ischemic vs hemorrhagic clinicals

Right vs left side hemispheric stroke

thrombolytic therapy reqs

door to needle time needs to be under ____ and should start tpa within ____ hrs of onset

one hour, 4-6

tpa moa

convert plasminogen to plasmin to break down fibrin

tpa guidlines of ____mg/kg with a max dose of ___. The first 10% is given ____ over one minute, the rest is given over ___ hour

0.9, 90. IVB, 1

Contraindications for tPA

4.5, INR under 1.7, warfarin, intracranial issue hx

in Afib INR target of ___, BP should be under ____mmhg

2-3, 185/110

ischemic stroke nursing tx

HOB up, bedrest, permissive HTN, no oversedation or rapid diuresis, alignment, prone position to promote hyperextension, ROM , fiber and 2-3L water, dysphagia help, regular toilet

ischemic stroke complications

swallowing, IICP, meningeal irritation, UTI, arrhythmias, hyperglycemia

most common hemorrhagic stroke is x2

intracerebral and subarachnoid

Causes of hemorrhagic strokes

cerebral amyloid angiopathy, aneurysms, avms

cerebral amyloid angiopathy def

damage from deposit of beta amyloid proteins in vessels

aneurysms def

dilation of cerebral artery walls

avms def

tangle of vessels that lack a cap bed with leaves it prone to rupture

most common cause of stroke for young people is dt

avms

hemorrhagic stroke from IICP and meningeal irritation signs

ha, photophobia, nuchal rigidity

hemorrhagic stroke clinicals

projectile vomit, severe headache

catecholamine surger from hemorrhagic stroke can lead to x2 complications

htn and arrhythmias

it avm/aneurysm that leaks blood and has a clot that seals the rupture site there is either no ss or severe bleeding and a fast

death

intracerebral hemorrhage is bleeding in the

brain tissue

subdural hematoma is when blood collects between . it is a _ problem and the worst one

dura and brain, venous

epidural hematoma is blood between _____ and it is an issue of the ____

skull and dura, arterial

hemorrhagic stroke complications

vasospasm, seizures, hydrocephalus, rebleeding, hypona, pneumonia, cerebral hypoxia

vasospasm is usually ____ after hemorrhage and to tx you ___ aneurysm or use meds like ____ blockers

7-9 days, clip, ca

hemorrhagic strok eroutine meds

htn, analgesics, sedation, seizures, nv, gastric protection, steroids, antispasm

sbp goal is

140