W10D2 Student

Concept: Intracranial Regulation

• Focus on understanding Intracranial Regulation in the context of nursing (NUR160).

• Key focal point for the week's study session.

Exemplars of Intracranial Regulation

• Increased Cranial Pressure (ICP)

• Traumatic Brain Injury (TBI)

Optimal ICR vs. Impaired ICR

• Optimal ICR:

  • Normal function of intracranial contents.

• Impaired ICR:

  • Levels of impairment can vary:

    • Severe

    • Moderate

    • Mild

Increased Intracranial Pressure (ICP)

• Etiology:

  • Various causes leading to ICP such as blood clots, tumors, etc.

Pathophysiology

• Pathways leading to increased ICP that affect brain function.

Clinical Manifestations of Increased ICP

• Changes in Level of Consciousness (LOC):

  • Deterioration in alertness and responsiveness.

• Ocular Symptoms:

  • Papilledema: swelling of the optic nerve.

  • Pupillary Changes: alterations in pupil responses.

  • Impaired Eye Movement: difficulty moving eyes properly.

• Posturing Types:

  • Decerebrate Posturing: extension of limbs.

  • Decorticate Posturing: flexion of limbs.

  • Flaccid Posturing: lack of muscle tone.

• Motor Function Changes:

  • Decreased abilities in movement and motor skills.

• Headache: common symptom of ICP.

• Seizures: potential due to increased ICP.

• Impaired Sensory & Motor Function: loss of sensitivity or movement control.

• Vital Signs Changes:

  • Cushing’s Triad:

    • Increased Systolic Blood Pressure

    • Changes in Pulse

    • Altered Respiratory Patterns

• Other Symptoms:

  • Vomiting, speech alterations, and in infants: bulging fontanels and cranial suture separation.

Glasgow Coma Scale (GCS)

• Eye Opening Responses:

  • 4: Spontaneously;

  • 2: To Speech;

  • 1: To Pain;

• Verbal Responses:

  • 5: Oriented;

  • 4: Confused;

  • 3: Inappropriate Words;

  • 2: Incomprehensible Sounds;

  • 1: No response.

• Motor Responses:

  • 6: Obeys Commands;

  • 5: Moves to Localized Pain;

  • 4: Flexion Withdrawal from Pain;

  • 3: Abnormal Flexion;

  • 2: Abnormal Extension;

  • 1: No response.

• Total Score Outcomes:

  • 15 = Best response;

  • 8 or less = Comatose;

  • 3 = Totally unresponsive.

Assessment of ICP

• Understanding differences in normal retina vs. papilledema.

• Posturing types: Decerebrate and Decorticate explained in detail.

Clinical Signs of TBI

• Raccoon Eyes: periorbital ecchymosis indicating potential head trauma.

• Battle's Sign: perisuricular ecchymosis indicating skull base fracture.

Diagnostic Tests for ICP

• Range of tests to assess for increased ICP and its underlying causes.

Medical Management of ICP

• Administering treatments such as Mannitol (IV) to manage ICP.

• Monitoring methods including intraparenchymal fiberoptic catheters and ventriculostomy for assessing ICP levels.

Nursing Interventions for ICP

• Positioning:

  • Utilize Semi-Fowler's position to optimize ICP management.

Traumatic Brain Injury (TBI)

• Types of Injury:

  • Penetrating Injury: punctures through skull.

  • Closed-Head Injury: blunt force impacting the head.

  • Possible outcomes include temporary or permanent brain dysfunction.

Classification of TBI

• Mild: GCS 13-15, LOC <30 mins, PTA <1 day.

• Moderate: GCS 9-12, LOC 30 mins - 24 hrs, PTA 1-7 days.

• Severe: GCS 3-8, LOC >24 hours, PTA >7 days.

Nursing Interventions for TBI

• Focus on monitoring and supportive care to protect brain function and assess recovery.