Download Module 10: Altered Cerebral Function, Increased Intracranial Pressure

Learning Guide
Module 10: Altered Cerebral Function, IICP
Marnie Quick, RN, MSN, CNRN
Altered Cerebral Function
1.
What causes altered cerebral function?
2.
What anatomical areas are involved in ‘normal’ consciousness and state their
function.
3.
Describe how you would assess for altered cerebral function (LOC).
4.
Why is it better to write out in your notes the behavior you see, rather than
just a term to describe level of consciousness?
5.
Describe the changes in pupillary and eye movement (EOM’s)/Dolls’ eyes
responses seen in the individual with decreasing neurologic function. What
cranial nerves are involved? How do you test? What is expected response to
testing?
6.
As the individual has decreasing cerebral functioning, what motor changes
would you expect to observe?
7.
Differentiate the abnormal posturing of decorticate and decerebrate posturing
and flaccid. Is flaccid worse?
8.
Describe and when would you see Babinski and Brudzinski testing utilized in the
comatose individual?
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9.
Describe the following states:
a. Irreversible coma
b. Locked-in Syndrome
c. Brain death
10.
What diagnostic tests are performed for altered cerebral function and why?
What information can a physician obtain from an LP, lumbar puncture, and why
might an LP not be done?
11.
In the ER, why might 50% IV glucose be given first to an individual in altered
levels of consciousness? What other types of medications are used and why?
12.
Is it possible for a comatose patient to hear and understand what others are
saying?
Increased Intracranial Pressure
13.
Relate the Monro-Kellie hypothesis to intracranial pressure.
14.
What is intracranial pressure? What are normal values?
15.
What normal body activities increase ICP?
16.
Why is cerebral perfusion pressure (CPP) important? How is it calculated? When
does brain death occur?
17.
Your patient has a CPP of 50 mm Hg., what does this mean?
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18.
How is cerebral blood flow regulated?
19.
How does paCO2 influence cerebral blood flow and ICP?
20.
How does cerebral edema affect ICP and CPP?
21.
How does Mannitol work? How is it given/nursing responsibilities?
22.
Describe the different types of hydrocephalus.
23.
How does shunting of cerebral spinal fluid (CSF) aide in decreasing IICP? How
can it be done?
24.
Draw each of the brain herniation syndromes and S&S of each.
Cingulate
Central
Uncal
Infratentorial
Extracranial
25.
Describe other signs of IICP.
26.
Differentiate between intraventricular catheter, subarachnoid screw, and
epidural fiberoptic catheters to measure intracranial pressure.
27.
Which ICP device can be used to sample or remove CSF?
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28.
If you do not have an ICP monitor, what signs are you assessing for to indicate
increased intracranial pressure rising? What is most significant?
29.
Describe Cushing Reflex. When does it occurs?
30.
What is the best position of the bed and body for an individual with potential for
developing IICP?
31.
When should you do neuro checks on a patient with a potential for developing
IICP?
32.
Why might a physician utilize barbiturate coma or hypothermia in an individual
with IICP? What are the nursing responsibilities?
33.
Why might a physician remove part of the cranium (bone flap) in an individual
with IICP? What are the nursing responsibilities post op?
34.
With the nursing diagnosis of Ineffective tissue perfusion: cerebral, what
nursing measures can you do or avoid, that would help control intracranial
pressure in your patient? And why?
35.
If pulling against restraints increases ICP, what other methods can be utilized
to control the clients’ restlessness?
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