Neurology Critical Care

NUR 351/352Diane 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 – 60-100mm 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 – 50-100mm 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 15-30 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