Acute Intracranial Probs
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Transcript Acute Intracranial Probs
Acute Intracranial
Problems
Megan McClintock, MS, RN
11/4/11
Head Injury
Head Injury
Skull Fractures
Basilar
Frontal
Temporal
Parietal
Posterior fossa
Head Trauma
Diffuse Injuries
Concussion
Diffuse axonal injury (DAI)
Focal Injuries
Lacerations
Contusions
Hematomas
Cranial nerve injuries
Complications
Epidural hematoma
Bleeding between the dura and the skull
Arterial or venous
Initial LOC, brief lucid interval, decrease in LOC
Headache, nausea, vomiting
Subdural hematoma
Bleeding between the dura mater and the arachnoid layer
Usually venous
Acute, subacute, or chronic
Symptoms similar to a stroke, TIA, or dementia
Intracerebral hematoma
Usually occurs in frontal or temporal lobes
Diagnostic Studies
CT
MRI (for smaller lesions)
Cervical spine xrays
Most important to diagnose timely and get them to
surgery (if needed) and keep ICP from increasing
Craniectomy
Craniotomy with surgical evacuation
Hemicraniectomy
Goals
Maintain cerebral blood flow
Remain normothermic
Control pain
Prevent infection
Attain maximum cognitive, motor, sensory function
Interventions
Prevention
Monitor for changes in neuro status
Encourage family members to stay
Lubricating eye gtts, tape eyes shut
Do not allow fever or shivering
Watch for otorrhea/rhinorhea
HOB up
Collection pad (no packed dressings)
No NG tubes
No sneezing or blowing nose
No nasotracheal suction
Brain Tumors
Can occur anywhere
Can be primary or secondary
Brain Tumors
Symptoms depend on location
Dx studies – CT, MRI, no LP, biopsy
Tx – surgical removal, VP shunt, radiation therapy,
chemotherapy
Cranial Surgery
Burr hole
Craniotomy
Craniectomy
Cranioplasty
Stereotactic
Shunt
Interventions
Hair is shaved in the OR
Usually need ICU after surgery
Prevention of increased ICP
Frequent neuro assessments for first 48 hrs
Closely monitor F&E status
Prevention of pain and nausea
HOB at 30 degrees (except for posterior fossa, burr hole)
Do not position patient on operative side with craniectomy
Brain Abscess
Accumulation of pus within the brain tissue
Sx – headache, fever, n/v, focal symptoms, s/s of ICP
Tx – antimicrobial therapy, may need surgical drainage or
removal (if encapsulated)
If untreated, mortality is almost 100%
Bacterial Meningitis
Usually Streptococcus pneumoniae, Neisseria
meningitidis, used to be Haemophilus influenzae
Less common in summer
MEDICAL EMERGENCY!!!!
Sx – fever, headache, n/v, nuchal rigidity, photophobia,
decreased LOC, ICP, skin rash
Cx – neuro deficits, chronic headache,
Waterhouse-Friderichsen syndrome
Treatment
Dx – blood culture, CT, LP (high protein, low glucose,
purulent)
Tx – immediate antibiotic therapy (after culture), may give
decadron
Interventions
Prevention with immunizations
Vigorous treatment of ear and resp infections
Seizure precautions
Codeine for pain
Dark room, cool cloth, quiet, decreased stimuli
Avoid restraints
Family at bedside
Control fever
Respiratory isolation!!!!
Viral Meningitis
Also called aseptic meningitis
Caused by a variety of viruses , sometimes through
personal contact or by insects, most people have the
viruses but don’t develop meningitis
Usually mild and self-limiting
Give antibiotics until you confirm that it is viral
Only treat symptoms
Encephalitis
Acute inflammation of the brain
Can be fatal
Usually caused by a virus
See as a complication of AIDS
Sx – fever, headache, n/v, then CNS abnormalities
Tx – may need ICU, antivirals,
1. Intracranial pressure monitoring is instituted for a patient
with a head injury. The patient’s arterial blood pressure is
92/50 mm Hg, and intracranial pressure is 18 mm Hg. Using
these values to calculate the patient’s cerebral perfusion
pressure (CPP), the nurse determines that
1. the CPP is adequate for normal cerebral blood flow.
2. to prevent cerebral hypoxemia, the patient’s blood pressure
should be increased.
3. the CPP is so low that ischemia and neuronal death are
imminent.
4. lowering the patient’s blood pressure will reduce the
intracranial pressure, increasing cerebral blood flow.
3. Management of the patient with bacterial meningitis includes
1. administering antibiotics immediately following collection of
specimens for culture.
2. waiting for results of a CSF culture to identify an organism before
initiating treatment.
3. providing symptomatic and supportive treatment because drug
therapy is not effective in treatment.
4. obtaining skull x-rays and CT scans to determine the extent of the
disease before treatment is started.