Worksheets211 ICP
Total questions: 24
Worksheet time: 17mins
Which of the following is a normal ICP for an adult?
1.5 - 6 mmHg
3-7 mmHg
5-15 mmHg
50-60 mmHg
Which pts have their auto-regulation for cerebral blood flow impaired? (Select all that apply)
Pt who consistently has BP of 155/90
Pt who consistently has BP of 178/70
Pt who consistently has BP of 150/55
Pt who consistently has BP of 159/61
Pt who consistently has BP of 100/62
Other than BP, what factors can prevent autoregulation from doing its job? (Select all that apply)
Decreased ICP
Cerebral ischemia
Hypocapnia
Hyperoxia
Alkalosis
If pt has systolic of 139/85 and ICP is 15, is the cerebral perfusion pressure (CPP) adequate enough to perfuse brain?
True or False: MAP of less than 60 is adequate perfusion for brain & body
True
False
Which are the two primary causes of alterations to intracranial regulation?
Head trauma & brain tumors
Hemorrhage & stroke
Hydrocephalus & encephalitis
Head trauma & stroke
Hemorrhage & brain tumors
True or False: Cerebral edema is associated with increase in brain tissue volume?
True
False
How does Increased ICP affect cerebral perfusion pressure (CPP)?
Increases CPP
Decreases CPP
Which nursing statement regarding factors affecting ICP shows need for further teaching?
Arterial & venous pressure affect blood flow to brain, affecting ICP
Abdominal workouts should be done frequently to reduce ICP
Poor posture can increase ICP
Hot vasodilates, increasing blood flow to brain
Cold vasoconstricts preventing O2 delivery, causing swelling
Which of the following clinical manifestations of ICP are early signs? (Select all that apply)
Change in LOC
Projectile vomiting
Sluggish pupils
Fixed pupils
Headache & nausea
Which of the following are later clinical signs of ICP (select all that apply)
Seizures
Loss of cough, gag, & swallowing reflex
Papilledema
Decorticate posturing
Decerebrate posturing
What are indicators of Cushing's Triad? (select all that appy)
BP of 120/80
BP of 180/60
HR of 120 with bounding pulse
HR of 55 with bounding pulse
Irregular, slow respirations
What are clinical signs of ICP for infants? (Select all that appy)
Indented fontanel
Increase in head circumference
Pt does not cry
Irritable
Which decline in motor function indicates serious damage?
Stroke like symptoms
Decorticate posturing
Decerebrate posturing
What are assessments that should be done with pts with ICP? (select all that apply)
Assess LOC once every shift
Hemodynamic monitoring
Glasgow Coma Scale
Babinski sign
Oculocephalic reflex
What interventions are done for pts with IICP? (Select all that apply)
Maintain airway patency to promote oxygenation
Increased stimuli to distract from pain
Monitor Is & Os and electrolytes
High fowler's position to promote jugular vein drainage
Administer stool softeners
Which statement indicates nurse is in need of further teaching in regards to interventions for pts with IICP?
Patient head should be in midline position to allow blood to flow easily
It's important for pt to have normal body temperature
Pt should be ambulated frequently to promote perfusion
Pt should be placed on seizure precautions
Pt should avoid coughing & sneezing
Which medication works within 15-20 minutes and pulls fluid out of the brain?
Mannitol (Osmitrol)
Furosemide (Lasix)
Dexamethasone (Decadron)
Phenytoin (Dilantin)
Vasoactive Drugs
True or false: Dilantin is a short term use drug due to Dilantin toxicity
True
False
Vasoactive drugs are used to manage BP. What type of drugs would be used if MAP is too low?
Vasoconstrictive drugs
Beta blockers
Which diagnostic tests can assess blood vessels in the brain?
CT Scan
Electroencephalogram
Angiography
Electrolyte labs
CSF analysis
What are the accurate statements of ventriculostomy? (select all that apply)
It can measure ICP
It can drain fluid
It enters the hypothalamus of the brain
Monitor for HA, nuchal rigidity, sensitivity to light
What are the functions of the subarachnoid bolt? (Select all that apply)
Monitor ICP
Drain fluid in brain
Monitor brain temperature
Measure oxygenation
Which surgical treatment involves excision and removal of portion of skull?
Craniotomy
Burr Hole
Craniectomy
