Neurology Critical Care

1. Neurology Critical Care NUR 351/352 Diane E. White RN CCRN PhD

2. 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

3. Terminology • PaO2 – cerebral arteries less sensitive to changes • Cerebral Edema - water content of brain tissue • Herniation – mass effect

4. 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

5. 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

6. Parts of the ICP Waveform • A waves – 50-100mm • B waves – less than 50mm • C waves – 16-20mm

7. 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

8. Nursing Interventions • HOB 15-30 degrees • Strict intake and output • Fluid restriction • Neuro checks • Vital Signs/Hemodynamic monitoring • Oxygenation • stimulus • Nutrition • Infection

9. Medical Interventions • Hyperventilation • Diuretic Therapy • Corticosteroids • Oxygen • Inotropes • Seizure prevention