NeurosensoryAlteredCerebralFunctionandIncreased.pptVIP

Neurosensory:Altered Cerebral Function and Increased Intracranial pressure (IICP)  Marnie Quick, RN, MSN, CNRN Normal brain physiology as relates to increased intracranial pressure Brain surrounded by ridged bone meninges Falx cerebri between hemispheres Tentorium cerebelli between cerebrum and cerebellum Regulation maintenance of ICP Normal intracranial pressure Essential volume components Factors influence ICP: Arterial/venous pressure Intraabdominal intrathoracic pressure Posture Temperature Blood gases (CO2) Normal activities that increase intrathoracic pressure cause rise in ICP Regulation maintenance of ICP: Normal Compensatory adaptations Monro-Kellie Doctrine applied- any increase in one component, cause a decrease in the other two Ability to compensate is limited so when maximal compensation occurs and the volume increases IICP Transient rises in pressure can occur with normal physiological functions Increased Intracranial Pressure (IICP) Cerebral edema/hydrocephalus Cerebral edema- Increases the volume of brain tissue which can cause herniation Hydrocephalus- Noncommunicating Communicating Subarachnoid space with arachnoid villi Regulation maintenance of ICP: Measuring intracranial pressure (ICP) Measured from Normal pressure brain 0-15 mm Hg by intracranial monitor Lumbar pressure 100-200 mm H2O (by LP) Clinical symptoms appear 20-25 mm Hg; severe ICP 40 mmHg Level/duration important! Cerebral Blood Flow Autoregulation- Ability of the brain to regulate own blood flow Automatic alteration in diameter of cerebral blood vessels to maintain constant blood flow to the brain despite changes in systemic arterial BP Must have at least 50 mm Hg of MAP to work As CPP dec autoregulation fails CBF decreases Cerebral Perfusion Pressure (CPP) Pressure needed to ensure blood flow to brain CPP=MAP-ICP Normal 70-100 mmHg; neuronal death 50 mm Hg Cerebral Blood Flow Pressure changes Compliance- expandabili