Placed after brain surgery monitoring after surgery

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assessment. Placed after brain surgery (monitoring after surgery). Some can drain CSF. ICP/EVD: Extraventricular drain. In order to have drain, you need ICP monitor. Can have one with drain or without drain depending on needs. Epidural, subarachnoid, parenchyma, most are places in ventricles. Never placed by nurses; only neurosurgeons. Can be placed in OR or ICU (right in room). Transducer System (based on physician preference) Fluid Filled Microchip Fiberoptic Catheter Nursing Management During Placement : 1. Set up equipment. 2. Maintain sterility. 3. Nurse dresses site. 4. Documentation. During ICP monitoring : 1. Hourly neuro checks. Hourly VS, ICP, MAP, CPP. 2. Maintain sterility. 3. Prevent complicati ons (infection; direct line to patient’s brain. Hemorrhage). Other Neurological Monitoring 1. Cerebral Oxygenation Monitoring (oxygenation of brain tissue itself) 2. Jugular Oxygen Saturation Monitored via a fiberoptic catheter Normal value 60%-70% Does not ensure adequate perfusion Values < 50% indicate ischemia Partial Pressure of Brain Tissue Oxygen Monitor probe placed in brain white matter Goal: PbtO 2 (Partial Pressure of Oxygen in Brain Tissue) greater than 20 mm Hg 3. Hemodynamic Monitoring 4. Continuous SpO2 or end-tidal CO2 5. Continuous EEG Increased ICP Diagnostic Tests Blood/Urine 1. ABGs (important especially with carbon monoxide bc changes with autoregulation. Increased carbon monoxide = dilation) 2. CBC (important due to hemorrhage) 3. Coagulation profile (important due to hemorrhage) 4. Electrolytes (sodium water follows sodium swelling in brain) 5. Serum osmolality 6. Urinalysis and osmolality Radiographic/Other 1. Computed tomography (CT) of the head (best test when someone has neuro issues bc fast) 2. Magnetic resonance imaging (MRI): if pt has ICP monitoring in place, they cannot have MRI (they can have CTs) 3. Cerebral blood flow with transcranial doppler 4. Evoked potentials 5. EEG 6. Angiography (if pt has had stroke) Increased ICP Nursing Management: Positioning 1. HOB elevation 30 degrees (gravity to drain CSF) 2. Neutral head position 3. Turn side to side (when you turn pt, you see rise in ICP but should return to baseline within few minutes) Watch for return to baseline CPP If doesn’t return to baseline, pt is not tolerating position & you need to turn them back Suctioning 1. Only when necessary bc can increase ICP 2. Preoxygenate 3. Limit suction to 8-10 seconds. 2-3 passes. Assessment 1. Hourly Neurological exam 2. Vital signs 3. Cushing’s triad (never want to see): HTN. Bradycardia. Abnormal RR & pattern. Means ICP has gotten so high, there is pressure on brain stem (regulates RR, HR, BP). Last thing you will see before patient herniates. Sit up patient 90 degrees; decrease blood in brain. Nursing activities: Avoid anything that will increase ICP 1. Avoid clustering of activities: come in assess & leave. Come in give meds & leave. Space things out to avoid increase in ICP.
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  • Fall '18
  • Traumatic brain injury

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