Unit #9 STUDENT
 Unit 9: Neuro assessment, ICP and organ
donation
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Unit Objectives
Describe anatomy and physiology of the CNS and PNS
Discuss assessment of LOC, including GCS
Describe risk factors, S/S, diagnosis, treatment, complications and nursing care of increased ICP
Discuss the purpose of DonorConnect, types of organ donation, S/S brain death, and when the nurse should
call DonorConnect
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Previous Nursing Knowledge:
CNS and PNS anatomy and physiology
Neurological nursing assessment
Reading Assignment: Brunner & Suddarth: Chapter 65 (p. 1946-1957) and Chapter 66 (p. 1972-1996);
review the DonorConnect website, www.donorconnect.life
Assignments/Quizzes: Prep Quiz; Article “Staying Alert about NAPS” (Harrington, 2006) and Quiz
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Unit Preparation and Outline
Chapter 65
Neurologic Review
Anatomy and Physiology
o CNS:
o PNS:
o Neurons contain
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Dendrites:
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Axons:
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Ganglia/nuclei:
o Neurotransmittors:
Central Nervous System
o Brain
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Cerebrum:
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Frontal:
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Parietal:
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Temporal:
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Occipital:
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Corpus callosum:
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Hypothalamus:
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Basal ganglia:
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Brain stem
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Midbrain:
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Pons:
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Medulla oblongata:
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Cerebellum
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Structures protecting the brain
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Meninges
o Dura mater
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Epidural space:
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Subdural space:
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Herniation:
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Arachnoid:
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Pia mater:
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Cerebrospinal fluid
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Cerebral circulation
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Blood-brain-barrier
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Spinal cord
o Spinal tracts: White matter of the spinal cord
o Vertebral column: Bones that protect the spinal cord
Peripheral Nervous System
o Cranial nerves
o Spinal nerves
o Autonomic nervous system:
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Unit #9 STUDENT
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Sympathetic nervous system: Fight-or-flight response
Parasympathetic nervous system: Visceral functions
Chapter 66
Altered LOC: Pt is not _ALERT_, does not follow _Commands_ or needs
persistent _stimuli_ to achieve a state of alertness. Measured on continuum from
full consciousness to coma.
o Observe for : alertness & ability to follow commands
o If pt doesn’t meet above criteria, observe for:
 Eye-opening
 Verbal response
 Motor response to stimuli
Glasgow Coma Scale (developed for trauma)
o Score determine by sum of 3 categories: Eye-opening, best verbal
response & best motor response.
o Max score: 15 (normal)
o Min score: 3 (deep coma)
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Eyes=3, Verbal=4, Motor response: 6 (total=13)
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Increased ICP
o Monro-Kellie hypothesis:
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Limited space for expansion of skull, so increase in any components (brain
tissue, blood, CSF) changes vol of others.
Most commonly causes for increased Intracranial pressure: in head injury,
but may be secondary to brain tumors, subarachnoid/intracranial
hemorrhage and toxic/viral encephalopathies ,(meningitis) infections,
stroke
o ICP-pressure exerted by volume of intracranial contents w/in cranial rises
& cerebral perfusion impaired.
Patho:
o Factors that increased ICP:
 Cerebral edema:
 Hypoxia:
 Hypercapnia: (too much acid)
 Impaired venous return:
 Increase in intrathoracic or abdominal pressure:
o Increased ICP may reduce cerebral flow, resulting in ischemia & death.
o Cerebral edema may occur
o As ICP rises, compensatory mechanisms in brain work to maintain blood
flow & prevent tissue damage.
Unit #9 STUDENT
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Perfusion Pressures
o Normal Intracranial Pressure (ICP) is 0-15 mmHg (15 is higher end)
o Normal Cerebral Perfusion Pressure (CPP) is 70-100mmHg (Calculated
by subtracting the ICP from MAP)- need indwelling device to measure
this.
o Patients with CPP of less than 50mmHg experience irreversible neurologic
damage
o If ICP is equal to MAP, cerebral circulation ceases
 Keep track of MAP to know where pt sits. Want MAP to be Higher
than ICP. Normal MAP is 65.
 Different types of monitors used to measure. Drill hole or feed
shunt. Relieve pressure on brain if fluid.
 ICP and cerebral oxygenation monitoring
o Ventriculostomy or intraventricular catheter monitoring devices
o Subarachnoid screw or bolt
o Epidural monitor
o Fiberoptic monitor
 Treatment
o Immediate management to relieve increased ICP requires:
 decreasing cerebral edema
 lowering volume of CSF
 decreasing cerebral blood volume while maintaining cerebral
perfusion
o Surgery for evacuation of blood clots, debridement and elevation of
depressed fractures
 Cushing’s triad:
 Brain herniation:
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 Organ Donation Services
Purpose of DonorConnect: Must be registered to be active donor. Decision can go on
living will. NO on drivers license just means they are not registered, it is not an official
no.
Types of organ donation: kidney
Donation after brain death:
DCD (donation after cardiac death)
Tissue donor: passed away—can be 8-12hr after time of death. If pt colled, can be 24hrs
When to call
Unit #9 STUDENT
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