Page 153 - Critical Care Notes

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Mini Mental Status Examination—cont’d

Task Instructions Scoring Score
Writing Ask patient to write a 1 point if sentence
sentence. has a subject and a
verb and makes
sense
Drawing Ask patient to copy a pair 1 point if the figure
of intersecting pentagons has 10 corners and
onto a piece of paper. 2 intersecting lines
Total possible score = 30. Score of 24 or above is considered normal.
ICP Measurement and Monitoring
Catheters or devices placed inside the head that sense the pressure inside the
brain cavity and send measurement to a recording device include:
■ Intraventricular catheter (ventriculostomy), which allows CSF to drain and
allows for intraventricular administration of medications
■ Intraventricular fiberoptic devices
■ Subarachnoid bolt or screw
■ Epidural or subdural catheter or sensor/monitor
Risks
■ Infection and bleeding
■ Obstruction
■ Damage to the brain tissue → neurological effects
■ Inability to accurately place catheter
Troubleshooting ICP Monitoring Problems
■ Check all connections.
■ Catheter may need to be repositioned.
■ Check for air in the system.
■ Check monitor cable.
■ Recalibrate or reposition transducer.
■ Increase gain or range on monitor.
■ Flush catheter with 0.25 mL NS as ordered.
ICP Catheter Waveforms
■ A (plateau) waves → cerebral ischemia
■ B waves → intracranial HTN and change in vascular volume
■ C waves → variations in systemic arterial pressure and respirations

NEURO