ICP increased intracranial pressure

Question 1

What intervention should be done for a patient who has increased intracranial pressure?

Answer 1

1. Frequent Neuro checks every hour
2. Monitor temperature and hemodynamics including map and CPP
3. CPP= MAP - ICP
4. Avoid sedatives or CNS depressants if possible
5. Administer ordered medication
6. Prepare patient for surgical intervention
7. Monitor electrolytes and urine output
8. Maintain head of bed 30–45°
9. Decrease stimuli
10. Avoid valsalva maneuver

Question 2

Why do we monitor temperature in a patient with elevated intracranial pressure?

Answer 2

With a loss of auto Namic regulation a patient’s temperature could become very elevated 104° +

Question 3

Why do we monitor hemodynamics in patients with increased intracranial pressure?

Answer 3

To assess for Cushing’s triad and to evaluate cerebral perfusion pressure

Question 4

What does Cushing’s triad consist of?

Answer 4

1. Bradycardia
2. Irregular respirations
3. Widened pulse pressure

Question 5

What are the symptoms of Cushing’s triad?

Answer 5

1. Elevated BP

2. Low heart rate
3. Low respiration rate

Question 6

What is a widened pulse pressure?

Answer 6

A large difference between the systolic blood pressure and the diastolic blood pressure

Question 7

Why do we avoid giving sedatives or other central nervous system depressants to a patient with increased intracranial pressure?

Answer 7

These medications can alter Neuro checks

Question 8

What type of medication can we give to a patient with ICP?

Answer 8

1. Osmotic diuretics
2. Hypertonic saline
3. Corticosteroids

Question 9

Why do we give osmotic diuretics, hypertonic saline solutions, and corticosteroids for patients with ICP?

Answer 9

These medications help to decrease the circulating CSF volume as well as to decrease any cerebral edema which decreases the pressure within the cranial cavity

Question 10

What does mannitol do in ICP?

Answer 10

Decreases edema

Question 11

What does a hypertonic saline 3% solution do in ICP?

Answer 11

Decrease edema

Question 12

What do corticosteroids do in ICP?

Answer 12

Decrease inflammation

Question 13

What type of medication is Mannitol?

Answer 13

Osmotic diuretic

Question 14

What kind of surgical interventions can be done for ICP?

Answer 14

1. Craniectomy

2. External ventricular drain

Question 15

What is a craniectomy?

Answer 15

A surgical intervention that removes a portion of the skull in order to allow space for cerebral swelling

Question 16

What is a external ventricular drain (EVD)?

Answer 16

A catheter placed into the ventricle to drain blood or CSF in the event of an elevated ICP

Question 17

What is one of the most important intervention you should do for an external ventricular drain (EVD) ?

Answer 17

The EBD should be leveled to the tragus (External auditory meatus) to be approximately in line with the fourth ventricle in the brain

Question 18

When the EVD is At level with the tragus, at what volume should we keep the drain open at?

Answer 18

10 cm H2O

Question 19

What does 10 cm H2O correlate to when a EVD is in place?

Answer 19

It correlates to approximately 7–8 mmHg ICP, therefore any increase in ICP above 7–8 would cause CSF to drain

Question 20

What would happen if the EVD is not leveled with the tragus?

Answer 20

Too much or too little CSF could not drain. Too little drainage could cause increased ICP and possible brain herniation

Question 21

Why do we want to monitor electrolytes in a patient with ICP?

Answer 21

Patients on mannitol or hypertonic saline could cause fluctuations in sodium levels which could lead to seizures

Question 22

Why do we monitor urine output in patients with ICP?

Answer 22

Patient should be monitored to ensure diuresis with mannitol and monitored for the possible development of diabetes insipidus

Question 23

Head of bed below 30° can do what in patient with ICP?

Answer 23

Increase blood flow to brain which increases ICP

Question 24

Head of bed greater than 45° does what to patients with ICP?

Answer 24

Increases intrathoracic pressure which decreases venous outflow from brain thus increasing intracranial pressure

Question 25

What is the number one goal in treating Cushing’s triad?

Answer 25

Preventing Cushing’s triad

Question 26

What is the overall goal in treating Cushing’s triad?

Answer 26

Treatment is aimed at decreasing the ICP, as well as reversing the cause of the ICP

Question 27

Where are the interventions to treating Cushing’s triad and lowering ICP?

Answer 27

1. Administering medication
2. Hyperventilating
3. Reverse trendelenburg position (with head elevated)
   4. Drain excess cerebrospinal fluid
   5. Craniotomy to relieve pressure

Question 28

If Cushing’s triad is left untreated for too long what can happen?

Answer 28

1. Herniation of the brain leading to uncal herniation

2. Infarction or death of the brain tissue

Question 29

What is uncal herniation?

Answer 29

It’s when herniation occurs causing the brain tissue to shift to the opposite side of the brain or down towards the brain stem