ICP increased intracranial pressure Flashcards
What intervention should be done for a patient who has increased intracranial pressure?
- Frequent Neuro checks every hour
- Monitor temperature and hemodynamics including map and CPP
- CPP= MAP - ICP
- Avoid sedatives or CNS depressants if possible
- Administer ordered medication
- Prepare patient for surgical intervention
- Monitor electrolytes and urine output
- Maintain head of bed 30–45°
- Decrease stimuli
- Avoid valsalva maneuver
Why do we monitor temperature in a patient with elevated intracranial pressure?
With a loss of auto Namic regulation a patient’s temperature could become very elevated 104° +
Why do we monitor hemodynamics in patients with increased intracranial pressure?
To assess for Cushing’s triad and to evaluate cerebral perfusion pressure
What does Cushing’s triad consist of?
- Bradycardia
- Irregular respirations
- Widened pulse pressure
What are the symptoms of Cushing’s triad?
1. Elevated BP
- Low heart rate
- Low respiration rate
What is a widened pulse pressure?
A large difference between the systolic blood pressure and the diastolic blood pressure
Why do we avoid giving sedatives or other central nervous system depressants to a patient with increased intracranial pressure?
These medications can alter Neuro checks
What type of medication can we give to a patient with ICP?
- Osmotic diuretics
- Hypertonic saline
- Corticosteroids
Why do we give osmotic diuretics, hypertonic saline solutions, and corticosteroids for patients with ICP?
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
What does mannitol do in ICP?
Decreases edema
What does a hypertonic saline 3% solution do in ICP?
Decrease edema
What do corticosteroids do in ICP?
Decrease inflammation
What type of medication is Mannitol?
Osmotic diuretic
What kind of surgical interventions can be done for ICP?
- Craniectomy
2. External ventricular drain
What is a craniectomy?
A surgical intervention that removes a portion of the skull in order to allow space for cerebral swelling
What is a external ventricular drain (EVD)?
A catheter placed into the ventricle to drain blood or CSF in the event of an elevated ICP
What is one of the most important intervention you should do for an external ventricular drain (EVD) ?
The EBD should be leveled to the tragus (External auditory meatus) to be approximately in line with the fourth ventricle in the brain
When the EVD is At level with the tragus, at what volume should we keep the drain open at?
10 cm H2O
What does 10 cm H2O correlate to when a EVD is in place?
It correlates to approximately 7–8 mmHg ICP, therefore any increase in ICP above 7–8 would cause CSF to drain
What would happen if the EVD is not leveled with the tragus?
Too much or too little CSF could not drain. Too little drainage could cause increased ICP and possible brain herniation
Why do we want to monitor electrolytes in a patient with ICP?
Patients on mannitol or hypertonic saline could cause fluctuations in sodium levels which could lead to seizures
Why do we monitor urine output in patients with ICP?
Patient should be monitored to ensure diuresis with mannitol and monitored for the possible development of diabetes insipidus
Head of bed below 30° can do what in patient with ICP?
Increase blood flow to brain which increases ICP
Head of bed greater than 45° does what to patients with ICP?
Increases intrathoracic pressure which decreases venous outflow from brain thus increasing intracranial pressure
