INTRACRANIAL PRESSURE

Question 1

What’s the normal ICP?

Answer 1

5-15 mmHg

Question 2

Hydrostatic force measured in the intracranial CSF compartment

Answer 2

Intracranial Pressure (ICP)

Question 3

Factors Influencing ICP

Answer 3

-Pressure in the body cavities
- Carbon dioxide levels in the blood
- Posture
- Body Temperature
- Blood Pressure

Question 4

ICP greater than 20 mmHg for longer than 5 minutes

Answer 4

Intracranial Hypertension

Question 5

“If the volume of any one of three components increases within the cranial vault and the volume from another is displaced, the total intracranial pressure will not change”

Answer 5

Monroe-Kellie Hypothesis

Question 6

Causes of Intracranial Hypertension

Answer 6

-Head Injury (most common)
- Brain Tumor
- Encephalopathies
- Subarachnoid hemorrhage
- Hydrocephalus
-Infection

Question 7

Pressure needed to ensure blood flow to the brain

Answer 7

Cerebral Perfusion Pressure

Question 8

Formula for CPP

Answer 8

CPP= MAP-ICP

Question 9

Normal CPP

Answer 9

70-100 mmHg

Question 10

if CPP is <50mmHG

Answer 10

CPP <50mmHg produces irreversible neurologic damage

Question 11

What happens if ICP is increased?

Answer 11

Decreased cerebral blood flow

Decreased cerebral blood flow is resulting to CUSHING’s RESPONSE

CUSHING’s RESPONSE- Systolic Hypertension, Widened Pulse Pressure, Bradycardia

Decreased cerebral blood flow results to Hypoxia, Death of Brain Cells, Edema around necrotic tissue, Compression of brainstem and respiratory center and Cushing’s Triad

CUSHING’S TRIAD- Hypertension, Bradypnea, Bradycardia

BRADYPNEA- Accumulation of CO2, Vasodilation, Further increase in ICP and leads to DEATH

Question 12

What’s the early manifestations of ICP?

Answer 12

-Changes in LOC (restlessness, confusion
- Anisocoria (Ipsilateral)
- Vision is blurred and doubled
- Extremity is weak
- Headache

Question 13

Worsened by movement or straining

Answer 13

Headache

Question 14

What’s the Late Manifestations of ICP?

Answer 14

-Progressively declining LOC
- Cushing’s Triad
- Projectile Vomiting
- Abnormal Posturing (Decorticate/Decerebrate)
- Flaccidity
-Loss of Reflexes
- Death

Question 15

What’s the complication of ICP?

Answer 15

Brain herniation

Question 16

Ipsilateral Dilatation of Pupils

Answer 16

Anisocoria

Question 17

A catheter is placed through a burr hole into the lateral ventricle of the brain

Answer 17

Intraventricular Catheter Monitoring (Ventriculostomy)

Question 18

This device can only measure ICP and drain CSF

Answer 18

Intraventricular Catheter Monitoring (Ventriculostomy)

Question 19

The main concern of Intraventricular Catheter Monitoring (Ventriculostomy)

Answer 19

High Risk For Infection

Question 20

Essential Concept of Intraventricular Catheter Monitoring (Ventriculostomy)

Answer 20

Right Hemisphere is the NON- DOMINANT hemisphere for language, so insertion into the right lateral ventricle reduces risk of language dysfunction.

Question 21

> 40 mmHg is considered as

Answer 21

Considered as widened pulse pressure

Question 22

Landmarks of the Foramen of Monroe (FOM)

Answer 22

1. Supine
2. Lateral

Question 23

If supine position, the landmarks of the foramen must be

Answer 23

Tragus

Question 24

If lateral or side-lying position, the landmarks of the foramen must be

Answer 24

Between the eyebrows

Question 25

Errors in Positioning of Transducer

The outcome if ZERO is far above FOM

Answer 25

• False low reading
• Insufficient drainage

Question 26

Errors in Positioning of Transducer

The outcome if ZERO is far below FOM

Answer 26

-False high reading
-Excessive drainage

Question 27

Important nursing actions for ventriculostomy

Answer 27

-Check levelling of ventriculostomy everytime a patient is repositioned
-Routinely assess insertion site using aseptic (sterile) technique
-Monitor the CSF for a change in drainage color or clarity
Normal Appearance: clear and colorless
Turbidity means presence of bacterial infection

Question 28

Medical Management of ICP (Airway Support)

Answer 28

Priority: Airway Support
-Oxygen Supplementation if Sp02 <94%
-Intubation, if severely hypoxemic
- Suction secretions, as ordered and as necessary

Question 29

Medical Management of Increased ICP (DRUG)

Answer 29

Mannitol IV

Question 30

Mechanism of action of Mannitol IV

Answer 30

-Osmotic diuretic that can cross the BBB
-Used to reduce ICP to normal level

Question 31

Side Effects of Mannitol

Answer 31

-Polyuria
- Crystallization of IV ports

Question 32

Position for the Management of Increased ICP

Answer 32

Low-fowler’s

Question 33

Rationale of Low-Fowler’s Position

Answer 33

Promotes drainage of venous blood from brain

Question 34

What’s the diet for the management of Increased ICP?

Answer 34

Blenderized, if with dysphagia
-Feed via NGT during acute period
-Check placement of tip
- Flush NGT with water (b4 and after)
-Position: Fowler’s
-Trial feeding prior to diet progression

Question 35

Supportive Care for the Management of Increased ICP

Answer 35

-Oral care every shift
- Laxatives, as ordered
- Reposition every 2 hours and provide necessary skin care
- Monitor diaper for soiling and change ASAP

Question 36

Rationale of Laxatives

Answer 36

To prevent straining at stool

Question 37

Surgical Management of ICP

Answer 37

Craniotomy and Decompressive Hemicraniectomy

Question 38

Used to evacuate hematoma for patients showing signs of worsening neurologic exam, increased ICP, or signs of brainstem compression

Answer 38

Craniotomy

Question 39

Considered as a surgical strategy to assist in management of refractory intracranial HTN

Answer 39

Decompressive Hemicraniectomy

Question 40

Decrease cerebral edema by reducing the oxygen and metabolic requirements of the brain, thus protecting the brain from continued ischemia

Answer 40

Decompressive Hemicraniectomy