nursing care of patients with increased ICP Flashcards
what is increased intracranial pressure
pressure within the crainio/spinal area compartment
normal ICP range
0-10 mmHg (others say 1-15)
- if >20 mmHg there is increased ICP use clinical judgement
cranial vault numbers
brain tissue= 1400 g (1.4 kg)
blood in brain = 75 ml
CSF = 75 ml
causes of increased ICP
head injury, brain tumor (even benign), subarachnoid hemorrhage, encephalopathies, stroke
effects of increased ICP
decreased cerebral perfusion, stimulates further cerebral swelling, shifting of brain tissue
earliest signs and symptoms of increased ICP
change in LOC ex: anxiety (very early), agitation, delayed response
cushings reflex/response (neuro)
if there is increase in pressure = decrease perfusion in brain which leads to vasomotor center (medulla/midbrain) affecting the blood pressure
Cushing reflex affecting blood pressure
higher pressure = more blood going to brain
- -> increased bp (SBP increased, DBP is maintained)
- widening PP
Cushing reflex affecting HR and Respiratory
HR and respiratory would be going down (opposite of shock)
noted when cerebral blood flow is decreased significantly
as ICP further increases how is does level of consciousness change
stupor, only reacts to painful stimuli
Motor response of increased ICP
abnormal motor response: decortication (abnormal flexion); decerebration (abnormal abduction and extension)
purpose of diagnostics for increased ICP
to determine the underlying cause
Dx for increased ICP
CT, MRI, PET, cerebral angiogram, lumbar puncture
what would a CT show
CT could show hemorrhage or tumor
Lumbar puncture
avoided as much as possible
-Sudden release of pressure may cause the brain to herniate→ brainstem may be sucked down to spinal cord=> immediate succession of breathing
management of increased ICP
treat underlying cause– tumor (remove), infection (abx), etc.
How do we relieve elevated ICP
osmotic diuretics, steroid, fluid restrictions, CSF draining, controlling fever, maintain system BP
osmotic diuretics to relieve increased ICP
mannitol - draw fluids out of circulation hypertonic saline (3% NaCl) - to pull out fluids
CSF draining to relieve increased ICP
- usually done for patients with ICP persistently > 20
- (1 ml usually extracted) – max 6 ml can be removed
- normally we are draining it→ we are not aware of it→ excess will be drained into lymphatic and sinuses → patients with tumor there is a procedure
types of CSF draining
direct puncture (more immediate done by neurosurgeon) and lumbar spinal catheter
controlling fever to relieve increased ICP
reduce oxygen and metabolic demand
theres an increase in demand when you have a fever = less oxygen to brain= hypoxemia
maintaining systemic bp to relieve increased ICP
permissive HTN - to maintain cerebral perfusion
-parameters: they will tell you where to keep the patients blood pressure→ never ever lower blood pressure to normal especially in acute phase
—JUST LIKE HTN EMERGENCY you never want to lower BP too fast.
what are the most immediate ways to relieve increased ICP
osmotic diuresis and steroid
Nursing interventions for increased ICP
maintain patent airway, adequate breathing pattern, maintain cerebral tissue perfusion, plan for negative fluid balance, infection prevention, monitor/manage potential complications
why maintain patent airway
hypoxia can lead to cerebral edema
breathing patterns to monitor for
- NO coughing (increases ICP more)
- cheyne-stokes respiration (fast shallow–slow deep–stop– then repeats)
- hyperventilation
- irregular respiration
- worst– decreased respiration
how to maintain cerebral tissue perfusion
- position-head in neutral position and 30 degrees or more (NOT high fowlers)
- avoid valsalva maneuver- prevent constipation
- avoid extreme flexion of hip - do not let them sit
note: sitting can increase abd pressure – lead to increasing ICP
I/O plan for negative fluid balance
the urine (output) should be greater than the input
what potential complications should we monitor for increased ICP
DI, SIADH, brain herniation (fatal)
