nursing care of patients with increased ICP

Question 1

what is increased intracranial pressure

Answer 1

pressure within the crainio/spinal area compartment

Question 2

normal ICP range

Answer 2

0-10 mmHg (others say 1-15)

- if >20 mmHg there is increased ICP use clinical judgement

Question 3

cranial vault numbers

Answer 3

brain tissue= 1400 g (1.4 kg)
blood in brain = 75 ml
CSF = 75 ml

Question 4

causes of increased ICP

Answer 4

head injury, brain tumor (even benign), subarachnoid hemorrhage, encephalopathies, stroke

Question 5

effects of increased ICP

Answer 5

decreased cerebral perfusion, stimulates further cerebral swelling, shifting of brain tissue

Question 6

earliest signs and symptoms of increased ICP

Answer 6

change in LOC ex: anxiety (very early), agitation, delayed response

Question 7

cushings reflex/response (neuro)

Answer 7

if there is increase in pressure = decrease perfusion in brain which leads to vasomotor center (medulla/midbrain) affecting the blood pressure

Question 8

Cushing reflex affecting blood pressure

Answer 8

higher pressure = more blood going to brain

• -> increased bp (SBP increased, DBP is maintained)
• widening PP

Question 9

Cushing reflex affecting HR and Respiratory

Answer 9

HR and respiratory would be going down (opposite of shock)

noted when cerebral blood flow is decreased significantly

Question 10

as ICP further increases how is does level of consciousness change

Answer 10

stupor, only reacts to painful stimuli

Question 11

Motor response of increased ICP

Answer 11

abnormal motor response: decortication (abnormal flexion); decerebration (abnormal abduction and extension)

Question 12

purpose of diagnostics for increased ICP

Answer 12

to determine the underlying cause

Question 13

Dx for increased ICP

Answer 13

CT, MRI, PET, cerebral angiogram, lumbar puncture

Question 14

what would a CT show

Answer 14

CT could show hemorrhage or tumor

Question 15

Lumbar puncture

Answer 15

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

Question 16

management of increased ICP

Answer 16

treat underlying cause– tumor (remove), infection (abx), etc.

Question 17

How do we relieve elevated ICP

Answer 17

osmotic diuretics, steroid, fluid restrictions, CSF draining, controlling fever, maintain system BP

Question 18

osmotic diuretics to relieve increased ICP

Answer 18

mannitol - draw fluids out of circulation 
hypertonic saline (3% NaCl) - to pull out fluids

Question 19

CSF draining to relieve increased ICP

Answer 19

• 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

Question 20

types of CSF draining

Answer 20

direct puncture (more immediate done by neurosurgeon) and lumbar spinal catheter

Question 21

controlling fever to relieve increased ICP

Answer 21

reduce oxygen and metabolic demand

theres an increase in demand when you have a fever = less oxygen to brain= hypoxemia

Question 22

maintaining systemic bp to relieve increased ICP

Answer 22

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.

Question 23

what are the most immediate ways to relieve increased ICP

Answer 23

osmotic diuresis and steroid

Question 24

Nursing interventions for increased ICP

Answer 24

maintain patent airway, adequate breathing pattern, maintain cerebral tissue perfusion, plan for negative fluid balance, infection prevention, monitor/manage potential complications

Question 25

why maintain patent airway

Answer 25

hypoxia can lead to cerebral edema

Question 26

breathing patterns to monitor for

Answer 26

• NO coughing (increases ICP more)
• cheyne-stokes respiration (fast shallow–slow deep–stop– then repeats)
• hyperventilation
• irregular respiration
• worst– decreased respiration

Question 27

how to maintain cerebral tissue perfusion

Answer 27

1. position-head in neutral position and 30 degrees or more (NOT high fowlers)
2. avoid valsalva maneuver- prevent constipation
3. avoid extreme flexion of hip - do not let them sit

note: sitting can increase abd pressure – lead to increasing ICP

Question 28

I/O plan for negative fluid balance

Answer 28

the urine (output) should be greater than the input

Question 29

what potential complications should we monitor for increased ICP

Answer 29

DI, SIADH, brain herniation (fatal)