Signs Of Increased Intracranial Pressure

Question 1

What are the three parts of Cushing’s Triad? And what is the timing of this sign?

Answer 1

1. Increased Systolic blood pressure and Widening pulse pressure.
2. Bradycardia [Decreased Heart Rate]
3. Irregular Respirations

Late Signs in ALL age groups.

Question 2

1. Irritability.
2. Restlessness. EX. wiggling around.
3. Drowsiness.
4. Indifferent > Neutral > They don’t care about anything.
5. Decrease in physical activity and motor skills. EX. parents will say that child is not this calm normally.
   What type of symptoms of increased ICP is this?

Answer 2

Behavioral Signs

Question 3

Pupils not as reactive or equal.
Sunsetting eyes > Sclera visible above Iris
Cranial nerve six palsy.
Seizures.
Slight change in level of consciousness. Restlessness.
What is the timing of this sign?

Answer 3

Early Signs in ALL age groups

Question 4

Significant Decrease in LOC.
Fixed and Dilated Pupils.
What is the timing of this sign?

Answer 4

Late Signs in ALL age groups.

Question 5

1. Tense and bulging fontanelles.
2. separated cranial sutures get the initial baseline so you will notice any difference.
3. eyes > sunsetting sign > hydrocephalus EARLY WARNING SIGN.
4. scalp veins distended > can be normal in newborns.
   Is this an early or late symptom of increased ICP?

Answer 5

Early

Question 6

1. Decreased level of consciousness.
2. Decrease in Glasgow coma scale scores.
3. Decreased motor response to commands.
4. Decreased sensory response to painful stimuli.
5. Alterations in pupil size and reactivity.
   Is this an early or late symptom of increased ICP?

Answer 6

Late

Question 7

What two tests can diagnose increased ICP?

Answer 7

MRI

CT scan

Question 9

1. Signs and symptoms will be subtle.
2. irritability.
3. poor feeding spitting up more than usual.
4. high-pitched cry on exam increased ICP.
5. Difficult to soothe.
   Is this an early or late symptom of increased ICP?

Answer 9

Early

Question 10

How do you know that a child has a headache? Infant?

Answer 10

Infant will cry and rub their head.

Child will cry and say that their head hurts.

Question 12

If the RN sees the early signs and symptoms of increased ICP notify the ______.

Answer 12

Doctor to write new orders.

Question 12

REMEMBER: kids can tolerate increased ICP better in the early stages then they will randomly ______.

Answer 12

CODE AND DIE!!

Question 13

Headache. 
Visual disturbances > Diplopia
Nausea and Vomiting. 
Dizziness or Vertigo. 
Slight change in vital signs. 
What is the timing of this sign?

Answer 13

Early Signs in ALL age groups

Question 13

1. Headache.
2. Vomiting with or without nausea. Projectile with no signs or symptoms. On exam.
3. Seizures.
4. Blurred vision > Diplopia > Double vision? On exam. EX. when a patient misses an object that they’re trying to grab that as a sign of blurred vision because the child will not be able to blurt verbalize that their vision is blurred.
   Is this a symptom of increased ICP in infants or children?

Answer 13

Children

Question 13

1. Complaints of fatigue > Always tired.
2. Somnolence
3. Inability to follow commands > Can’t do things they normally do.
4. Memory loss > Can’t remember normal things like their favorite food.
5. Weight-loss.
   Are there clothes getting looser? Ask the parent.
   What type of symptoms of increased ICP is this?

Answer 13

Behavioral Signs

Question 14

Irritability. 
Bulging fontanelle. 
Wide sutures > Increased Head Circumference. 
Dilated scalp veins. 
High-pitched catlike cry.
What is the timing of this sign?

Answer 14

Early Signs in Infants

Question 15

1. Papilledema.
2. Decerebrate & Decorticate posturing. ON EXAM.
3. Cheney Stokes respirations.
4. Cushing’s triad: ON EXAM.
   A. Widening pulse pressure with I ncreased systolic blood pressure.
   B. Bradycardia.
   C. Altered respirations.
   Is this an early or late symptom of increased ICP?

Answer 15

Late