Increase Intracranial Pressure

Medical Surgical Nursing

Increase Intracranial Pressure

Brain

Brain tissue (1,400g) Blood (75mL) CSF (75mL) Normal ICP 10 to 20 mmHg

Monro-Kellie Hypothesis

Limited space for expansion in the skull, an increase in anyone of the components causes a change in the volume of the others.

Pathophysiology

Increase ICP is a syndrome that affects many patients with acute neurologic conditions. This is because pathologic conditions alter the relationship between intracranial volume and pressure.

Elevated ICP most commonly associated with head injury Secondary Effects

Brain tumors Subarachnoid hemorrhage Toxic and viral encephalities

Brain TumorBrain Tumor

Decrease Cerebral Blood FlowDecrease Cerebral Blood Flow

Ischemia and Cell DeathIschemia and Cell Death Early Cerebral IschemiaEarly Cerebral Ischemia

Vasomotor Stimulation(brainstem)

Vasomotor Stimulation(brainstem)

Increase Systemic Pressure(s/sx slow pulse, cheyne-stokes

resp.,elevated temp.)

Increase Systemic Pressure(s/sx slow pulse, cheyne-stokes

resp.,elevated temp.)

Increase ICPIncrease ICP

Diagnostic Findings

Cerebral Angiography Computed Tomography (CT) Scanning Magnetic Resonance Imaging (MRI) Positron Emission Tomography (PET) Transcranial Doppler

Cerebral Angiography

The first image shows normal brain blood flow

The second image shows presence of cerebral aneurysm that can cause decease cerebral blood flow may lead to increase ICP

Computed Tomography Scanning The first image shows a

normal view of the brain

The second image shows brain with tumor and edema that may lead to increase ICP

Magnetic Resonance Imaging The first image shows

normal MRI result The second image

shows with brain tumor that causes increase ICP

Positron Emission Tomography The first image shows

normal PET result The second image

shows with brain tumor that may lead to increase ICP

Transcranial Doppler

The top shows a TCD of a normal artery

Bottom shows a severely stenosed internal carotid artery causes decrease cerebral blood flow may lead to increase ICP

Nursing Process

The Patient with Increased Intracranial Pressure

Assessment

History Present Illness Obtain Subjective Data

Neurologic examination Mental Status LOC Cranial Nerve Function Cerebral Function (balance and coordination) Reflexes Motor and Sensory Function Abnormal Respiratory Pattern

Nursing Diagnosis

Ineffective airway clearance related to diminished protective reflexes

Ineffective breathing patterns related to neurologic dysfunction

Ineffective cerebral tissue perfusion related to the effects of increased ICP

Deficient fluid volume related to fluid restriction

Risk for infection related to ICP monitoring system

Planning and Goals

Maintenance of patent airway Normalization of respiration Adequate cerebral tissue perfusion through

reduction in ICP Restoration of fluid balance Absence of infection Absence of complication

Nursing Intervention

Maintaining patent airway and adequate ventilation Monitor vital signs and neurochecks Maintain fluid balance Position client with head of the bed elevated 30 to

45 degrees and neck in neutral position Maintain a quiet environment Avoid use of restraints Prevent straining at stool Prevent excessive cough and vomiting Prevent complication of immobility Preventing infection Administer medication as ordered

Evaluation

Maintained patent airway Attains optimal breathing pattern Attains desired fluid balance Infection prevented Complications prevented