Increase Intracranial Pressure. Brain Brain tissue (1,400g) Blood (75mL) CSF (75mL) Normal ICP 10 to...
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- Slide 1
- Increase Intracranial Pressure
- Slide 2
- Slide 3
- Brain Brain tissue (1,400g) Blood (75mL) CSF (75mL) Normal ICP
10 to 20 mmHg
- Slide 4
- 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.
- Slide 5
- Pathophysiology
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- 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.
- Slide 7
- Elevated ICP most commonly associated with head injury
Secondary Effects Brain tumors Subarachnoid hemorrhage Toxic and
viral encephalities
- Slide 8
- Brain Tumor Decrease Cerebral Blood Flow Ischemia and Cell
DeathEarly Cerebral Ischemia Vasomotor Stimulation (brainstem)
Increase Systemic Pressure (s/sx slow pulse, cheyne- stokes
resp.,elevated temp.) Increase ICP
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- Diagnostic Findings
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- Cerebral Angiography Computed Tomography (CT) Scanning Magnetic
Resonance Imaging (MRI) Positron Emission Tomography (PET)
Transcranial Doppler
- Slide 11
- 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
- Slide 12
- 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
- Slide 13
- Magnetic Resonance Imaging The first image shows normal MRI
result The second image shows with brain tumor that causes increase
ICP
- Slide 14
- Positron Emission Tomography The first image shows normal PET
result The second image shows with brain tumor that may lead to
increase ICP
- Slide 15
- 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
- Slide 16
- ICP Precautions Elevate head of bed 30 degrees. Seizure
prophylaxis: Phenytoin will reduce seizures in the first week after
injury but does not change the overall outcome. Steroids are
ineffective in controlling ICP in the trauma setting.
- Slide 17
- Manipulation of ICP Decrease cerebral metabolic demand
sedation, analgesia, barbiturates avoid hyperthermia avoid seizures
Hyperventilation decreases blood flow to brain only acutely for
impending herniation Mannitol Blood
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- Manipulation of ICP Mannitol dehydrate the brain, not the
patient! monitor osmolality Hypertonic saline Decompressive
craniectomy Brain
- Slide 19
- ICP Monitoring ICU patients who have sustained head trauma,
brain hemorrhage, brain surgery, or conditions in which the brain
may swell might require intracranial pressure monitoring. The
purpose of ICP monitoring is to continuously measure the pressure
surrounding the brain.
- Slide 20
- Why Monitor? Detect events Manage intracranial pressure Manage
cerebral perfusion pressure
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- How? Ventriculostomy Intraparenchymal fiberoptic catheter
Subarachnoid monitor Useful adjuncts: Arterial line Central venous
line Foley catheter
- Slide 22
- Manipulation of ICP External drainage therapeutic as well as
diagnostic technical issues infectious issues CSF
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- What to do with the information... Goal: adequate oxygen
delivery to maintain the metabolic needs of the brain. Intracranial
pressure 50-70 mm Hg CPP=MAP-ICP
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- Indications for ICP monitoring Glasgow coma scale
- Raised ICP>25mm Hg Management of Raised ICP First Line Rx
Measure ICP Maintain CPP>70 mm Hg Ventricular Drain Normal
Vent/Oxygenation MannitolSedation Raised ICP>25mm Hg CT
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- Management of Raised ICP Second Line Rx Second Line Rx Maintain
CPP>70 mm Hg Furosemide Chemical Paralysis CSF Removal
Vasopressor Barbiturates Hyperventilation Monitor S j O 2 Raised
ICP>25mm Hg
- Slide 27
- Nursing Process The Patient with Increased Intracranial
Pressure
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- Assessment
- Slide 29
- 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
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- Nursing Diagnosis
- Slide 31
- 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
- Slide 32
- Planning and Goals
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- 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
- Slide 34
- Nursing Intervention
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- 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
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- Evaluation
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- Maintained patent airway Attains optimal breathing pattern
Attains desired fluid balance Infection prevented Complications
prevented
- Slide 38