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
Slide 6
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
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
Slide 18
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.
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
Slide 23
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
Slide 24
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
Slide 26
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
Slide 28
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
Slide 30
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
Slide 33
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
Slide 35
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
