NURSING MANAGEMENT OF INCREASED INTRACRANIAL PRESSURE Etiology of
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NURSING MANAGEMENT OF INCREASED INTRACRANIAL PRESSURE
Etiology of Increased ICP Too much cerebrospinal fluid (the fluid around the brain-meningitis) A tumor (benign or malignant) Bleeding into the brain (Hemorrhagic stroke or aneurysm) Swelling in the brain (encephalitis) High blood pressure http: //www. uptodate. com/contents/evaluation-and-managementof-elevated-intracranial-pressure-in-adults
Physiology-Increased Intracranial Pressure Not a disease but secondary process from an insult to the brain Prolonged pressure above 15 mm. Hg (normal 5 -10 mm. Hg)
Clinical Manifestations of ICP Decreased level of consciousness (LOC) � lethargy, confusion, behavior changes (irritability, agitation), restlessness Headache, vision changes (diplopia lack of peripheral vision) Nausea and vomiting Change in speech pattern (e. g. , slurred speech, clear speech that doesn’t make sense) Aphasia Change in sensorimotor and motor function Pupillary changes (dilated and nonreactive or constricted and nonreactive) Cranial nerve dysfunction Ataxia Seizures Severe hypertension Abnormal posturing
Cushing’s Triad 1. Hypertension (Systolic BP) 2. Widened Pulse Pressure 3. Bradycardia (170/50…. 180/40…. 200/20)
Posturing with ICP Decorticate posturing � Lesions that interrupt the corticospinal pathways Decerebrate posturing � dysfunction brainstem in the
Assessment 2 types of neurological assessment � Rapid neuro exam Glascow Coma Scale, LOC, orientation, movement of arms and legs, Pupil size and reaction to light � Complete neuro exam LOC (mental status), memory and attention, PERRLA, cranial nerves, motor function, sensory function, deep tendon reflexes, cerebellar function Comparing one side to the other (Left – Right) � subtle changes can be found with comparsion
Assessment of Labs/Diagnostics Underlying cause and assessment will determine labs (There is not one lab test to indicate ICP) � e. g. , if infection is suspected, a White Blood Cell (WBC) count would be necessary Computed tomography (CT) of the brain Magnetic Resonance Imaging (MRI) of the brain Skull and spine x-rays Cerebral angiography Positron Emission Tomography (PET) scan of the brain Electroencephalography (EEG) Lumbar puncture (spinal tap)
Plan/Goal for ICP Adequate cerebral perfusion Minimize cerebral tissue damage/death with early interventions
Interventions Monitor neurologic status and vital signs Monitor respiratory status Calculate and monitor cerebral perfusion pressure Monitor central venous pressure (CVP) Raise head of the bed to 15 -30 degrees or as ordered (assists venous drainage) Bowel and Bladder function Avoid neck flexion and extreme hip/knee flexion Fluid restriction Administer medications to promote a ICP � osmotic and loop diuretics, corticosteroids Administer analgesics, sedatives as needed Antibiotics as indicated http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 2452989/
Evaluation – Desired Outcomes Normal ICP (5 -10 mm. Hg) is maintained Ischemia is minimized Vital signs are stabilized Client returns to baseline functioning
References Rangel-Castillo, L, Gopinath, S. , & Robertson, C. S. (2009). Management of intracranial hypertension. Neurologic Clinics, 26(2), 521 -541. Ignatavicius, D. D. & Workman, M. L. (2010). Medicalsurgical nursing: patient-centered collaborative care (6 th ed. ). St. Louis, MO: Saunders Elsevier. Lewis, S. L. , Heitkemper, M. M. , Dirksen, S. R. , & Bucher, L. (2014). Medical-surgical nursing: Assessment & management of client problems (9 th ed. ). St. Louis, MO: Mosby Hogan, M. , Dentlinger, N. C. , & Ramdin, V. (2014). Medical-surgical: nursing pearson nursing reviews and rationales (3 rd ed. ). Boston, MA: Pearson.
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