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NURSING MANAGEMENT OF INCREASED INTRACRANIAL PRESSURE.

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Presentation on theme: "NURSING MANAGEMENT OF INCREASED INTRACRANIAL PRESSURE."— Presentation transcript:

1 NURSING MANAGEMENT OF INCREASED INTRACRANIAL PRESSURE

2 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-management-of- elevated-intracranial-pressure-in-adults

3 Physiology-Increased Intracranial Pressure  Not a disease but secondary process from an insult to the brain  Prolonged pressure above 15 mmHg (normal 5-10 mmHg)

4 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

5 Cushing’s Triad 1. Hypertension (Systolic BP) 2. Widened Pulse Pressure 3. Bradycardia (170/50….180/40….200/20)

6 Posturing with  ICP  Decorticate posturing  Lesions that interrupt the corticospinal pathways  Decerebrate posturing  dysfunction in the brainstem

7 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

8 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)

9 Plan/Goal for  ICP  Adequate cerebral perfusion  Minimize cerebral tissue damage/death with early interventions

10 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/PMC2452989/

11 Evaluation – Desired Outcomes  Normal ICP (5-10 mmHg) is maintained  Ischemia is minimized  Vital signs are stabilized  Client returns to baseline functioning

12 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). Medical- surgical 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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