WELCOME

MANAGEMENT OF INCREASED INTRA

CRANIAL PRESSURE

Deepa Merin Kuriakose1st Semester MSc Nursing

Medical College, Kottayam

INTRODUCTIONIncreased ICP is a life-threatening situation that results from

an increase in any or all of the three components (Brain Tissue, Blood, CSF) of the skull. Cerebral edema is an

important factor contributing to increased ICP The rigid cranial vault contains Brain Tissue (1400 gm),

Blood (150 ml) and CSF (150 ml). The volume and pressure of these three components are usually in a state of

equilibrium because it is a closed space, If one component enlarges, the other must compress and after spatial

compensation is exhausted, with relatively small increase in volume, the intra cranial pressure will increase. With

increased intra cranial pressure, blood flow and oxygen delivery may be compromised and secondary injury occurs. Normal ICP ranges from 0-15 mmHg with the use of pressure

transdueer. A sustained pressure above upper limit is considered abnormal.

ETIOLOGY

1. Conditions that increase brain volume.Space Occupying Masses (Hematomas,Abscesses, Tumors, Anessysm) Cerebral Edema (Head Injury)

2. Conditions that increase blood volume.

3. Obstructions of Venom Outflow

PATHOPHYSIOLOGY

It is directly proportional to cerebral edema.Vasegenic edema is the most common type of edema seen in patients with cerebrovascular problems and trauma. It predominantly affects the white matter, causes extracellular fluid accumulation, increasing the brain bulk and elevating ICP Decrease regional CBF Decrease CPP Increase CO2 Decrease O2 Increase acidosis from the products of cell metabolism Vasodilation Increase CBF Increase CBV Increase ICP Possible impairment of Local autoregulation.

CHEMICAL FEATURES

Cushing’s Response (Cushing’s Reflex): Is a comparatory response designed to provide adequate CPP in the presence of rising ICP.

1. A rise in the systolic ICP 2. Widening of the pulse pressure 3. Brady Cardia

CRUSHING’S TRIAD

At a certain volume or pressure the brain’s ability to autoregulate becomes in effective and begins

ineffective and decompensation begins. The crushing triad includes (a grave sign)

1. Brady Cardia 2. Hyper tension and 3. Bradyprea (Abnormal respiratory pattern)

EARLY FINDINGS

1. Deterioration in the level of consciousness2. Pupillary Diffusion 3. Visual Abnormalities 4. Determination of Motor Function 5. Headache 6. Vomiting 7. Changes in Vital Signs (Altered B.P. and Pulse)

MANAGEMENT

MEDICAL MANAGEMENT

Respiratory Support Oxygen Airway Support Hyperventilation Decreased PCO2 35 to 28 mmHg. Vasoconstriction of the cerebral arteries, Reduced CBF and increased venous return from the brain.

A High CO2 level increases ICP

Corticosteroids

Blood Pressure Medication

Antipyretics and Muscle Relaxants

Anticonvulsants

I/V Fluids

Medications for ICP

Surgical Intervention of ICPV.P.Shunt :- Shunts CSF from the ventricles into the periforeum.Implementation Post Procedure :- Position the client supine and turn from back to non operative side.Monitor for signs of increasing ICP resulting from shunt failure.Monitor for signs of infusion

 C.S.F. Drainage : Ventricular DrainageSurgery : Remove haematoma, tumor, abscess,

removal or debulking of the lesion.

MONOTORING ICP

The purpose of ICP monitoring are to identify increased pressure early in its

course (before cerebral damage occurs), to quantify the degree of elevation, to initiate appropriate treatment, to provide access to

CSF for sampling and drainage and to evaluate the effectiveness of treatment.

Different Approaches of ICP Monitoring

Intraventricular catheter Subarachroid bolt/screw

Epidural or Subdural Catheter or Sensor

Fiberoptic Transducer Tipped Catheter

ICP PRESSURE WAVES

A (Plateau) Waves

B Waves

C Waves

NURSING MANAGEMENT

Neurological Assesment Establishing and Maintaining a Patent Airway Positioning and Moving Patients Monitor urinary out put and specific gravity Ventricular Drainage Interpret the ICP waves and be alert about atypical readings General Nursing Management

Nursing Care Plan

Client is bedridden, client is not able to cough effectively

GCSL8

Client Immobile

Client is not able to perform ADL

Client in a comatosed stage

Increased ICP, R/T, cerebral edema

CONCLUSIONBesides the carefully planned physical care

provided, patients with increased ICP, the nurse must also be aware of the psychological well

being of the patients and their families. There is a need for supports, information and education of both patients and families. The nurse should asses the family members desire and need to

assist in providing care for the patient and allow for their participation as appropriate.

Thank You  

Deepa Merin Kuriakose

1st Semester MSc Nursing

Medical College, Kottayam