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Icp Intra Cranial Pressure

The document discusses increase intracranial pressure, noting that it occurs when there is an imbalance between the components inside the skull. It covers the pathophysiology, causes such as brain tumors and head injuries, diagnostic tools, treatments to reduce pressure such as medications and surgery, monitoring of pressure, and nursing care for patients with increased intracranial pressure. The goal of treatment is to maintain adequate blood flow to the brain to meet its metabolic needs by keeping intracranial pressure below 20 mmHg and cerebral perfusion pressure above 50-70 mmHg.

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Meikha Tamnge Batjun
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479 views38 pages

Icp Intra Cranial Pressure

The document discusses increase intracranial pressure, noting that it occurs when there is an imbalance between the components inside the skull. It covers the pathophysiology, causes such as brain tumors and head injuries, diagnostic tools, treatments to reduce pressure such as medications and surgery, monitoring of pressure, and nursing care for patients with increased intracranial pressure. The goal of treatment is to maintain adequate blood flow to the brain to meet its metabolic needs by keeping intracranial pressure below 20 mmHg and cerebral perfusion pressure above 50-70 mmHg.

Uploaded by

Meikha Tamnge Batjun
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Increase Intracranial Pressure

Brain

 Brain tissue (1,400g)


 Blood (75mL)
 CSF (75mL)
 Normal ICP 10 to 20 mmHg
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.
Pathophysiology
 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.
Elevated ICP most commonly associated
with head injury
 Secondary Effects
 Brain tumors
 Subarachnoid hemorrhage
 Toxic and viral encephalities
Brain Tumor

Decrease Cerebral Blood Flow

Ischemia and Cell Death Early Cerebral Ischemia

Vasomotor Stimulation
(brainstem)

Increase Systemic Pressure


(s/sx slow pulse, cheyne-stokes
resp.,elevated temp.)

Increase ICP
Diagnostic Findings
 Cerebral Angiography
 Computed Tomography (CT) Scanning
 Magnetic Resonance Imaging (MRI)
 Positron Emission Tomography (PET)
 Transcranial Doppler
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
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
Magnetic Resonance Imaging

 The first image shows


normal MRI result
 The second image
shows with brain tumor
that causes increase
ICP
Positron Emission Tomography

 The first image shows


normal PET result
 The second image
shows with brain tumor
that may lead to
increase ICP
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
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.
Manipulation of ICP
Blood

 Decrease cerebral metabolic demand


 sedation, analgesia, barbiturates

 avoid hyperthermia

 avoid seizures

 Hyperventilation
 decreases blood flow to brain

 only acutely for impending herniation

 Mannitol
Manipulation of ICP

Brain

 Mannitol
 dehydrate the brain, not the patient!
 monitor osmolality
 Hypertonic saline
 Decompressive craniectomy
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.
Why Monitor?

 Detect “events”
 Manage intracranial pressure
 Manage cerebral perfusion pressure
How?

 Ventriculostomy
 Intraparenchymal fiberoptic catheter
 Subarachnoid monitor
 Useful adjuncts:
 Arterial line
 Central venous line
 Foley catheter
Manipulation of ICP

CSF
 External drainage
 therapeutic as well as diagnostic
 technical issues
 infectious issues
What to do with the
information...

 Goal: adequate oxygen delivery to maintain the


metabolic needs of the brain.
 Intracranial pressure <20
 Cerebral perfusion pressure >50-70 mm Hg
CPP=MAP-ICP
Indications for ICP monitoring

 Glasgow coma scale <8


 Clinical or radiographic evidence of
increased ICP
 Post-surgical removal of intracranial
hematoma
 Less severe brain injury in the setting
which requires deep sedation or
anesthesia
Measure ICP

Maintain CPP>70 mm Hg
Management of
Raised ICP Raised ICP>25mm Hg

 First Line Ventricular Drain


Rx
Raised ICP>25mm Hg CT

Normal Vent/Oxygenation
Mannitol
Sedation
Maintain CPP>70 mm Hg

Management of Raised ICP>25mm Hg

Raised ICP
Furosemide
Chemical Paralysis
 Second Line CSF Removal
Vasopressor
Rx

Raised ICP>25mm Hg

Barbiturates
Hyperventilation
Monitor SjO2
Nursing Process

The Patient with Increased Intracranial


Pressure
Assessment
 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


Nursing Diagnosis
 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
Planning and Goals
 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
Nursing Intervention
 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
Evaluation
 Maintained patent airway
 Attains optimal breathing pattern
 Attains desired fluid balance
 Infection prevented
 Complications prevented

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