Client with Increased Intracranial Pressure

What is the normal lab value of ICP?

0-15 mmHg

What are some complications of increased ICP?

1. Brain Herniation. 2. DI and SIADH.

What are some miscellaneous signs of increased ICP?

1. Headaches. 2. Changes in pupils and pupil responses. If profound coma, fixed and dilated. 3. Projectile vomiting can occur because vomiting center in brain stimulated.

What is posturing?

A response to painful or noxious stimuli. Indicates that the motor response centers of the brain are compromised. Client will be rigid, tight, and burning calories.

What is Decerebrate posturing?

All 4 extremities in rigid extension. It's the worst. Can occur only on one side too.

Why should you keep temp below 100.4?

An increased temp will increase cerebral metabolism which increases ICP.

Why should you space nursing interventions with increased ICP?

Anytime you do something to your client, ICP increases.

What is Decorticate posturing?

Arms flexed inward and bent in toward the body and the legs are extended

What is the purpose of barbiturate induced coma in increased ICP?

Decrease cerebral metabolism. Use phenobarbital.

Why should you maintain oxygenation with increased ICP?

Decreased O2 levels and high CO2 levels cause cerebral vasodilation which increases ICP further.

What is the greatest risk with ICP monitoring devices?

Infection

How should you maintain adequate cerebral perfusion?

It is a balancing act. You don't want hypertension or bradycardia because that would decrease brain perfusion. Use isotonic saline and inotropic agents like dobutamine and norepinephrine to prevent hypertension.

What are the components of increased ICP treatment?

Maintain oxygenation. Maintain adequate cerebral perfusion. Keep temp below 100.4. Elevate head of bed. Keep head midline so the jugular veins can drain. Watch ICP monitor with turning. Avoid restraints, bowel/bladder distention, hip flexion, Valsalva, and isometrics. No sneezing and no nose blowing. Limit suctioning and coughing. Space nursing interventions. Use GCS. Monitor vital signs. Barbiturate induced coma. Osmotic diuretics. Steroids. ICP monitoring devices.

What are the late signs of increased ICP?

Marked change in LOC progressing to stupor, then coma. Vital sign changes. Posturing.

What is the purpose of osmotic diuretics in increased ICP?

Pull fluid from brain cells and filters it out through kidneys. Use mannitol. Decreases ICP.

What is the purpose of steroids in increased ICP?

Steroids decrease cerebral edema. Dexamethasone.

How do you keep temp below 100.4?

The hypothalamus may not be working properly, and a cooling blanket may be needed. Hypothermia used as treatment to decrease cerebral edema by decreasing the metabolic demands of brain.

If the Glasgow coma score is below 8, what should you think of?

Think intubation.

What is brain herniation?

This herniation obstructs the blood flow to the brain leading to anoxia and then brain death.

What are the vital sign changes of increased ICP?

Called Cushing's Triad and requires immediate intervention to prevent brain ischemia. 1. Systolic hypertension with a widening pulse pressure. 2. Slow, full, and bounding pulse. 3. Irregular respirations. Change in pattern. Mean apnea and prognosis is bad.

What are the signs and symptoms of increased ICP?

▫ Earliest sign is change in LOC. ▫ Speech slurred or slowed. ▫ Delay in response to verbal suggestion. Slow to respond to commands. ▫ Increasing drowsiness. ▫ Restless with no apparent reason. ▫ Confusion.

What are some ICP monitoring devices?

▫ Ventricular catheter monitor or subarachnoid screw. ▫ No loose connections. ▫ Keep dressings dry or bacteria can travel through.