Increased Intracranial Pressure Nursing Care Plan & Management

Notes

Description
  • Increased intracranial pressure is a rise in the pressure inside the skull that can result from or cause brain injury. is the pressure in the skull that results from the volume of three essential components: cerebrospinal fluid (CSF), intracranial blood volume and central nervous system tissue. The normal intracranial pressure is between 5-15 mmHg. This is slightly lower than the mean systemic arterial pressure but considerably higher than venous pressure.icp
  • The intact cranium is essentially inexpandable containing about 1400 grams of central nervous system (CNS) or brain tissue, 75 ml of blood and about 75 ml of cerebrospinal fluid (CSF). These three components of the cranial vault maintain a state of equilibrium. Their pressure and volume determine the condition of balance.
  • According to Monro-Kellie hypothesis, any increase in one of these elements must be balanced or compensated by a proportional constriction either or both of the other two components such as decreasing the volume of cerebral blood flow, shifting CSF flow (into the spinal canal) or increasing CSF absorption. Absence of these compensatory changes results to increased intracranial pressure. Once ICP reaches around 25 mmHg marked elevation in intracranial pressure will be noted.Increased intracranial pressure is a rise in the pressure inside the skull that can result from or cause brain injury.
  • AKA: ICP; Intracranial pressure – increased; Intracranial hypertension; Acute increased intracranial pressure; Sudden increased intracranial pressure
Causes
  • Aneurysm rupture and subarachnoid hemorrhage
  • Brain tumor
  • Encephalitis
  • Head injury
  • Hydrocephalus (increased fluid around the brain)
  • Hypertensive brain hemorrhage
  • Intraventricular hemorrhage
  • Meningitis
  • Subdural hematoma
  • Status epilepticus
  • Stroke
Signs and symptoms
  • In general, symptoms and signs that suggest a rise in ICP including headache, vomiting without nausea, ocular palsies, altered level of consciousness, back pain and papilledema. If papilledema is protracted, it may lead to visual disturbances, optic atrophy, and eventually blindness.
  • In addition to the above, if mass effect is present with resulting displacement of brain tissue, additional signs may include pupillary dilatation, abducens palsies, and the Cushing’s triad. Cushing’s triad involves an increased systolic blood pressure, a widened pulse pressure, bradycardia, and an abnormal respiratory pattern.In children, a low heart rate is especially suggestive of high ICP.
  • Irregular respirations occur when injury to parts of the brain interfere with the respiratory drive. Cheyne–Stokes respiration, in which breathing is rapid for a period and then absent for a period, occurs because of injury to the cerebral hemispheres or diencephalon. Hyperventilation can occur when the brain stem or tegmentum is damaged.
  • As a rule, patients with normal blood pressure retain normal alertness with ICP of 25–40 mmHg (unless tissue shifts at the same time). Only when ICP exceeds 40–50 mmHg do CPP and cerebral perfusion decrease to a level that results in loss of consciousness. Any further elevations will lead to brain infarction and brain death.
  • In infants and small children, the effects of ICP differ because their cranial sutures have not closed. In infants, the fontanels, or soft spots on the head where the skull bones have not yet fused, bulge when ICP gets too high.
Complications
  • Death
  • Permanent neurological problems
  • Reversible neurological problems
  • Seizures
  • Stroke
Medical Mangement
  • The treatment for IH depends on the etiology. In addition to management of the underlying causes, major considerations in acute treatment of increased ICP relates to the management of stroke and cerebral trauma.
  • A very common treatment for long-term, especially idiopathic, cranial hypertension is medication with a special diuretic, especially one prescribed by a neurologist.
  • In patients who have high ICP due to an acute injury it is particularly important to ensure adequate airway, breathing, and oxygenation. Inadequate blood oxygen levels (hypoxia) or excessively high carbon dioxide levels (hypercapnia) cause cerebral blood vessels to dilate, increasing the flow of blood to the brain and causing the ICP to rise.Inadequate oxygenation also forces brain cells to produce energy using anaerobic metabolism, which produces lactic acid and lowers pH, also dilating blood vessels and exacerbating the problem.Conversely, blood vessels constrict when carbon dioxide levels are below normal, so hyperventilating a patient with a ventilator or bag valve mask can temporarily reduce ICP. Hyperventilation was formerly a part of the standard treatment of traumatic brain injuries, but the induced constriction of blood vessels limits blood flow to the brain at a time when the brain may already be ischemic—hence it is no longer widely used. Furthermore, the brain adjusts to the new level of carbon dioxide after 48 to 72 hours of hyperventilation, which could cause the vessels to rapidly dilate if carbon-dioxide levels were returned to normal too quickly.Hyperventilation is still used if ICP is resistant to other methods of control, or there are signs of brain herniation because the damage herniation can cause is so severe that it may be worthwhile to constrict blood vessels even if doing so reduces blood flow. ICP can also be lowered by raising the head of the bed, improving venous drainage. A side effect of this is that it could lower pressure of blood to the head, resulting in a reduced and possibly inadequate blood supply to the brain. Venous drainage may also be impeded by external factors such as hard collars to immobilize the neck in trauma patients, and this may also increase the ICP. Sandbags may be used to further limit neck movement.
  • In the hospital, the blood pressure can be artificially increased in order to increase CPP, increase perfusion, oxygenate tissues, remove wastes and thereby lessen swelling.[Since hypertension is the body’s way of forcing blood into the brain, medical professionals do not normally interfere with it when it is found in a patient with a head injury. When it is necessary to decrease cerebral blood flow, MAP can be lowered using common antihypertensive agents such as calcium channel blockers.If there is an intact blood–brain barrier, osmotherapy may be carried out by administering IV mannitol to create a hypertonic solution within the blood to draw water out of the neurons. This helps to reduce the fluid within the intracranial space, however prolonged administration may lead to increase in ICP.
  • Struggling, restlessness, and seizures can increase metabolic demands and oxygen consumption, as well as increasing blood pressure.Analgesia and sedation (particularly in the pre-hospital, ER, and intensive care setting) are used to reduce agitation and metabolic needs of the brain, but these medications may cause low blood pressure and other side effects.Thus if full sedation alone is ineffective, patients may be paralyzed with drugs such as atracurium. Paralysis allows the cerebral veins to drain more easily, but can mask signs of seizures, and the drugs can have other harmful effects.Paralysing drugs are only introduced if patients are fully sedated (this is essentially the same as a general anaesthetic)
  • Intracranial pressure can be measured continuously with intracranial transducers. A catheter can be surgically inserted into one of the brain’s lateral ventricles and can be used to drain CSF (cerebrospinal fluid) in order to decrease ICP’s. This type of drain is known as an EVD (extraventricular drain).In rare situations when only small amounts of CSF are to be drained to reduce ICP’s, drainage of CSF via lumbar puncture can be used as a treatment. There are many clinical studies of non-invasive intracranial pressure measurement methods currently being proposed, aimed to find reliable and accurate way to measure ICP non-invasively. Such method could improve diagnostics of traumatic brain injury and many other conditions associated with intracranial hypertension.
  • Craniotomies are holes drilled in the skull to remove intracranial hematomas or relieve pressure from parts of the brain.As raised ICP’s may be caused by the presence of a mass, removal of this via craniotomy will decrease raised ICP’s.
  • A drastic treatment for increased ICP is decompressive craniectomy, in which a part of the skull is removed and the dura mater is expanded to allow the brain to swell without crushing it or causing herniation.The section of bone removed, known as a bone flap, can be stored in the patient’s abdomen and recited back to complete the skull once the acute cause of raised ICP’s has resolved. Alternatively a synthetic material may be used to replace the removed bone section.
Nursing Intervention
  • Assess respiratory and neurological status
  • Vital Sign’s Monitor and Documents (Plus,Blood Pressure)
  • Check Laboratory Test such as CPP
  • Administration oxygen as order
  • Give medication therapy as order
  • Maintain Nutritional and food status
  • Maintain Diet plan give soft and healthy meal according to ditreation order
  • Sucction only as needed
  • keep the patient in semi-Fowler’s positions
  • promot healthy and comfortable environmental
  • educate client’s about every kind of procedure
  • assist with turning,coughing,and deep breathing
  • Maintain the position and patency of the NG tube
  • Enforce bed rest
  • promote mouth care and skin care
  • Maintain skin care change position every hourly to prevent bed sore
  • Maintain seizure precautions
  • Provide emotional support client’s and his family

References:
  • http://nursingcrib.com/pathophysiology/increased-intracranial-pressure/
  • http://www.umm.edu/ency/article/000793all.htm
  • http://en.wikipedia.org/wiki/Intracranial_pressure
  • http://cncplan.blogspot.com/2012/06/nursing-intervention-for-icp-increased.html
  • image courtesy of ADAM via http://assets0.scripps.org/encyclopedia/graphics/images/en/9453.jpg

Exam

Welcome to your MSN Exam for Increased Intracranial Pressure! This exam is carefully curated to help you consolidate your knowledge and gain deeper understanding on the topic.

 

Exam Details

  • Number of Questions: 25 items
  • Mode: Practice Mode

Exam Instructions

  1. Practice Mode: This mode aims to facilitate effective learning and review.
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Remember, this exam is not just a test of your knowledge, but also an opportunity to enhance your understanding and skills. Enjoy the learning journey!

 

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💡 Hint

Think about mannitol’s primary role in reducing intracranial pressure by drawing fluid out of the brain tissues through osmotic effects.

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1. Nurse Laura is caring for a client with a subdural hematoma who becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol. For what purpose is mannitol prescribed in this case?

💡 Hint

Think about how carbon dioxide levels can impact intracranial pressure and which goal would directly help in preventing ICP from rising.

2 / 25

2. Nurse Lisa is caring for a male patient with suspected increased intracranial pressure (ICP). While setting respiratory goals to help manage the patient's condition, which of the following is the most appropriate objective?

💡 Hint

Certain procedures can trigger spikes in ICP. Consider actions that may cause abrupt increases in intracranial pressure due to stimulation or airway management techniques.

3 / 25

3. Nurse Linda is caring for a patient with increased intracranial pressure (ICP). Which intervention should the nurse avoid to prevent further increases in ICP?

💡 Hint

Consider which position might obstruct venous drainage from the brain, potentially worsening ICP.

4 / 25

4. Nurse Amy is caring for a female patient with increased intracranial pressure (ICP). As she adjusts the patient's position, she ensures proper alignment to prevent any further elevation in ICP. Which position should Nurse Amy avoid for this patient?

💡 Hint

Consider symptoms that occur as ICP advances, often affecting the gastrointestinal system more intensely, rather than changes in heart rate or blood pressure.

5 / 25

5. Nurse Carla is monitoring a patient for signs of worsening increased intracranial pressure (ICP). As she observes the patient, she knows that later signs of ICP typically include which of the following?

💡 Hint

Consider which medication would be used to blunt the cough reflex and prevent a spike in ICP during suctioning.

6 / 25

6. Nurse Karen is caring for a female patient with increased intracranial pressure (ICP) who is intubated and on mechanical ventilation. To prevent further increases in ICP during suctioning, which drug would the nurse anticipate administering endotracheally before the procedure?

💡 Hint

Elevated phenytoin levels often lead to neurological side effects related to motor coordination and cognitive function rather than triggering seizures or affecting sodium levels.

7 / 25

7. Nurse Julia is caring for a patient with a phenytoin level of 32 mg/dl, which is above the therapeutic range. Which of the following symptoms might she observe?

💡 Hint

Normal ICP values are much lower than blood pressure and usually stay within a narrow range for proper brain function.

8 / 25

8. Nurse Sarah is reviewing normal intracranial pressure (ICP) values while caring for a patient in the ICU. Which of the following is considered a normal range for ICP?

💡 Hint

This lobe is responsible for processing sensory input, including touch and temperature perception.

9 / 25

9. Nurse James is assessing a client who reports being unable to feel the temperature of a hot oven while cooking. Which lobe of the brain might be dysfunctional in this case?

💡 Hint

Mannitol works by promoting osmotic diuresis. The best sign of its effectiveness is related to fluid output rather than changes in vital signs or lab values.

10 / 25

10. Nurse Amy is evaluating a client with a subdural hematoma who was given mannitol to lower intracranial pressure (ICP). Which of the following findings would best indicate that the mannitol is effective?

💡 Hint

The goal is to maximize the space between the vertebrae by flexing the spine, which helps in easier access to the lumbar area.

11 / 25

11. Nurse Megan is preparing a client for a lumbar puncture. In which position should the nurse place the client for the procedure?

💡 Hint

Remember that CPP is calculated by subtracting the ICP from the mean arterial pressure (MAP). First, calculate MAP using the blood pressure provided.

12 / 25

12. Nurse Sarah is caring for a client with a head injury and monitoring for increased intracranial pressure (ICP). The client’s blood pressure is 90/60 mmHg, and his ICP is 18 mmHg. Based on these values, what is the client’s cerebral perfusion pressure (CPP)?

💡 Hint

Early signs of ICP often include general discomfort and symptoms that affect the gastrointestinal system, rather than severe neurological impairments.

13 / 25

13. Nurse Clara is educating the family of a patient who recently suffered a concussion about the early signs of increased intracranial pressure (ICP). Which of the following would she identify as an early indicator?

💡 Hint

Increased ICP tends to affect vital signs in a specific way, especially involving heart rate and blood pressure.

14 / 25

14. Nurse Jordan is reviewing symptoms of increased intracranial pressure (ICP) with a patient diagnosed with a brain tumor. Whether benign or malignant, the tumor could eventually raise ICP. Which of the following is not typically associated with signs of increased ICP?

💡 Hint

Consider which drug type is used to reduce metabolic demand on the brain and lower ICP, often through sedation or reducing brain activity.

15 / 25

15. Nurse Jenna is preparing medications for a patient with increased intracranial pressure (ICP). Which type of drug might be administered to help manage this condition?

💡 Hint

The oculovestibular reflex response to cold water—slow movement of the eyes toward the stimulus followed by nystagmus in the opposite direction—indicates a normally functioning brainstem.

16 / 25

16. Nurse Rachel is assisting with caloric testing of the oculovestibular reflex in an unconscious client. After cold water is injected into the left ear, the client shows eye movements toward the left, followed by rapid nystagmus toward the right. The nurse recognizes that this finding indicates:

💡 Hint

Cushing’s triad—a classic sign of increased ICP—includes hypertension, bradycardia, and irregular respirations. Temperature may also rise with increasing ICP.

17 / 25

17. Nurse Julia is monitoring a client with increased intracranial pressure (ICP). Which of the following trends in vital signs would indicate that ICP is rising?

💡 Hint

The earliest signs of ICP are usually related to changes in behavior or mental status. Think about how the brain might respond initially to increased pressure.

18 / 25

18. Nurse Taylor is assessing a patient who was admitted after a head injury from a car accident. While monitoring for signs of increased intracranial pressure (ICP), she remains alert for early indicators. Which of the following would most likely be the first sign to appear?

💡 Hint

Consider changes in the client's level of consciousness, as these can be early indicators of rising ICP. Look for signs of altered mental status or sleepiness.

19 / 25

19. Nurse Mike is monitoring a male client who was brought to the emergency department after a motor vehicle accident. The nurse begins to suspect increasing intracranial pressure (ICP) when noticing which of the following signs?

💡 Hint

Consider the risk of causing herniation with certain procedures when ICP is elevated.

20 / 25

20. Nurse Angela is caring for a client admitted with a subarachnoid hemorrhage who reports a severe headache, neck stiffness (nuchal rigidity), and projectile vomiting. The nurse understands that a lumbar puncture (LP) would be contraindicated in which of the following situations?

💡 Hint

Think about the lobe responsible for processing information related to memory, hearing, and understanding language.

21 / 25

21. Nurse Olivia is assessing a patient who is experiencing difficulties with memory and learning. These issues are most likely related to which lobe of the brain?

💡 Hint

Consider signs that suggest increased pressure in the brain, particularly those that involve the gastrointestinal system or neurological status in young children.

22 / 25

22. Nurse Emily is monitoring a 4-year-old child in the emergency department for signs of increased intracranial pressure (ICP) after a fall from a bicycle that resulted in head trauma. Which of the following signs would raise concern for increased ICP?

💡 Hint

Peripheral pain response is best assessed by applying pressure to areas that target distal nerves, rather than using methods focused on central or facial areas.

23 / 25

23. Nurse Alex is assessing the motor function of an unconscious client and needs to test the client's peripheral response to pain. Which method should Nurse Alex use?

💡 Hint

Behavioral and mental status changes often appear early when ICP begins to rise. Focus on symptoms related to agitation or altered consciousness.

24 / 25

24. Nurse Sarah is closely monitoring a patient with a severe head injury for signs of increasing intracranial pressure (ICP). Which of the following findings is the most indicative of rising ICP?

💡 Hint

The earliest signs of increased ICP usually involve mental or behavioral changes rather than changes in vital signs.

25 / 25

25. Nurse Kelly is monitoring a patient after head trauma for signs of increased intracranial pressure (ICP). Which of the following signs would most likely appear first?

Nursing Care Plan