ICP

Causes of Intracranial Pressure (This Hat)

Tumore

Hematoma

Infections

Stroke

Hydrocephalus

Abscess

Traumatic Brain Injury

Signs of ICP Early

• change in LOC (restless, confused, drowsy)

• headache

• vision/pupil change

Signs of ICP Late

• LOC deteriorates to difficulty to arousal and leads to coma

• pupils are fixated and dilated

• temperature changes

• irregular respiration

• abnormal posturing

• Cushing triad (differ from syndrome: hypertension widen pulse, bradycardia +bounding pulse, irregular respiration

Abnormal Positioning

1. Decorticate: arm flexure in towards chest while legs extend (Core=chest)

2. Decerebrate: arms extended and pronated and legs extended and plantar flexed (extension worsen and deeper brainstem level)

ICP Nursing Interventions

Neuro: GSC, posturing

Cardio/resp: patent airway , head midline, HOB 30 degree

Nutrition: fluid & electrolyte imbalance

fever raises metabolic rate and o2 need to prevent shivering

therapeutic hypothermia <96.8 F, stablize BBB, prevent cell death, decrease metabolic rate,

Nursing Interventions ICP

avoid neck/hip flexion

valsalva (stool softeners)

clustering stimulating care

suction less than 10 sex after hyper oxygenating

quiet/dim room

Meds: Osmotic Diuretics

Mannitol

increases serum osmolality pulling water out of the brain tissue

Meds: Loop Diuretics

Furosemide

reduces fluid volume

Meds: Glucocorticoid

Dexamethasone

reduces edema: may alternate with mannitol

Meds: Sedative (-lam+-pam)

decreases cerebral metabolic demands and helps ventilation while decreased ICP

Meds: Neuromuscular Blockers (-curonium, -curium)

help ventilation, stop posturing and coughing that can spike ICP

Meds Barbiturate

Pentobarbital

decreases cerebral metabolism and O2, limit swealling