Increased Intracranial Pressure

1. Increased Intracranial Pressure Pretoria hoyte

2. The Brain • the first layer of protection for the brain is bone • Meninges is the second layer • The third and final layer of protection for the brain is Cerebrospinal fluid

3. Etiology • is the pressure exerted by the cranium on the brain tissue, cerebrospinal fluid (CSF), and the brain's circulating blood volume. • Increased ICP is a complex grouping of events that occurs because of multiple neurological conditions

4. Etiologycont. • Traumatic brain injury is a devastating problem with both high mortality and high subsequent morbidity • Injury to the brain occurs both at the time of the initial trauma (the primary injury) and subsequently due to ongoing cerebral ischemia (the secondary injury).

5. Etiologycont. • Cerebral edema, hypotension, and axonal hypoxic conditions are well recognized causes of this secondary injury.

6. Causes of ICP • Causes of increased intracranial pressure can be classified by the mechanism in which ICP is increased: • mass effect such as brain tumor, infarction with edema, contusions, subdural or epidural hematoma, or abscess all tend to deform the adjacent brain. • generalized brain swelling can occur in ischemic-anoxia states, acute liver failure, hypertensive encephalopathy, pseudotumor cerebri, hypercarbia, and Reye hepatocerebral syndrome. These conditions tend to decrease the cerebral perfusion pressure but with minimal tissue shifts.

7. Causes cont. • increase in venous pressure can be due to venous sinus thrombosis, heart failure, or obstruction of superior mediastinal or jugular veins • increased CSF production can occur in meningitis, subarachnoid hemorrhage, or choroid plexus tumor.

8. Cushing’s response (widened pulde pressure, increased systolic b/p, and bradycardia) Diplopia Change in personality Ipsilateral pupil Ataxic breathing Signs & Symptoms In general, symptoms and signs that suggest a rise in ICPincluding • Headache • nausea • vomiting, • ocular palsies • altered level • of consciousness • papilledema • Blown pupil

9. Diagnostic Tests • MR scan can show actual structural herniation and shifting of the brain • Most of the time acute increased ICp is a medical emergency, and there is little time for diagnostic tests.

10. Diagnostic Testcont. • Intracranial pressure can be measured by means of a lumbar puncture • or continuously with intracranial transducers (a catheter is inserted through a burr hole in the skull)

11. Treatment • One of the most important treatments for high ICP is to ensure adequate airway, breathing, and oxygenation, since inadequate oxygen levels or excess carbon dioxide cause cerebral blood vessels to dilate and ICP to rise. • Osmotic diuretics (draws water from the edematous brain tissue)

12. Treatmentcont. • Anticonvulsants are given to prevent seizures (Dilantin) • Opioids should be avoided (causes respiratory depression) • Corticosteroids (are thought to control edema surrounding cerebral tumors and abscesses)

13. Nursing Interventions • Elevate the head of the bed 30 to 45 degrees to promote venous return • Position paitent to avoid flexion of the hips • Restrict fluid intake • Avoid Valsalva’s maneuver • Perform suctioning prn • Admin. O2 via mask or cannula to improve cerebral perfusion

14. Nursing Interventionscont. • Use a hypothermia blanket to control body temp. • Perform neuro checks every 30 minutes

15. Prognosis • For the patient with increased ICP depends on the cause and rapidness with which it is treated