Increased Intracranial Pressure All Answers Correct

Increased Intracranial Pressure All Answers Correct What is Intracranial Pressure? ️The cranium has three comparements: 80% the brain, 10% blood and 10% CSF. Intracranial pressure is the pressure exerted within the cranium by these contents. Pressure usually ranges from 5-15mmHg. Monro-Kellie hypothesis ️The pressure-volume relationship between ICP, volume of CSF, blood, and brain tissue, and cerebral perfusion pressure (CPP) is known as the Monro-Kellie doctrine or the Monro Kellie hypothesis. If the volume of one component increases, the volume of the other component must decrease to keep the pressure within normal range. Increased ICP (The Cascade) ️When ICP increases, cerebral vasoconstriction occurs, which reduces cerebral blood and causes ischemia. If ischemia lasts longer than 5 minutes, the result is irreversible brain damage. ICP is also affected by CO2 and O2 in the blood, increased CO2 or decreased O2 cause vasodilation of the cerebral arteries. Increased ICP manifestations ️Changes in person's LOC, motor function, speech, vitals and becomes more dramatic as ICP increases. Location/cause will determine the symptoms. Later symptoms include decorticate (flexion) and decerebrate (extension) posturing indicate IICP in the patient and must be treated immediately. Cushing response occurs late in development of IICP. Cushing Triad ️Cushing's triad is a clinical triad variably defined as having: Irregular respirations (caused by impaired brainstem function) Bradycardia. Systolic hypertension (Widening Pulse Pressure) Two Major Complications with IICP ️Inadequate cerebral perfusion Cerebral herniation Early Signs of IICP: Compensatory mechanisms intact ️Altered LOC (confusion, restlessness,) Unilateral pupil change in size, equality, and or reactivity Alterted respiratory pattern (bradypnea or irregular pattern) Unilateral hemiparesis (one sided weakness) Variable signs include: focal findings (e.g speech, difficulty, visual disturbances), pailledema, vomiting, headache, seizures caused by irritation of the brain. Papilledmea ️Papilledema (or papilloedema) is optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks. Late signs of Increased ICP: Compensatory mechanisms failing ️Decreased LOC (stupor) Unilateral or bilateral puillary changes: size, equality, and or reactivity(global pressure) Ineffective breathing pattern (cheyne-stokes respiration) Abnormal motor response (decorticate or decerebrate posturing) Variable signs: HTN with widened pulse pressure. Bradycardia, hyperthermia Terminal signs of Increased ICP (Decompensation) ️Coma Bilaterally fixed and dilated pupils -no reaction to light Respiratory and cardiac arrest absence of motor response (flaccid) Dying Variable signs: HTN with widened pulse pressure. Bradycardia, hyperthermia ICP cascade pathophysiology map ️Insult to brain -> tissue edema -> Increased ICP -> compression of ventricles -> compression of blood vessels -> decreased cerebral blood flow -> decreased O2 with death of brain cells -> edema around necrotic tissue -> increased ICP with compression of brain stem and respiratory center -> accumulation of CO2 -> vasodilation -> increased ICP resulting from increased blood volume and death. Brain Herniation ️Brain herniation occurs late in the course of IICP. In an attempt to save the brain tissue, the brain shifts from an area of high pressure to low pressure. One common site of herniation is the foramen magnum (the hole at the base of the brain where the spinal cord exits. Nursing Diagnosis ️Ineffective airway clearance, ineffective tissue perfusion, impaired skin integrity, and self-care deficit Overall goals for Increased intracranial pressure ️ICP normalized, maintain patent airway, normal fluid and electrolyte balance, no complications secondary to immobility Nursing care IICP ️Normothermia PaO2 maintenance at 100mmHg or greater ABG analysis guides O2 therapy, may require mechanical ventilation Tylenol 1000mg every 4-6hr Cold cloth on body, cooling blanket, lower room temperature keep person quiet because it generates heat Drug IICP ️Mannitol -seperate IV potent diuretics pulls liters of fluid at a time, causes brain to shrink and calms pressure Loop diuretics Corticosteriods -decrease inflammation (Decadrom) Barbiturates -coma: take over bodily function and induce coma Antiseizure drugs -dilantin: phenytonin, prophylatic with NS -big loading dose, then daily dose to prevent seizures Antipyretics Nutritional Therapy ️Client is in hypermetabolic state and hypercatabolic state, need for glucose (Glucose IV will cause worsening Edema) neutral IV-Saline or lactated ringers. Keep client normo