Increased Intracranial Pressure (ICP)

NEURO - Topic Overview

• Focuses on neurological conditions and their management.

Increased Intracranial Pressure (ICP)

• ICP exceeding 15 mmHg is considered elevated.
• Normal ICP ranges from 10-20 mmHg according to Brunner.
• Causes of increased ICP include head injuries, stroke, inflammatory lesions, brain tumors, and surgical complications.
• Pathophysiology centers on the Monro-Kellie Hypothesis, where an increase in one component (brain, CSF, blood) necessitates a volume change in others.
• Compensation occurs through increased CSF absorption, blood shunting, and decreased CSF production.
• Decompensation involves decreased cerebral perfusion and PO2, leading to brain hypoxia, lactic acid release, and cerebral edema.
• Brain herniation typically occurs in the brain stem and pons.
• Decreased cerebral blood flow triggers vasomotor reflexes, resulting in slow bounding pulses.
• Increased carbon dioxide levels leads to vasodilation, increasing blood flow and ICP.
• Cerebral edema is the abnormal accumulation of fluid in intracellular or extracellular spaces, or both.
• Herniation results from excessive ICP, causing brain tissue to press down on the brain stem.

Cerebral Response to Increased ICP

• Cushing's response involves the vasomotor center triggering a rise in blood pressure to increase ICP.
• Sympathetic response increases BP while the heart rate slows, and respiration becomes slow.

Clinical Manifestations of Increased ICP

• Early signs include changes in the Level of Consciousness (LOC) and pupillary changes (fixed, slowed response).
• Early signs also include headache and projectile vomiting.
• Late signs present as Cushing reflex (systolic hypertension, bradycardia, wide pulse pressure), bradypnea, hyperthermia and abnormal posturing due to brain compression or herniation.

Nursing Interventions for Increased ICP

• Maintain a patent airway by elevating the head of the bed 15-30 degrees to promote venous drainage.
• Oxygen administration or controlled hyperventilation helps reduce CO2 blood levels, constricting vessels and reduce edema.
• Medications such as Mannitol (to reduce fluid balance), Corticosteroids (to reduce edema) and anticonvulsants are administered.
• Reduce environmental stimuli, avoid activities that increase ICP (Valsalva maneuver, coughing, shivering, vigorous suctioning).
• Keep the head in a neutral position, avoiding extreme flexion and Valsalva maneuvers.
• Monitor for secondary complications like Diabetes Insipidus (D.I.) or Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH).

Altered Level of Consciousness (LOC)

• Altered LOC is a function and symptom of multiple pathophysiological conditions.
• Disruption in neuronal transmission results in improper brain function.
• Causes include head injury, toxicity, and metabolic derangement.
• Assessment involves checking orientation to time, place, and person, motor function, and sensory function.
• Decerebrate and decorticate posturing are assessed.
• Interventions involve maintaining patient airway, elevate the head of the bed to 30 degrees and suctioning.
• Protect the patient by using side rail padding and preventing potential injury from restraints according to doctor's orders, assessing every hour and renewing doctor's orders.

Headache - Cephalgia

• Primary headaches have no organic cause.
• Secondary headaches have an organic cause.
• Migraine attacks are periodic, they disturb the vascular system and lead to disturbance.

Aura Phase Migraine

• Patients experience bright spots or flashing lights lasting 5-60 minutes resulting from vasoconstriction and a "brownout".

Headache Phase Migraine

• The cerebral vasodilation results in decreased serotonin causing headaches, vomiting and nausea on both sides of the head.

Recovery Phase Migraine

• The area is sensitive to touch and the patient feels exhausted.

Migraine Interventions

• Avoid migraine precipitating factors.
• Modify lifestyle
• Relieve pain using beta-blockers, and serotonin antagonists

Demyelinating Diseases

• Multiple sclerosis results from progressive demyelination of white matter in the brain and spinal cord, leading to neurologic dysfunction, with the PNS unaffected.
• Structures usually involved in MS include the optic and oculomotor nerves and spinal nerve tracts.
• Diagnostic Tests include MRI for a primary diagnosis and CSF analysis for immunoglobulin G.

MS Types

• Clinically isolated syndrome (CIS): first single episode with symptoms persist for more than 24 hours
• Primary progressive MS (PMS): symptoms worsen progressively, with some experiencing times of stability and periods when symptoms worsen and then get better.
• Relapse-remitting MS (RRMS): Episodes of increasing symptoms with periods of remission.
• Secondary Progressive MS (SPMS): people experience episodes of relapse and remission, but then the disease will start to progress steadily.

Clinical Manifestations of MS

• Muscle weakness: Lack of use or stimulation and nerve damage.
• Numbness and tingling: pins and needles-type sensation
• Positive Lhermitte’s sign: electric shock-like sensation when they move their neck.
• Bladder problems: Difficulty emptying bladder or involuntary urination.
• Bowel problems: Constipation can cause fecal impaction, which can lead to bowel incontinence
• Fatigue, Dizziness and Vertigo with Sexual dysfunction: Male and Females loose interest in sex
• Vision problems: Double or blurred vision, can lead to a partial or total loss of vision.
• Emotional changes and depression: Demyelination in the brain leads to trigger brain emotional changes.
• Gait changes- due to muscle weakness, dizziness and fatigue.
• Tremor and involuntary quivering movements.
• Learning and Memory issues can make difficult to concentrate on one thing.

Medical Management of MS

• Corticosteroids reduce edema and inflammation of the myelin sheath.
• Interferon beta-1a or interferon beta-1b decreases frequency of relapses.
• Chlordiazepoxide mitigates mood swings.

Nursing interventions of MS

• Elevate head of patients with MS
• Use eye patches
• Use warm packs
• Encourage exercise and speech therapy

Nursing and Medical Treatment of MS

• Baclofen or dantrolene relieve spasticity.
• Bethanechol or oxybutynin relieve urine retention and minimize urinary frequency and urgency.
• Exercise is encouraged on weakened parts, using a wheelchair.
• Eye patch on unaffected side, warm packs, stress management, and speech therapy are all recommended.

Nursing interventions of MS

• Give mouth care
• Turn patient every 2 hours
• Use trochanter rolls and foot boards

Guillain-Barre Syndrome

• It's an acute autoimmune disease which leads to inflammation of the peripheral nerves and damaging motor, sensory and myelin.
• Unknown origin, may follow viral infections

Manifestations of Guillain-Barre Syndrome

• Demyelination of PNS can lead to ascending weakness and potentially respiratory failure.
• This is potentially a life threatening condition because nerve damage to the musles can damage nerves in the respiratory system

GBS cont...

• Plasmapheresis is a key feature, but must be a diagnosed by a healthcare professional.
• Nursing focuses include mechanical ventilation and ICU admission.

Alzheimer’s disease

• Is is a degenerative disease in the brain, characterized as impaired thinking memory and thinking

Phases of Alzeimer's Disaeae

• Early, moderate and moderate to severe stages
• Diagnosed via MRI or a brain scan
• The ultimate test is an Autopsy

Medication and nursing treatment for Alzheimers

• Administer medication to treat
• Maintain patent airway
• Provide mouth care

Mainfestations of alzhemimer's disease

• 4 A's = Amnesia, Apraxia, Agnosia, Aphasia

Stages of Alzhiemrs

• Mind, moderatory and severe

Parkinson's Disease

• Tremors
• Rigidity, affects balance and coordiation

Medication and nursing cares for Parkinson

• Focuses on comfort and safety as patient
• Administer medication such as levodopa.

Diagnostic of Parkinson's

• Test by 4 cardinals -- Tremor, Bradykinesia, Rigor, Posteral Instability

Phases and Mainfestatoins of Parkinson

• Can test memory, and can experience microphonia or micrographia, stoop posture, oilly moist skin

Medical treatment and care for Parkisons

• Amantadsine and anticholinergic therapy.

Myanestia Gravis

• Is a chronic autoimmune disorder that effects nurones and skeletal muslces
• Body become progressively weaks, but gets worse on movement
• Is more severe in women

Mainfestations of Myasthenia Gravis

• Double vision, dropping , and hard to breath
• It is a nurone transmission process

GBS Processs

• Immune attach cause myelin destruction

MG Diagnostics and treatment

• Bloood and neuro test
• Treat via Anti-acetylcholinesterase

MS vs Cholinergic Crisis

• Over medicate

Meninigitis

• Inflammation of the membranes in the brain, very close together
• Can cause life threatening symptoms, requires urgent treatment and care
• Common symptoms is headcahe, vomiting with photosentivitiy

Classifications

• Classified by different factors, use of a GCS will help measure severity

Types of Spinal Cord Injury

• Complete
• Incomplete

Spinal Shock

• Transient reflex depression of cord function below level of injury.

SCI Classification

• Quadriplegia
• Paraplegia
• Tetraplegia is sensation with one extremity.

Etiology/Testing Spinal Shock

• Monitor with a CT Scan
• Immobilize, use a Cervical Collars

Injuries During SCI

• Positions vary, so different symptoms and injuries can be observed

Treatmeant and diagnosis of Spinal Shock

• Diagnosed via Lumar puntcture
• Provide mental support during this difficult period

Clinical Mainfestations

Dilated or unequal size of pupils Vision changes Respiratory failure Vomiting Headache Confusion Trouble with balance Altered LOC Signs = Battle Signs, Racoon eyes, Halo Signs Medical Treatments

##Seizures

• Preictal = Phase before seizure. -Ictal = During the Seizure -PostIctal = after the Seizure -Inter = Between seizures.

  ##2 Types Petit, Absence Seizures Status= medical emergency.

Seizure Interventions

• Assess breathing and give oxygen if needed
• Ease cline to floor
• Loosen Clothing and don Restraim
• Remove from environment
• DO NOT put tongue blade in mouth.

Seizures - cont.

• Metabolic and toric conditions are reasons to see seizures
• Nursing focus to observe type of seizure
• Protect the patient
• Do not restrain the person
• And let seizure pass

TBI

• Is is an insult to brain and and causes injuries

TBI - cont.

• Diffuse Axonal Injury is damage to numerous parts .

Clasifciations TBI

• Based on Glascow Scale and severity

TB Clinical mainifesations

• Look for vision chagnes, vomiting, changes, leaking fluid
• Test level of concussion
• Maintain patent airway