Intracranial Regulation

Intracranial Regulation

Unit 4

Module 4A

Jill Huffman, MSNed, RN

Learning Outcomes

• Collaborate with the interprofessional team to coordinate high-quality care for patients with increased intracranial pressure.

• Implement nursing interventions to help the patient and family cope with the psychosocial impact caused by increased intracranial pressure.

• Apply knowledge of anatomy, physiology, and pathophysiology to assess patients with increased intracranial pressure.

• Use clinical judgment to plan care for patients with increased intracranial pressure.

• Teach the patient and caregiver(s) about common drugs for increased intracranial pressure.

Learning Resources

• Ignatavicius, D. (2021). Pp. 912-922

• Ignatavicius, D. (2021). Study Guide Chapter 41 (questions 18-34)

• Silvestri, L. (2023). Pp. 855, 858-859.

• ATI RN Adult Medical Surgical Nursing 11.0 – Chapter 14

• ATI RN Nursing Care of Children 11.0 – Chapter 14.

Traumatic Brain Injury (TBI)

• Damage to the brain from an external mechanical force and not caused by neurodegenerative or congenital conditions.

• Can lead to temporary and permanent impairment in cognition, mobility, sensory perception, and/or psychosocial function.

• Direct injury – force produced by a blow to the head

• Indirect injury – force applied to another body part with a rebound effect to the brain

• Acceleration Injury – caused by an external force contacting the head, suddenly placing the head into motion

• Deceleration Injury – occurs when the moving head is suddenly stopped or hits a stationary object

Traumatic Brain Injury (TBI)

• Can be either an open or closed head injury

• Head injuries are classified as mild, moderate, or severe, depending upon the Glasgow coma Scale ratings and the length of time the client was unconscious.

Types of Brain Injury

• Concussion or mild traumatic brain injury

• Contusion

• Diffuse Axonal Injury (shearing)

• Intracranial Hemorrhage

Secondary Brain Injury

• Process that occurs after the initial injury and worsens or negatively impacts the patient’s outcome.

• The result of insufficient oxygen and nutrients to the cells in the brain.

• Post Concussion Syndrome – headaches, impaired cognition, vertigo, dizziness. Can last for weeks to months after injury. Most common in mild TBI

• Hypotension and Hypoxia – most common cause of secondary injury in moderate to severe TBI

• Increased Intracranial Pressure - intracranial pressure (ICP) of 10-15 mmHg is normal, and greater than 20 mmHg is considered detrimental to the brain. Leading cause of death from head trauma.

• Hemorrhage – all hematomas are potentially life-threatening because they take up space and are surrounded by edema

• Brain Herniation Syndrome – with the presence of ICP the brain tissue may shift and herniate downward. Life-threatening and rapid-response teams must be notified

• Hydrocephalus – abnormal increase in the cerebral spinal fluid (CSF)

Risk Factors

• Motor vehicle accidents or motorcycle crashes

• Illicit drug and alcohol use

• Sports injuries

• Assault/Shaken Baby

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• Prevents accurate assessment of neurologic assessment
• Can cause respiratory depression
• Administer naloxone to reverse agent if patient becomes overmedicated or does not tolerate

Craniotomy:

• Removal of nonviable brain tissue and allows for expansion
• Involves drilling a burr hole or creating a bone flap to permit access to the affected area.
• Life-saving procedure
• Many complications including:
  • severe neurologic impairment
  • infection
  • persistent seizures
  • neurological deficiencies
  • death

Organ Procurement:

• Patients with severe TBI often die and the patient may be an organ donor
• Before brain death is declared, contact the local organ-procurement organization as soon as possible
• Determine if the patient is an organ donor. This information is usually on the driver's licenses, state-issued card, or advanced directives
• Some families may not agree with the patient's decision to be an organ donor resulting in an ethical dilemma. Many agencies have an ethics specialist or committee who can help with these situations.

Health Promotion and Disease Prevention:

• Wear helmets when skateboarding, riding a bike or motorcycle, skiing, and playing football or any other sport that can cause a head injury
• Wear seat belts when driving or riding in a car
• Avoid dangerous activities such as speeding, driving under the influence of alcohol or drugs
• Lock up all firearms
• Avoid riding in the back of pickup trucks
• Prevent falls especially in older adults
  • older adults are at a greater risk of complications including systemic and wound infections, diminished coping mechanisms, and complications related to other medical conditions.