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Increased Intracranial Pressure Excess of fluid (blood, CSF) or matter (brain) within the cranium causing pressure buildup due to proportional imbalance Cranial system will initially compensateincreased ICP occurs when compensation is exhausted Medical emergencyimmediate intervention Causes of Inc...
Increased Intracranial Pressure Excess of fluid (blood, CSF) or matter (brain) within the cranium causing pressure buildup due to proportional imbalance Cranial system will initially compensateincreased ICP occurs when compensation is exhausted Medical emergencyimmediate intervention Causes of Increased ICP Tumor Infection Closed head injury Bleeding CSF accumulation Measurement of CSF Pressure Measured by spinal tap, ventricular puncture (most common) Clinical manifestations Growth and development play a major role- need to know for exam!! Subtle to begin with: Irritability, personality changes (behavioral changes will happen first) Headache when lying flat, in the morning N/V Sleepiness Blurred vision (diplopia) poor feeding Infants: Bulging fontanel (posterior closes 3 months, anterior closes 18 months) Cranial suture separation High-pitched cry Increased head circumference Widened suture linesincreased head circumference Children with open fontanel compensate for increased volume with skull expansion and widening sutures Skull expansion NOT seen in 2-year-old because fontanels are closed Sun setting eyes Increased ICP forces child’s eyes to look downless of pupil, more of iris and sclera Reflexes- retention of infantile reflexes, rooting, grasping, moro, Babinski, tonic neck Diagnosis Dependent of manifestations Cushing’s Triad Late sign Increased systolic BP Decreased HRfrom brain swelling Decreased respirations (Cheyne stokes) ICP monitoring Burrow hole Management/Nursing Interventions PRESSURE Position HOB 30-35 degrees, head midline, hips straight (↓ intraabdominal pressure) Respiratory Prevent hypoxia and hypercapnia Monitor ABGs Elevated Temperature Antipyretics, cool baths, remove extra blankets, decrease room temp Systems to monitor Neuro checks: PEERLA, follow commands, strength, GCS Straining activities avoided Avoid vomiting, give antiemetics, no sneezing, coughing, blowing nose, stool softeners, calm environment Unconscious Patient Do not over sedate, assess lung sounds, skin breakdown, nutrition RX Barbituratesdecrease brain metabolism Vasopressorsincrease BP IVF, Epi, antihypertensives, anticonvulsants Edema management Medically treat first while figuring out what is causing fluid buildup Mannitoldehydrates the brain Surgical: extra ventricular drain or closed drainage system (VA or VP shunt)
