Critical Care Nursing Theory: Neurological Disorders (2024) PDF

Critical Care Nursing Theory Chapter 9 Neurological Disorders Dr. Rana Al Awamleh 2024 Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 1 Stroke (Brain Attack) Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 2 ...

Critical Care Nursing Theory Chapter 9 Neurological Disorders Dr. Rana Al Awamleh 2024 Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 1 Stroke (Brain Attack) Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 2  Brain attack Brain attack" is another term for a stroke, which happens when blood flow to a part of the brain is interrupted or reduced either by a blockage (ischemic stroke) or a rupture of a blood vessel (hemorrhagic stroke).. This deprives brain tissue of oxygen and nutrients, causing brain cells to die within minutes. Strokes are medical emergencies that need immediate attention to reduce the risk of severe brain damage and long-term disability. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 3  Causes and Risk Factors ❑ Main Causes: 1. High blood pressure 2. Atherosclerosis (plaque buildup) 3. Aneurysms ❑ Risk Factors: 1. Uncontrollable: Age, family history, gender (men are at higher risk) 2. Controllable: High blood pressure, diabetes, high cholesterol, smoking, obesity, atrial fibrillation Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 4  Diagnosis The diagnosis of a stroke involves a series of assessments to confirm the type of stroke, identify its cause, and determine the most appropriate treatment. 1. Initial Assessment and History: Medical History: Review of symptoms, time of onset, and relevant medical history (e.g., prior strokes, cardiovascular disease, risk factors like diabetes or high blood pressure). Physical and Neurological Exam: Checks for weakness, numbness, coordination, vision, speech, and level of consciousness. 2. Diagnostic Imaging: Imaging is essential to determine the type and location of the stroke, helping differentiate between ischemic and hemorrhagic strokes: CT Scan: Quickly detects bleeding in the brain, which helps identify a hemorrhagic stroke. Can sometimes detect large ischemic strokes shortly after onset. MRI: Provides more detailed images than a CT scan and is more sensitive in detecting small or early ischemic strokes. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 5  Diagnosis 3. Vascular Imaging: Used to visualize blood vessels and locate blockages, clots, or abnormalities in the blood vessels supplying the brain such as Carotid Ultrasound, MRA (Magnetic Resonance Angiography), and CTA (Computed Tomography Angiography), Cerebral Angiography: An invasive test that uses a catheter and contrast dye to give a detailed view of blood flow in the brain; often reserved for complex cases. 4. Blood Tests: Blood work is performed to help identify underlying health conditions or risk factors that could influence treatment. Blood Sugar Levels: To rule out hypoglycemia (low blood sugar), which can mimic stroke symptoms. Complete Blood Count (CBC) and Coagulation Tests: Check for clotting disorders, anemia, or infection. Lipid Profile: Assesses cholesterol levels, as high cholesterol is a risk factor for stroke. Electrolytes and Renal Function: To ensure kidney function is normal for safe administration of treatments. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 6  Diagnosis 5. Heart Tests: Heart abnormalities, particularly those leading to blood clots, can increase stroke risk. Electrocardiogram (ECG): Checks for arrhythmias like atrial fibrillation, which increases stroke risk. Echocardiogram. 6. Stroke Scales and Assessments: Medical professionals often use specific scales to gauge stroke severity, guide treatment, and assess recovery: NIH Stroke Scale (NIHSS): Rates the severity of stroke symptoms and helps monitor progress or decline over time. (See Black Board). Modified Rankin Scale (mRS) and Barthel Index: Used after initial treatment to evaluate disability levels and functional outcomes. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 7  Types of Stroke ❖ Ischemic Stroke: Caused by a blood clot or blockage in an artery supplying the brain. ❑ Subtypes: Thrombotic (within the brain) and Embolic (travels from other body parts) ❖ Hemorrhagic Stroke: Caused by a ruptured blood vessel, leading to bleeding in or around the brain. ❑ Subtypes: Intracerebral (within brain tissue) and Subarachnoid (around the brain) ❖ Transient Ischemic Attack (TIA): Temporary blockage; resolves within minutes to hours. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 8  Symptoms of an Ischemic Stroke Symptoms often appear suddenly and may include: Sudden weakness or numbness on one side of the body (especially in the face, arm, or leg) Difficulty speaking or understanding speech Vision problems in one or both eyes Confusion or mental fog Dizziness, loss of balance, or coordination Severe headache (though more common in hemorrhagic strokes) The FAST acronym is commonly used to remember key signs: Face drooping Arm weakness Speech difficulty Time to call emergency services Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 9  Treatment of Ischemic Stroke Thrombolytic Therapy (tPA):Tissue Plasminogen Activator (tPA) is a clot-busting drug that can dissolve the clot if administered within a 3-4.5-hour window from symptom onset. tPA is highly effective but is not suitable for all patients (e.g., those at high risk for bleeding). Mechanical Thrombectomy: A procedure in which a catheter is used to physically remove the clot from the blocked artery. Usually performed within six hours of symptom onset but can be effective up to 24 hours in some cases. Antiplatelet and Anticoagulant Medications: Medications such as aspirin or clopidogrel (antiplatelets) may be prescribed to prevent future clot formation. For patients with atrial fibrillation or clotting disorders, anticoagulants like warfarin or newer agents (e.g., apixaban) are often recommended. Other Supportive Care: Blood pressure management to prevent further complications. Blood sugar control in diabetic patients. Rehabilitation involving physical, occupational, and speech therapy to improve function and independence. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 10  Prevention of Ischemic Stroke Preventative measures are crucial to reduce the risk of an ischemic stroke: 1. Lifestyle modifications: Regular exercise, a healthy diet, maintaining a healthy weight, and quitting smoking. 2. Managing chronic conditions: Keeping blood pressure, cholesterol, and diabetes under control. 3. Heart health: Managing conditions like atrial fibrillation and taking preventive medications if necessary. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 11  Symptoms of Hemorrhagic Stroke Sudden, severe headache (often a warning sign of a subarachnoid hemorrhage). Nausea and vomiting. Blurred or double vision. Sensitivity to light. Weakness or numbness on one side of the body. Confusion or loss of consciousness in severe cases. Seizures may occur, depending on the location and extent of bleeding. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 12  Treatment of Hemorrhagic Stroke The goal of treatment is to control bleeding, reduce pressure on the brain, and stabilize vital functions: 1. Emergency Care: Blood pressure management to prevent further bleeding. Medications may be given to control blood pressure, reduce swelling in the brain, or reverse blood-thinning effects if the patient is on anticoagulants. 2. Surgical Treatment: Aneurysm Clipping: A surgical procedure to place a clip on the neck of an aneurysm to stop blood flow. Endovascular Coiling: A less invasive procedure where coils are inserted into an aneurysm to encourage clotting and prevent rupture. Surgical Removal of Hematoma: In cases of large intracerebral hemorrhage, surgery may be needed to remove the clot and relieve pressure on the brain. 3. Supportive Care: Managing complications like seizures, swelling, and infections. Rehabilitation: Physical, occupational, and speech therapy to help regain lost functions. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 13  Prevention of Hemorrhagic Stroke Preventative measures focus on controlling high blood pressure and avoiding risk factors: ✓ Control blood pressure through medication, diet, and exercise. ✓ Avoid smoking and limit alcohol intake. ✓ Use blood thinners cautiously, under medical guidance, especially if you are at high risk. ✓ Regular check-ups if you have a family history of aneurysms or other vascular conditions. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 14  Transient Ischemic Attack (TIA) o Transient Ischemic Attack (TIA): often called a "mini-stroke." A TIA occurs when there is a temporary blockage of blood flow to the brain, causing stroke-like symptoms that usually resolve within a few minutes to a few hours. Unlike an actual stroke, a TIA doesn’t cause permanent brain damage, but it is a serious warning sign for future strokes. o Key Characteristics of TIA Short Duration: Symptoms are temporary and typically last less than an hour but can persist up to 24 hours. No Permanent Damage: Because blood flow is quickly restored, TIA doesn’t usually cause lasting brain injury. Warning Sign: Having a TIA significantly increases the risk of a future stroke; approximately 1 in 3 people who have a TIA will eventually have a full stroke, with the highest risk occurring within 48 hours after a TIA. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 15  Symptoms of TIA TIA symptoms are similar to stroke symptoms but resolve quickly. They may include: Sudden numbness or weakness, particularly on one side of the body. Difficulty speaking or understanding speech. Vision problems in one or both eyes. Loss of balance, dizziness, or lack of coordination. Sudden severe headache, though less common. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 16  Treatment of TIA The primary goal of TIA treatment is to prevent future strokes, focusing on managing underlying risk factors and lifestyle modifications: 1.Medications: 1. Antiplatelet drugs (e.g., aspirin or clopidogrel) to prevent clot formation. 2. Anticoagulants (e.g., warfarin, apixaban) may be prescribed if there is an increased risk of embolism from conditions like atrial fibrillation. 3. Blood pressure and cholesterol-lowering medications. 2.Lifestyle Modifications: 1. Healthy diet and regular exercise to control weight and blood pressure. 2. Quit smoking and limit alcohol consumption. 3. Control blood sugar in diabetic patients. 3.Surgical Procedures: 1. Carotid Endarterectomy: A surgical procedure to remove plaque from the carotid arteries in cases of severe narrowing. 2. Carotid Angioplasty and Stenting: A minimally invasive procedure to widen narrowed carotid arteries and place a stent to keep them open. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 17  Prevention of TIA Prevention strategies focus on reducing stroke risk factors, including: ✓ Regular monitoring and control of blood pressure and cholesterol. ✓Managing diabetes and other medical conditions. ✓Avoiding tobacco products and adopting a healthy lifestyle. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 18 Cerebral Edema Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 19  Definition Cerebral edema is the medical term for swelling in the brain, which occurs when excess fluid accumulates in brain tissue. This condition can increase pressure within the skull, potentially leading to severe complications, including damage to brain cells, reduced blood flow, and in severe cases, brain herniation (where brain tissue is pushed out of its normal position). Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 20  Pathophysiology and Types 1. Disruption of the Blood-Brain Barrier (Vasogenic Edema) Normally, the blood-brain barrier (BBB) controls the movement of substances between blood vessels and brain tissue. In vasogenic edema, injury (e.g., trauma, infection, tumor) disrupts the BBB, allowing fluid and proteins to leak into the extracellular space. This type of edema often affects the white matter and is a common response to tumors, abscesses, and inflammation. 2. Cellular Injury (Cytotoxic Edema) Cytotoxic edema occurs when brain cells (neurons and glial cells) are damaged, leading to fluid accumulation inside cells rather than between them. Causes include ischemia (reduced blood flow) and hypoxia (low oxygen), which impair cell function and lead to cell swelling. This type of edema typically affects gray matter and is commonly seen in cases of stroke, cardiac arrest, and toxin exposure. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 21  Pathophysiology and Types 3. Increased Cerebrospinal Fluid (CSF) Pressure (Interstitial Edema) CSF is produced in the brain ventricles and typically circulates to cushion the brain and spinal cord. In interstitial edema, elevated CSF pressure from conditions like hydrocephalus (blockage in CSF drainage) causes fluid to seep into surrounding brain tissue. This increases the fluid in the brain’s extracellular spaces and raises intracranial pressure. 4. Osmotic Imbalance (Osmotic Edema) Osmotic edema occurs when there’s an imbalance between the osmolarity (concentration of solutes) in blood and brain tissue. When blood becomes hypoosmolar (lower solute concentration), water moves into brain cells and tissue, causing them to swell. This may be triggered by conditions like hyponatremia (low blood sodium), often due to overhydration or metabolic disturbances. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 22  Consequences of Cerebral Edema Increased Intracranial Pressure (ICP): Swelling increases pressure in the skull, which can compress blood vessels and reduce blood flow, risking brain cell death. Brain Herniation: Severe swelling can push brain tissue out of its normal position, potentially compressing the brainstem and leading to respiratory and cardiovascular failure. Decreased Cerebral Blood Flow: ICP restricts blood flow, causing ischemia and hypoxia, which further exacerbate swelling and damage. Coma or death Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 23  Causes Traumatic Brain Injury (TBI): Any head injury can cause swelling in the brain due to tissue damage. Stroke: Both ischemic (due to blood clots) and hemorrhagic (due to bleeding) strokes can result in cerebral edema. Infections: Infections like meningitis or encephalitis can cause brain inflammation and swelling. Brain Tumors: Tumors in the brain can block fluid circulation or compress nearby tissues, leading to edema. Hypoxia: Low oxygen levels (such as from suffocation or drowning) can lead to swelling. Toxic Exposure: Certain toxins or drugs can cause brain cells to swell. High Altitude Cerebral Edema (HACE): Occurs in people ascending to high altitudes without proper acclimatization. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 24  Symptoms of Cerebral Edema Symptoms can vary depending on the severity but may include: Headache Nausea and vomiting Dizziness or confusion Altered mental state or consciousness Seizures Vision changes Weakness or numbness on one side of the body Difficulty with balance and coordination Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 25  Diagnosis 1. Clinical Evaluation History and Symptoms: Review of symptoms such as headache, nausea, vomiting, confusion, vision changes, and seizures. History of recent trauma, infections, stroke, or high-altitude exposure is also important. Physical and Neurological Exam: Neurological assessments include checking mental status, pupil response, motor skills, coordination, and sensory functions. Increased intracranial pressure (ICP) signs may include papilledema (swelling of the optic nerve) and altered consciousness. 2. Imaging Studies Computed Tomography (CT) Scan: A CT scan is often the first-line imaging test in emergency settings due to its speed and ability to detect edema, bleeding, tumors, and other structural issues. Magnetic Resonance Imaging (MRI): 3. Intracranial Pressure (ICP) Monitoring For patients with severe cerebral edema, direct ICP monitoring may be necessary. A probe is inserted through a small hole in the skull to measure pressure within the skull. This is primarily used in critical care settings to monitor and manage ICP levels in real time, especially in cases of traumatic brain injury or hydrocephalus. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 26  Diagnosis 4. Electroencephalogram (EEG) EEG may be used if seizures are suspected or observed, as cerebral edema can trigger seizure activity. This test monitors brain electrical activity to detect abnormal patterns. 5. Blood Tests and Laboratory Studies Complete Blood Count (CBC): To detect infection, anemia, or inflammation. Electrolyte Panel: To check for electrolyte imbalances like hyponatremia, which can contribute to osmotic edema. Arterial Blood Gas (ABG): To assess oxygen and carbon dioxide levels, as hypoxia can worsen cerebral edema. Infection Markers: Cultures and specific antibody tests may be ordered if an infection like meningitis or encephalitis is suspected. 6. Lumbar Puncture (Spinal Tap) This test is performed to analyze cerebrospinal fluid (CSF) for infection, inflammation, or abnormal pressures. However, it is used cautiously because it can be risky if there is elevated ICP due to brain swelling. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 27  Treatment The treatment of cerebral edema focuses on reducing brain swelling, relieving intracranial pressure (ICP), and managing the underlying cause. Prompt treatment is essential to prevent serious complications, such as brain herniation and permanent neurological damage. 1. Medications Osmotic Diuretics (e.g., Mannitol): Mannitol is commonly used to draw fluid out of brain tissue and reduce ICP by creating an osmotic gradient. It’s administered intravenously and is especially useful in emergency situations for rapid ICP reduction. Hypertonic Saline: Hypertonic saline solution (usually 3% or 7.5%) helps reduce cerebral edema by pulling excess fluid from brain tissue into the bloodstream. It is used in critical care to maintain ICP within safe limits and prevent further brain swelling. Corticosteroids (e.g., Dexamethasone): Steroids are primarily used to reduce vasogenic edema associated with brain tumors or inflammation (e.g., from infections). They work by reducing the permeability of blood vessels, thus decreasing fluid leakage into brain tissue. Anti-Seizure Medications: If seizures occur or are at risk, anti-seizure medications like phenytoin or levetiracetam are prescribed to prevent seizure activity, which could further increase ICP. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 28  Treatment 2. Surgical Interventions Decompressive Craniectomy: In cases of severe cerebral edema where ICP is dangerously high, a portion of the skull may be removed temporarily to allow the brain to expand without compressing other structures. This procedure is used as a last resort in critical cases, such as after traumatic brain injury. Ventriculostomy: A catheter is inserted into the brain’s ventricles to drain excess cerebrospinal fluid (CSF) and relieve pressure. It also allows direct monitoring of ICP and is commonly used in cases of hydrocephalus or interstitial edema. Tumor Resection or Abscess Drainage: If the edema is caused by a brain tumor or abscess, surgery to remove the mass may be necessary to relieve pressure and decrease swelling. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 29  Treatment 3. Supportive Therapies Oxygen Therapy and Ventilation Support: Oxygen therapy ensures adequate oxygen levels in the blood, which helps prevent hypoxia-induced brain swelling. In cases of severe cerebral edema, mechanical ventilation may be used to control carbon dioxide levels, as high CO₂ can increase ICP. Fluid Management: Careful regulation of fluids is essential to avoid overhydration, which could worsen cerebral edema. Intravenous fluids are often hypertonic solutions to help maintain the osmotic balance between blood and brain tissue. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 30  Treatment 4. Treating the Underlying Cause Antibiotics/Antivirals: If cerebral edema is due to an infection like meningitis or encephalitis, appropriate antibiotics or antiviral medications are administered. Blood Pressure Management: In cases where high blood pressure contributes to edema (e.g., hypertensive encephalopathy), antihypertensive medications are used to lower blood pressure and reduce further swelling. Management of High-Altitude Cerebral Edema (HACE): Descending to a lower altitude, oxygen supplementation, and medication like dexamethasone are key treatments for high-altitude cerebral edema. 5. Monitoring and Long-Term Care Intracranial Pressure Monitoring: Continuous monitoring of ICP in critical care settings is essential to guide treatment adjustments. Rehabilitation: After the acute phase, patients may require physical, occupational, or speech therapy to recover from any neurological deficits caused by cerebral edema. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 31  \ Intracranial Hypertention Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 32  Definition Intracranial Pressure (ICP) refers to the pressure exerted by fluids (such as cerebrospinal fluid and blood) inside the skull and on the brain tissue. Normally, ICP is maintained within a narrow range (about 5–15 mmHg in adults). However, when ICP increases beyond this range, it can compress brain tissue, reduce blood flow, and potentially cause severe neurological damage. Normal Intracranial Pressure (ICP) typically ranges between 5 and 15 mmHg in adults when measured in a resting, supine position. Pressures consistently above 20 mmHg are considered elevated and can indicate intracranial hypertension, which may require medical intervention to prevent damage to brain tissue. Intracranial Hypertension (ICH): also known as increased intracranial pressure (ICP), is a condition in which the pressure within the skull exceeds the normal range. This elevated pressure can compress brain structures, reduce blood flow to the brain, and potentially lead to severe complications, such as brain damage or herniation (where brain tissue shifts from its normal position). Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 33  Types of Intracranial Hypertension 1. Acute Intracranial Hypertension: Occurs suddenly, often due to traumatic brain injury, stroke, or rapid swelling. It is a medical emergency. 2. Chronic Intracranial Hypertension: Pressure increases slowly over time and may be caused by conditions like brain tumors or hydrocephalus. 3. Idiopathic Intracranial Hypertension (IIH): Also known as pseudotumor cerebri, this form has no known cause, though it is commonly seen in young women and is associated with obesity and certain medications. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 34  Causes of Increased ICP 1. Traumatic Brain Injury (TBI): Head injuries can cause brain swelling, bleeding, or accumulation of fluids, all of which increase ICP. 2. Stroke: Both ischemic and hemorrhagic strokes can increase ICP, either due to brain swelling or accumulation of blood. 3. Cerebral Edema: Swelling due to infection, tumors, hypoxia, or metabolic imbalances leads to elevated ICP. 4. Brain Tumors: Tumors take up space within the skull, increasing pressure on brain tissues. 5. Hydrocephalus: Excessive accumulation of cerebrospinal fluid (CSF) within the brain’s ventricles leads to increased ICP. 6. Infections: Conditions like meningitis and encephalitis cause inflammation and fluid buildup around the brain. 7. Idiopathic Intracranial Hypertension (IIH): Increased ICP with no clear cause, often affecting young overweight women. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 35  Symptoms of Intracranial Hypertension Symptoms vary depending on the severity but often include: Headache: Often worse in the morning or when lying down. Nausea and Vomiting: Frequent and often unexplained. Visual Changes: Blurred or double vision, and in some cases, vision loss due to optic nerve swelling (papilledema). Tinnitus: A whooshing or pulsing sound in the ears. Altered Mental State: Confusion, drowsiness, or lethargy. Seizures: Due to increased pressure disrupting normal brain function. Motor or Sensory Changes: Weakness, numbness, or balance issues. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 36  Diagnosis of Intracranial Hypertension 1.Clinical Examination: Includes a review of symptoms, medical history, and a neurological exam. 2.Ophthalmic Examination: Swelling of the optic nerve (papilledema) can indicate increased ICP. 3.Imaging: 1. CT Scan: Rapidly identifies causes such as hemorrhage, tumors, or hydrocephalus. 2. MRI: Offers detailed images of brain tissue, useful for identifying masses or subtle edema. 4.Direct ICP Monitoring: In cases of severe ICH, an intracranial catheter can be inserted to measure pressure directly within the skull. 5.Lumbar Puncture (Spinal Tap): Used cautiously to measure CSF pressure, though it’s generally avoided if ICP is critically high due to the risk of brain herniation. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 37  Treatment of Intracranial Hypertension Treatment depends on the underlying cause and the severity of the pressure: 1. Medications: Diuretics (e.g., Mannitol) and Hypertonic Saline: Used to reduce fluid accumulation and decrease ICP. Corticosteroids: Administered to reduce inflammation around tumors but generally not effective for trauma-related edema. Carbonic Anhydrase Inhibitors (e.g., Acetazolamide): Commonly used in idiopathic intracranial hypertension to decrease CSF production. 2. Surgical Interventions: Decompressive Craniectomy: Removes part of the skull to relieve pressure. Shunt Placement: For cases of hydrocephalus, a shunt may be placed to drain excess CSF and lower ICP. Ventriculostomy: Involves inserting a catheter into the brain’s ventricles to drain CSF and reduce pressure. 3. Lifestyle Changes: Weight loss, reducing salt intake, and discontinuing certain medications (e.g., oral contraceptives) may help lower ICP in idiopathic cases. Dr. Rana Al Awamleh/ Assistant Professor, Critical Care Nursing 38