BY: GEISSEN MARIE GALINGANA
ARLENE MACATANGAY
FROILAN SALAZAR
Intracranial pressure (ICP)
- increase in intracranial bulk brought about by
increase in one of intracranial components.
3 Components of the Brain
-Blood
-Brain
-CSF
Monro- Kellie Hypothesis
- an increased in any of the components of
the brain.
Causes
-Head injury
-Brain hemorrhage
-Infection
-Tumors
-Localized abscess
-Accumulation of exercise amount of CSF
-Cerebral edema
Normal Value of ICP
Infant and Newborn- 5 mmHg
Children- 6-15 mmHg
Adult- 15 mmHg
Types, Signs and Symptoms of ICP
Extra-Axial hemorrhage (outside the
brain tissue)
-Epidural
-Subdural
-Subarachnoid
Intra-Axial Hemorrhage (within the brain
tissue)
-Intracerebral
-Intraventricular
Discussion of Different
Types, Signs and
Symptoms of ICP
ICP (hyper, brady, brady)
-Hypertension
-Bradycardia
-Bradypnea
Shock (hypo, tachy, tachy)
-Hypotension
-Tachycardia
-Tachypnea
Discussion of Cushing’s
Triad
Pathophysiology of
ICP
Assessment
2 types of neurological assessment
Rapid neuro exam
- Glascow Coma Scale, orientation ,
movement of arms and legs, pupil size
and reaction to light.
Complete neuro exam
- LOC (mental status), memory and
attention, PERRLA, cranial nerves, motor
function, sensory function, deep tendon
reflexes, cerebral function.
Laboratory and Diagnostics
-Underlying cause and assessment will
determine labs ( there is not one lab test
to indicate increased in ICP ) if the
infection is suspected, a WBC count would
be necessary.
-Computed tomography (CT)
-Magnetic Resonance Imaging (MRI)
-Skull and spine x-rays
-Electroencephalography (EEG)
-Lumbar puncture (spinal tap)
-Cerebral angiography
-Position Emission Tomography (PET)
Management
In monitoring ICP:
Ventriculostomy
- neurosurgical procedure that
involves creating a hole within a cerebral
ventricle.
Subarachnoid
-denoting or occurring in the fluid-
filled space around the brain between the
arachnoid membrane and the pia mater,
through which major blood vessels pass.
Osmotic Diuretic ( Manitol )
-Lower cerebral edema
-Fluid restriction
Inotropic Agents
-Maintain Cerebral Perfusion
Antipyretic and Barbiturates
-Reduce metabolic demands
Craniotomy
- surgical incision in which a bone
flap is temporarily removed from the skull
to access the brain.
Craniectomy
-neurosurgical procedure that
involves removing a portion of the skull
in order to relieve pressure on the
underlying brain.
Nursing Intervention
-Maintain neurologic status and vital signs
-Monitor respiratory status
-Calculate and monitor cerebral perfusion
pressure
-Monitor central venous pressure (CVP)
-Raise head of the bed to 15-30 degrees or
as ordered (assist venous drainage)
-Bowel and Bladder function
-Avoid neck flexion and extreme hip/knee
flexion
-Fluid restriction
-Avoid valsalva maneuver
-Avoid excessive coughing or sneezing
-Avoid heavy lifting
-Administer medication to promote a
decrease in ICP ( osmotic and loop
diuretics, corticosteroids)
-Administer analgesics, sedatives as needed
-Antibiotic as indicated
