intracranial pressure (icp) megan mcclintock, ms, rn megan mcclintock, ms, rn11/4/11
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Factors Affecting ICP
Arterial & venous pressure (high or low)
Intrabdominal/intrathoracic pressure
Posture
Temperature
Blood gases (acidosis, hypoxia, high CO2) All are potent vasodilators
Compensation
Change in CSF volume Absorption/production Movement of CSF to the spinal subarachnoid
space
Change in intracranial blood volume Collapse of cerebral veins/dural sinuses Cerebral vasoconstriction/dilation Change in venous outflow
Change in brain tissue volume Distension of dura Compression of brain tissue
Symptoms of ICP
Change in LOC Most sensitive & reliable indicator of neuro status
Change in VS Cushing’s triad
Change in pupils Response to light, blurred vision, diplopia, eye
movements, papilledema
Change in motor function Hemiparesis/hemiplegia, decorticate or decerebrate
posturing
Headache
Vomiting
Assessment
Glasgow Coma Scale
Pupils
Cranial Nerves
Eye movement
Motor strength
Vital signs (including respiratory pattern - pg 1435)
Treatment CSF drain, ICP monitoring
ET tube/trach to keep PaO2 at 100, PaCO2 30-35
Surgical removal of mass
Hemicraniectomy
Only light sedation (ie. Versed, Ativan)
Be careful with drugs that alter the neuro state Rapid-acting opioids (Morphine, Fentanyl) are
best Propofol is good (rapid-acting, short half-life) Avoid benzodiazepines
Drugs
Mannitol Osmotic diuretic given intravenously Decreases ICP by plasma expansion and osmotic
effect
Hypertonic saline (3%) Can be as effective as mannitol or used concurrently Raises the osmolality of the ECF in the brain
Corticosteroids Used for vasogenic edema around tumors and
abscesses but not for head-injured patients
Barbiturates Reduce metabolic rate decreasing CBF and ICP
Interventions
No fever or shivering (or agitation, pain, seizures)
No Valsalva, coughing, sneezing
Avoid restraints
Family member at bedside
Seizure precautions
Quiet, non-stimulating environment
Light touch and talk even if in a coma
Interventions
Respiratory Patent airway Watch breathing patterns Side-lying Watch for snoring Careful use of suctioning HOB 30 degrees Prevent abdominal distension (NG tube – depends on
injury) Monitor ABGs
Nutrition