MEDICAL SURGICAL NURSING

LESSON PLAN ON
INTRACRANIAL PRESSURE
SUBMITTED TO, SUBMITTED BY,

SUBMITTED ON,
 IDENTIFICATION DATA

• Name of the student teacher : Ms. monali salunke

• Course : First Year M.Sc. Nursing
• Subject : Medical Surgical Nursing
• Unit :
• Topic : Intracranial pressure.
• Date :
• Venue :
• Time :
• Number of students : 03
• Method of teaching : Lecture cum discussion
• A.V. Aids : Black board, power point, chart, palm plates.
• Previous knowledge of students : A group having less knowledge regarding Intracranial pressure.
 GENERAL OBJECTIVES
At the end of this lesson plan students will be able to learn about intracranial pressure in-detailed.

SPECIFIC OBJECTIVES
After completion of this lesson plan students will be able to;
• Introduce the intracranial pressure.
• Define intracranial pressure.
• Explain the aetiology of increased intracranial pressure.
• Enlist the signs and symptoms of intracranial pressure.
• Explain the pathophysiology of increased intracranial pressure.
• Explain the diagnostic evaluation of intracranial pressure
• Know the intracranial pressure monitoring.
• Describe medical management of intracranial pressure.
• Describe the surgical management of intracranial pressure.
• Explain the nursing management of intracranial pressure.
• Describe the complications of intracranial pressure.
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2min Introduce the • INTRODUCTION:
topic

The pressure in the cranial vault is measured in millimetres of

mercury (mm Hg) and is normally less than 20 mm Hg.
The cranium is a rigid structure that contains three main
components: brain, cerebrospinal fluid, and blood. Any increase in the
volume of its contents will increase the pressure within the cranial
vault.

Lecture cum Palmplate Define

3min Define • DEFINITION: discussion intracranial
intracranial
pressure.?
pressure. Intracranial pressure (ICP) is the pressure exerted by fluids
such as cerebrospinal fluid (CSF) inside the skull and on
the brain tissue.

ICP (intracranial pressure) is the pressure exerted by the

contents inside the cranial vault-the brain tissue (grey and white
matter), CSF and the blood volume.
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5min Describe the • CAUSES: Lecture cum Chart What are the
causes of discussion causes of
increased The causes of increased intracranial pressure (ICP) can be divided increased
intracranial based on the intracerebral components causing elevated pressures: intracranial
pressure. pressure?
1. Increase in brain volume-
Generalized swelling of the brain or cerebral edema from a variety of
causes such as trauma, ischemia, hyperammonaemia, uremic
encephalopathy, and hyponatremia
2. Mass effect-
• Hematoma
• Tumor
• Abscess
• Blood clots
3. Increase in cerebrospinal fluid-
• Increased production of CSF
• Choroid plexus tumor
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4. Decreased reabsorption of CSF-
• Obstructive hydrocephalus
• Meningeal inflammation or granulomas
5. Increase in blood volume-
• Increased cerebral blood flow during hypercarbia, aneurysms
• Venous stasis from
• Venous sinus thromboses,
• Elevated central venous pressures, e.g., heart failure
6. Other causes-
• Idiopathic or benign intracranial hypertension
• Skull deformities such as craniosynostosis
• Hypervitaminosis A, tetracycline use

4min Enlist the Lecture cum Power What are the

signs and discussion point signs and
symptoms of • SIGNS AND SYMPTOM: symptoms of
increased increased
intracranial intracranial
pressure. • headache pressure?
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• nausea

• vomiting

• increased blood pressure

• decreased mental abilities

• confusion about time, and then location and people as the

pressure worsens

• double vision

• pupils that don’t respond to changes in light

• shallow breathing

• seizures

• loss of consciousness

• coma
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5min Explain the • PATHOPHYSIOLOGY: Lecture cum Palmplate Explain the
pathophysiology discussion pathophysiology
of increased Due to etiological factors. of increased
intracranial intracranial
pressure. pressure?

Components of ICP is disturbed- brain tissue, CSF,

blood volume.

An increase in the volume of ANY ONE component

must be accompanied by a reciprocal decrease in one
of the other components.

When this volume-pressure relationship becomes

unbalanced, ICP increases.
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5min Explain the • DIAGNOSTIC EVALUATION: Lecture cum Palmplate Explain the
pathophysiology discussion pathophysiology
of increased - Medical history. of increased
intracranial - Physical exam including a neurological exam to test senses, intracranial
pressure. balance and mental status pressure?
- Lumbar puncture
- CT Scan
- MRI

• Elevation in ICP can be graded as follows:

1) Normal ICP - 0 - 15mm Hg

2) Mild elevation - 16 - 20 mm Hg
3) Moderate elevation - 21 - 30 mm Hg
4) Severe elevation - 31 - 40 mm Hg
5) Very severe elevation - 41 mm Hg and above

4min Know the • Intracranial Pressure Monitoring (ICP): Lecture cum Power How we are
monitoring of discussion point monitoring
intracranial Intracranial pressure is measured in two ways. One way is intracranial
pressure. to place a small, hollow tube (catheter) into the fluid-filled space in pressure?
the brain (ventricle). Other times, a small, hollow device (bolt) is
placed through the skull into the space just between the skull and
the brain.
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Both devices are inserted by the physician either in the
intensive care unit (ICU) or in the operating room. The ICP device is
then attached to a monitor that gives a constant reading of the
pressure inside the skull.

5min Describe the Lecture cum Power What is the

• MEDICAL MANAGEMENT: point
medical discussion medical
management of - Sedation/analgesia to control pain, agitation, and excessive management of
increased muscular activity (eg, due to delirium). increased
intracranial intracranial
pressure. - Hydration with isotonic fluids. If there are no signs of pressure?
dehydration or fluid overload, IV fluids with normal saline can
be started at 50 to 75 mL/h. The rate can be adjusted based on
serum sodium, osmolality, urine output, and physical
assessment.

- Osmotic diuretics to lower ICP and maintain serum

osmolality between 295 to 320 mOsm/kg. A 3% saline solution
is another osmotic agent used to control ICP. Fluid and
electrolyte balance should be monitored closely while either
therapy is used.
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- Blood pressure (BP) control when hypertension is severe (> Lecture cum
180/95 mm Hg). Mean arterial pressure needs to be high discussion
enough to maintain CPP even when ICP increases. Hypotension
should be promptly treated to avoid cerebral hypoperfusion.
- Corticosteroids are effective only for vasogenic edema (from
disruption of the blood-brain barrier) due to brain tumors and
sometimes abscesses.
- Hyperventilation causes hypocapnia, which causes
vasoconstriction, thus decreasing cerebral blood flow.
Hyperventilation to moderate levels (PaCO2 = 25-35) is
generally considered a short-term temporizing measure to
decrease ICP. Extreme hyperventilation (PaCO2 <25mmHg)
should be avoided.

• SURGICAL MANAGEMENT:
3min Describe the Lecture cum Power What is the
- CSF drainage using an external ventricular drain or lumbar point surgical
medical discussion
drain. management of
management of
- Decompressive craniectomy involves removing a portion of increased
increased
the skull to reduce ICP and is often a last resort for impending intracranial
intracranial
herniation. pressure?
pressure.
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5min Know the • NURSING MANAGEMENT: Lecture cum Palmplate What is the
nursing discussion nursing
management of - Physical assessment management of
increased - Neurological assessment increased
intracranial - Glasgow Coma Scale ;(min score-3, max score- 15 GCS below intracranial
pressure. 8- indicative of coma) pressure?

• NURSING DIAGNOSIS:

1) Ineffective tissue perfusion (cerebral) related to reduction of

arterial blood flow and cerebral edema as evidenced by
CPP<60 mm hg, GCS score <8, altered mental status, changes
in mental status

• INTERVENTIONS:

- Maintain hemodynamic parameters within normal range.

- Calculate and monitor CPP.
- Monitor neurologic status.
- Maintain input and output chart.
- Administer medication.
- Administer oxygen
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2) Decreased intracranial adaptive capacity related to decreased
cerebral perfusion as evidenced by ICP More than 20 mm of
hg, elevated systolic pressure, bradycardia and widened pulse
pressure

INTERVENTIONS:

- Monitor vital signs, ICP and neurologic status.

- Position the head end of the bed 30 degree or more.
- Maintain normal temperature.
- Give sedatives.
- Administer osmotic diuretics.
- Decrease stimuli in patient’s environment.

3min Explain the Lecture cum Power What are the

• COMPLICATIONS:
complications discussion point complications of
of increased Complications of increased ICP include; increased
intracranial intracranial
pressure. - Brain damage pressure?
- Seizure
- Stroke
- Coma
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2min Summarised SUMMARY

the topic
intracranial In this lesson plan we have discussed, regarding
pressure. definition of intracranial pressure, causes and signs and symptoms of
increased intracranial pressure, pathophysiology, diagnostic
evaluation and how to monitor intracranial pressure, medical
management, surgical management and nursing management of
increased intracranial pressure and their complications.

CONCLUSION

After this lesson plan, I have concluded that, increased

intracranial pressure is a neurologic emergency caused by a variety
of neurologic injuries and is associated with worse outcomes,
including brain ischemia and death. Prompt diagnosis, careful
analysis of the underlying pathophysiology, and invasive monitoring
and therapy of this condition are essential for successful
management. Invasive methods of diagnosis and monitoring have
their own risks.