Medical Surgical Nursing

Increase Intracranial
Pressure
Brain

 Brain tissue (1,400g)

 Blood (75mL)
 CSF (75mL)
 Normal ICP 10 to 20 mmHg
Monro-Kellie Hypothesis

 Limited space for expansion in the skull, an

increase in anyone of the components
causes a change in the volume of the others.
Pathophysiology
 Increase ICP is a syndrome that affects many
patients with acute neurologic conditions.
This is because pathologic conditions alter
the relationship between intracranial volume
and pressure.
Elevated ICP most commonly associated
with head injury
 Secondary Effects
 Brain tumors
 Subarachnoid hemorrhage
 Toxic and viral encephalities
 Brain Tumor

Decrease Cerebral Blood Flow

Ischemia and Cell Death Early Cerebral Ischemia

Vasomotor Stimulation
(brainstem)

Increase Systemic Pressure

(s/sx slow pulse, cheyne-stokes
resp.,elevated temp.)

Increase ICP
Diagnostic Findings
 Cerebral Angiography
 Computed Tomography (CT) Scanning
 Magnetic Resonance Imaging (MRI)
 Positron Emission Tomography (PET)
 Transcranial Doppler
Cerebral Angiography
 The first image shows
normal brain blood flow
 The second image
shows presence of
cerebral aneurysm that
can cause decease
cerebral blood flow may
lead to increase ICP
Computed Tomography Scanning
 The first image shows a
normal view of the
brain
 The second image
shows brain with tumor
and edema that may
lead to increase ICP
Magnetic Resonance Imaging
 The first image shows
normal MRI result
 The second image
shows with brain tumor
that causes increase
ICP
Positron Emission Tomography
 The first image shows
normal PET result
 The second image
shows with brain tumor
that may lead to
increase ICP
Transcranial Doppler
 The top shows a TCD
of a normal artery
 Bottom shows a
severely stenosed
internal carotid artery
causes decrease
cerebral blood flow may
lead to increase ICP
Nursing Process

The Patient with Increased Intracranial

Pressure
Assessment
 History
 Present Illness

 Obtain Subjective Data

 Neurologic examination
 Mental Status

 LOC

 Cranial Nerve Function

 Cerebral Function (balance and coordination)

 Reflexes

 Motor and Sensory Function

 Abnormal Respiratory Pattern

Nursing Diagnosis
 Ineffective airway clearance related to
diminished protective reflexes
 Ineffective breathing patterns related to
neurologic dysfunction
 Ineffective cerebral tissue perfusion related to
the effects of increased ICP
 Deficient fluid volume related to fluid
restriction
 Risk for infection related to ICP monitoring
system
Planning and Goals
 Maintenance of patent airway
 Normalization of respiration
 Adequate cerebral tissue perfusion through
reduction in ICP
 Restoration of fluid balance
 Absence of infection
 Absence of complication
Nursing Intervention
 Maintaining patent airway and adequate ventilation
 Monitor vital signs and neurochecks
 Maintain fluid balance
 Position client with head of the bed elevated 30 to
45 degrees and neck in neutral position
 Maintain a quiet environment
 Avoid use of restraints
 Prevent straining at stool
 Prevent excessive cough and vomiting
 Prevent complication of immobility
 Preventing infection
 Administer medication as ordered
Evaluation
 Maintained patent airway
 Attains optimal breathing pattern
 Attains desired fluid balance
 Infection prevented
 Complications prevented