Overview
This lecture covers the key concepts, signs, nursing care, diagnostics, and medications related to increased intracranial pressure (ICP), highlighting critical exam points for nursing students.
Definition & Causes of Increased ICP
- Increased intracranial pressure means high pressure inside the skull, compressing brain tissue and the brainstem.
- Causes include head bleeding (aneurysm, stroke), swelling (trauma, meningitis), and brain tumors.
- Increased pressure compresses blood vessels, leading to reduced brain oxygen (cerebral hypoxia).
Early, Moderate, and Late Signs & Symptoms
- Early sign: altered level of consciousness (decreased mental status, irritability, restlessness, sleepiness).
- Moderate signs: constant headache, sudden vomiting without nausea (priority finding).
- Late signs: irregular breathing (Cheyne-Stokes), stiff neck (nuchal rigidity), fixed/dilated pupils, Babinski reflex (toes fan out), seizures, coma, abnormal posturing (decorticate and decerebrate).
Critical Assessment Findings & Prioritization
- Priority findings: vomiting without nausea, fixed/dilated pupils, decreased GCS score, Babinski reflex in adults.
- Cushing’s triad: widened pulse pressure (high systolic/low diastolic), bradycardia, decreased respiration = brainstem compression.
- Assessment comes before intervention: immobilize C-spine and get immediate CT scan for trauma.
Diagnostics
- CT scan is first-choice imaging; MRI is not used due to time constraints.
- Lumbar puncture is contraindicated as it can worsen ICP.
- ICP monitoring via subarachnoid screw for long-term cases (normal ICP: 5–15 mmHg).
Nursing Interventions
- Immobilize head in neutral position and log-roll as one unit.
- Maintain CO2 below 35 by hyperventilating (reduces ICP).
- Place head of bed at 30–35°; avoid flexion/bending and Valsalva maneuvers (coughing, sneezing, holding breath).
- Suction only when necessary, for less than 10 seconds, with 100% oxygen before/after.
- Perform frequent neuro checks using Glasgow Coma Scale (GCS).
Glasgow Coma Scale (GCS)
- GCS evaluates level of consciousness; lower scores indicate worse brain injury.
- GCS < 8 requires intubation; report any GCS decrease to provider immediately.
- GCS components: response to stimuli (verbal, pain), orientation (person, place).
Pharmacological Management
- Mannitol (osmotic diuretic) decreases cerebral edema via IV; monitor for heart failure, pulmonary edema (crackles).
- Phenitoin for seizure prevention; dexamethasone (steroid) and phenobarbital (barbiturate) reduce swelling/brain activity.
Key Terms & Definitions
- Increased ICP — Elevated pressure inside the skull.
- Cerebral hypoxia — Low oxygen to the brain.
- Babinski reflex — Toes fan out when stroked, abnormal in adults with ICP.
- Cushing’s triad — Widened pulse pressure, bradycardia, low respiration due to brainstem compression.
- GCS (Glasgow Coma Scale) — Tool for assessing consciousness; <8 indicates coma.
Action Items / Next Steps
- Memorize early and late signs of increased ICP for exams.
- Practice GCS assessment and know when to report score changes.
- Review proper nursing interventions and contraindicated procedures for ICP.
- Study drug effects and monitoring for mannitol.