INCREASED INTRACRANIAL

PRESSUREhttp://www.youtube.com/watch?v=Z3qVl8Gb2J4

BRAIN ANATOMYhttp://www.youtube.com/watch?v=FUEwGGsB43c&feature=related

CSFhttp://www.youtube.com/watch?v=K9BYEO9725k

DEFINITION

O http://www.youtube.com/watch?v=Uy_W5hMKKbE

O The cranium is a closed cavity filled with contents that are virtually noncompressible.

O Rapid or prolonged increases in an intracranial pressure present a serious threat to life.

O This increased pressure may result from edema, bleeding, trauma, or space-occupying lesions.

DEFINITION

O Once the pressure exceeds the accommodation point, the brain will herniate through weak points (for example, the foramen magnum).

O Irreversible neurological damage or death will result.

SIGNS & SYMPTOMSO Change in level of consciousness.

May occur over a period of minutes, hours, or days.

Characterized by a diminished response to environmental stimuli.

Responsiveness ranges from alert and oriented to no response to stimuli.

Confusion, restlessness, disorientation, and drowsiness may be signs of an impending change.

SIGNS & SYMPTOMS

HeadacheIncreases in severity with

coughing, sneezing, or straining at stool.

Vomiting

SIGNS & SYMPTOMSPapilledema/pupil changes.

Edema and pressure of both the optic nerve and the oculomotor nerve at the point at which they enter the globe is caused by venous congestion resulting from increased intracranial pressure.

Pupil on the affected side may be nonreactive.

Pupils may be unequal, dilated, pinpoint, or nonreactive.

SIGNS & SYMPTOMS Elevation of blood pressure with a

widened pulse pressure. Decreased pulse rate (may be

increased initially). Decreased respiratory rate (may be

irregular).

Nursing Management

O Monitor vital signs closelyO Accurately assess and document

neurological statusO Evaluation of alterations of

consciousness is crucial since symptoms progress rapidly.

Nursing ManagementO Maintain patent airway

O Intubation and hyperventilation may be indicated to provide adequate cerebral perfusion of oxygenated blood and decrease carbon dioxide induced vascular spasm

O If patient is not intubated, position the patient on his side to decrease the possibility of airway occlusion

O use oral or nasopharyngeal airway, prnO Be aware that stimulation of coughing when

suctioning increases intracranial pressure and may precipitate seizure activity.

Nursing ManagementO Administer medications as ordered

O Mannital (osmotic diuretic, to decrease cerebral edema)

O Corticosteroids (to reduce cerebral edema)

O Dilantin (as a precautionary measure to prevent seizure activity)

O Antibiotics.

Nursing ManagementO Elevate head of bed (30º)

O Promotes return of venous blood.O Under no circumstances should

patient's head be lower than the body.

Nursing ManagementO Administer hypertonic I.V. solutions

as orderedO Dextrose in water (hypotonic) crosses

the blood-brain barrier and increase cerebral edema and intracranial pressure

O Fluids will be restricted to reduce intracranial pressure

O Accurate intake and output records must be kept.

Nursing ManagementO Protect patient from injury should

seizures occurO Pad side railsO Secure a tongue blade to the head of

the bed for easy access.

Nursing ManagementO Maintain normal body temperature

O Intracranial bleeding is frequently accompanied by increases in body temperature that are resistant to antipyretic agents

O Monitor rectal temperature frequentlyO Place patient on hypothermia blanket,

as ordered, for temperature over 102ºF.

Patient EducationFamily members of patients who return home following injury to the head should be instructed to return the patient to the hospital if any of the following problems occur:

Fever greater than 100ºF. Pulse less than 50 beats per minute. Vomiting Slurred speech Dizziness Blurred or double vision Unequal pupil size Blood or fluid discharge from ears or nose Increased sleepiness Inability to move extremities Convulsions Unconsciousness