INCREASED
INTRACRANIAL PRESSURE
- the balance among the 3
components (brain tissue, blood,
CSF) maintains ICP.
- The Monro-Kellie doctrine states
that the 3 components must stay at
a relatively constant volume within
the closed skull.
- Normal ICP – 5-15mmHg
- Cerebral Perfusion Pressure (CPP)
drives oxygen delivery to cerebral
tissue. (60-100mmHg)
- MAP – ICP = CPP
*MAP = DP(2)+SP/3 – ICP = CPP
Intracranial Pressure (ICP)
• is the pressure exerted by fluids such as cerebrospinal fluid (CSF)
within the skull and on the brain tissue.
Significance: Maintaining normal ICP is crucial for adequate brain
function and perfusion.
Causes:
• Trauma: Head injury, hematomas (subdural, epidural)
• Medical Conditions: Brain tumors, hydrocephalus,
infections (meningitis, encephalitis)
• Other Causes: Stroke, aneurysm, severe hypertension, high
altitude.
Increased Intracranial
Pressure (ICP)
• impedes circulation to
the brain, impedes the
absorption of CSF, and
affects the functioning of
nerve cells
• leads to brainstem
compression and death
Pathophysiology
Insult to brain Decreased cerebral Accumulation of
blood flow CO2
Tissue edema Decreased O2 with
Vasodilation
death of brain cells
Increased ICP
Edema around necrotic Increased ICP resulting
tissue from increased blood
Compression of volume
ventricles
Increased ICP with
compression of brainstem
Compression of DEATH
& respiratory center
blood vessels
Assessment
▪ Altered level of consciousness, which is the most
sensitive and earliest indication of increasing ICP
▪ Headache
▪ Abnormal respirations
▪ Slowing of pulse
▪ Elevated temperature
▪ Vomiting
▪ Pupil changes
▪ Late signs of increased ICP include increased
systolic blood pressure, widened pulse pressure, and
slowed heart rate
Assessment
▪ Late signs include changes in motor function from
weakness to hemiplegia
▪ positive Babinski reflex
▪ decorticate or decerebrate posturing, and seizures
Interventions
• Monitor respiratory status and prevent hypoxia.
• Avoid the administration of morphine sulfate to prevent
the occurrence of hypoxia.
• Maintain mechanical ventilation as prescribed;
maintaining the PaCO2 at 30 to 35 mm Hg (30 to 35 mm
Hg) will result in vasoconstriction of the cerebral blood
vessels, decreased blood flow, and therefore decreased
ICP.
• Maintain body temperature
Interventions
• overall goals are:
❖maintain a patent airway
❖have ICP within normal limits
❖have normal fluid and electrolyte balance
❖have no complications secondary to immobility and decreased
LOC
• Prevent shivering, which can increase ICP.
• Decrease environmental stimuli.
• Monitor electrolyte levels and acid-base balance.
Interventions
• Monitor intake and output.
• Limit fluid intake to 1,200 mL/day.
• Instruct the client to avoid straining activities, such as
coughing and sneezing.
• Instruct the client to avoid Valsalva’s maneuver.
Medical Interventions
Antiseizure
• Seizures increase metabolic requirements and cerebral blood
flow and volume, thus increasing intracranial pressure (ICP).
• Medications may be given prophylactically to prevent seizures.
Antipyretics and Muscle Relaxants
• Temperature reduction decreases metabolism, cerebral blood
flow, and thus ICP.
• Antipyretics prevent temperature elevations.
• Muscle relaxants prevent shivering.
Medical Interventions
Blood Pressure Medication
• Blood pressure medication maybe required to maintain
cerebral perfusion at a normal level.
• Notify the health care provider if the blood pressure range is
lower than 100 or higher than 150 mmHg systolic.
Corticosteroids
• stabilize the cell membrane and reduce leakiness of the blood-
brain barrier.
• decrease cerebral edema.
Medical Interventions
Intravenous Fluids
• Fluids are administered intravenously via an infusion pump to
control the amount administered.
• Infusions are monitored closely because of the risk of promoting
additional cerebral edema and fluid overload.
Hyperosmotic Agent
• (Mannitol) increases intravascular pressure by drawing fluid
from the interstitial spaces and from the brain cells
• Monitor renal function
• Diuresis is expected
Surgical Interventions
Ventriculoperitoneal Shunt • Monitor for signs of infection.
• diverts cerebrospinal fluid from
the ventricles into the
peritoneum
Post-procedure Interventions
• Position the client supine and
turn from the back to the non-
operative side.
• Monitor for signs of increasing
intracranial pressure resulting
from shunt failure.
nursing management
▪ maintain head-up position
✓ at least 30 degrees (no neck and hip flexion); decrease
cerebral edema
✓ reduces sagittal sinus pressure
✓ promotes venous drainage from the head
▪ maintain patent airway due to low LOC
▪ measure and monitor ABGs regularly
▪ avoid Valsalva maneuver, coughing, sneezing
