Increased IntraCranial Pressure

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 Definition:

  Increased intracranial pressure is a rise in the pressure inside the skull that can result from or cause brain 🧠 injury.

  


    Increased ICP can reduce circulation to the brain  🧠, impede the absorption of CSF, affect the functioning of the nerve cells and lead to brainstem compression and death.



Cause:

 Many conditions can increase Intracranial pressure. They are,

  • Aneurysm rupture and subarachnoid hemorrhage
  • Brain 🧠 tumour
  • Encephalitis
  • Head injury
  • Hydrocephalus
  • Hypertensive brain haemorrhage
  • Interventricular hemorrhage
  • Meningitis
  • Subdural hematoma
  • Status epilepticus
  • Stroke


Signs and Symptoms:

  1. Behavioural changes
  2. Decreased consciousness
  3. Headache💊😭
  4. Lethargy
  5. Elevated 🌡️ temperature 
  6. Seizures
  7. Pupil changes
  8. Neurological symptoms including weakness, numbness, eye 👁️movement problems and double vision
  9. Vomiting
  10. Rise in the blood pressure with wide pulse pressure
  11. Slowing of 🫀 pulse

Diagnostic Test:
  • History and physical examination: can lead to the diagnosis of increased ICP
  • CT and MRI scan : of the head can determine the cause of increased ICP and confirm the diagnosis
  • ICP can be measured during a spinal tap (lumbar puncture)


Management:
Sudden rise of ICP is an emergency. The patient is managed in an intensive care unit. Treatment include, 
  • Breathing support
  • Draining of cerebrospinal fluid to lower the pressure
  • Medications include : Anti-edema measures(hyper osmotic agents eg:Mannitol), Anti- convulsants,     Anti- pyretics, Anti- hypertensives and Corticosteroids
  • If a tumour , hemorrhage or other underlying problems has caused the increase in intracranial pressure the cause should be treated
  • Ventriculoperitoneal shunt(VP Shunt) created in severe cases


Nurse's Interventions:
  1. Place the patient in supine position on the bed with elevated head end to 30 -40degrees as prescribed
  2. Prevent flexion of head and hips
  3. Monitor vitals
  4. Respiratory status should be monitored to prevent hypoxia
  5. Maintain mechanical ventilation as prescribed
  6. Maintain body temperature 🌡️🤒 and prevent 🥶 shivering, which can increase ICP
  7. Monitor electrolyte levels and acid - base balance ⚖️
  8. Monitor intake and output levels
  9. Limit fluid intake to 1200ml/day as prescribed
  10. Instruct the patient to avoid straining activities such as 😷 coughing and sneezing 🤧
  11. Administer medication 💊to decrease ICP as prescribed
  12. Prepare the patient for ventriculoperitoneal shunt if needed
Post-operative Care:
  • Position the patient supine and turn from the back to the non-operative side
  • Monitor for signs of increased intracranial pressure resulting from shunt failure
  • Monitor for signs of infection

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