Increased ICP

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acr a
In tr
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In cr
ss u re
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Prepared By
Ayesha Fareed
Introduction
 The rigid cranial vault contains

 Brain tissue (1,400 g),
 Blood (75 mL)
 CSF (75 mL)
 These components make ICP.
 ICP is usually measured in the lateral ventricles
Normal ICP is 10 to 20 mm Hg
.
 The Monro-Kellie hypothesis states that because of

the limited space for expansion within the skull, an
increase in any one of the components causes a change
in the volume of the others.
Under normal circumstances,
 minor changes in blood volume and CSF volume
occur constantly due to alterations in intrathoracic
pressure like
 (coughing, sneezing, straining), posture, blood pressure,
and systemic oxygen and carbon dioxide levels.
Pathophysiology
Increased ICP cerebral perfusion,
stimulates further swelling (edema) and shifts brain
tissue through openings in the rigid dura
herniation, a dire, frequently fatal event.
Etiology of Increased ICP
Head injury Brain tumors Subarachnoid hemorrhage
Encephalopathy
Elevated ICP
Auto regulation
Auto regulation refers to the brain’s ability to change the diameter of its
blood vessels automatically to maintain a constant cerebral blood flow
during alterations in systemic blood pressure.
At a certain volume or pressure, the brain’s ability to auto regulate
becomes ineffective and decompensation(ischemia and infarction) begins.
When this occurs, the patient exhibits significant changes in mental status
and vital signs.
The bradycardia, hypertension, and bradypnea associated with this
deterioration are known as Cushing’s triad, a grave sign.
Clinical Manifestations
The earliest sign of increasing ICP is
 change in Loss Of Control.
 Slowing of speech and delay in response to verbal suggestions.
 Restlessness (without apparent cause), confusion, or increasing
drowsiness
 stuporous
 Reacting only to loud auditory or painful stimuli.
 comatose and exhibits abnormal motor responses in the form of
decortication, decerebration, or flaccidity
Detecting Later Signs of Increased ICP
 LOC continues to deteriorate until the patient is comatose.
 The pulse rate and respiratory rate decrease, and the blood pressure and
temperature rise.
 Altered respiratory patterns develop, including Cheyne-Stokes breathing,
apnea, ataxic breathing.
 Projectile vomiting
 Hemiplegia or decorticate or decerebrate posturing
 Loss of brain stem reflexes (pupillary, corneal, gag, and swallowing reflexes,
is an ominous sign)
Assessment and Diagnostic Findings
 Cerebral angiography
 Computed tomography (CT)
 Scanning
 Magnetic resonance imaging (MRI)
 Positron emission tomography (PET)
 Transcranial Doppler
 Note: Lumbar puncture is avoided in patients with increased ICP
because then sudden release of pressure can cause the brain to herniate.
Complications
1. Brain stem herniation

2. Diabetes insipidus
Management
 Increased ICP is a true emergency and must be treated promptly.

 Invasive monitoring of ICP
 Decrease cerebral edema
 lowering the volume of CSF
 Reduce cerebral blood volume
 Maintain cerebral perfusion
 Reduce metabolic demand
Nursing Management
 Maintain airway patency

 Attain Normal Respiratory Pattern
 Monitor Fluid Balance
 Prevent Infections
 Monitor and Manage Complications
e l o f
L e v
e r e d e s s
A l t u s n
s c io
C o n
Altered level of consciousness
 An altered level of consciousness (LOC) is apparent in the patient who is not

oriented, does not follow commands, or needs persistent stimuli to achieve a state
of alertness.
 LOC is gauged on a continuum:
Normal state of alertness and full cognition
Coma
 Coma is a clinical state of unconsciousness in which the
patient is unaware of self or the environment for prolonged
period.
 Akinetic Mutism is a state of unresponsiveness to the
environment in which the patient makes no movement or
sound but sometimes opens the eyes.
 Persistent vegetative state is a condition in which the
patient is described as wakeful but devoid of conscious
content, without cognitive or affective mental function.
Causes
The cause may be neurologic (head injury, stroke),

toxicologic (drug overdose,alcohol intoxication), or
metabolic (hepatic or renal failure,diabetic ketoacidosis).
The underlying causes of neurologic dysfunction are
disruption in the cells of the nervous system,
neurotransmitters, or brain anatomy.
cellular edema and other mechanisms such as antibodies
disrupting chemical transmission at receptor sites.
Pathophysiology
A disruption in the basic functional units (neurons)

or neurotransmitters results in faulty impulse
transmission, impeding communication within the
brain or from the brain to other parts of the body
Clinical Manifestations
As the patient’s state of alertness and
consciousness decreases, there will be
changes in the
 pupillary response, eye opening
response, verbal response, and motor
response.
Initial changes may be reflected by subtle
behavioral changes such as restlessness or
increased anxiety
Diagnostic Findings
 CT Scan
 MRI
 PET
 EEG
 Laboratory Test
 Serum Ammonia
 Blood Urea
 Nitrogen levels
 Blood Glucose Level
Complications
Potential complications for the patient with altered

LOC include respiratory failure, pneumonia,
pressure ulcers, and aspiration.
Respiratory failure may develop shortly after the
patient becomes unconscious.
Medical Management
The first priority of treatment for the patient

with altered LOC is to obtain and maintain a
patent airway.
The circulatory status (blood pressure, heart

rate) is monitored.
intravenous catheter is inserted.
Brain death
 In some circumstances, the family may need to face the

death of their loved one.
 The neurologic patient is often pronounced brain dead
before physiologic death occurs.
 The term brain death describes irreversible loss of all
functions of the entire brain, including the brain stem.
 When discussing a patient who is brain dead with family
members, it is important to use the term “dead”; the term
“brain dead” may confuse them.

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n i a l

 The rigid cranial vault contains

 The Monro-Kellie hypothesis states that because of

Head injury Brain tumors Subarachnoid hemorrhage

1. Brain stem herniation

 Increased ICP is a true emergency and must be treated promptly.

 Maintain airway patency

 An altered level of consciousness (LOC) is apparent in the patient who is not

The cause may be neurologic (head injury, stroke),

A disruption in the basic functional units (neurons)

Potential complications for the patient with altered

The first priority of treatment for the patient

The circulatory status (blood pressure, heart

 In some circumstances, the family may need to face the

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