This document discusses increased intracranial pressure (ICP) or intracranial hypertension. It begins by describing the normal composition and pressure of the contents within the skull. Increased ICP is defined as a pressure over 20 mm Hg. Potential causes include brain injuries, tumors, hemorrhages, or obstructions in CSF flow. Signs and symptoms result from raised pressure displacing brain tissue and restricting blood flow. The document outlines medical and nursing management to reduce ICP through various interventions like medication, oxygen therapy, head positioning, and monitoring for complications.

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Brain
84%
Blood
4%
CSF
12%
Brain Blood CSF
BLLOD BRAIN CSF

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INCREASED INTRACRANIAL PRESSURE
(INTRACRANIAL HYPERTENSION)
 Our skull creates a hard casing in
which our cranial contents rest and is
protected from injury. The cranial
contents consist of three components.
Brain tissue or cells make up 84% of
the cranial contents. Our
cerebrospinal fluid 12% and cerebral
blood volume is 4%.

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Normal ICP
 Intracranial pressure is the pressure
exerted in the cranium by its
components: Brain, blood and CSF.
Normal intracranial pressure is
5-15mm of Hg.

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Definition of Increase Intracranial
Pressure( intracranial hypertension)
 Pressure greater than 20 mm
Hg is considered to represent
Increase intracranial pressure
or intracranial hypertension.

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Etiology and Risk Factors
Brain related causes
 Space occupying lesion (SOL)
 Head injury
 Brain tumor
 Cerebral Hemorrhage
 Brain surgery
 infarction with edema
 Generalized brain swelling can occur in ischemic-
anoxia states, acute liver failure, hypertensive
encephalopathy, pseudotumor cerebri, hypercarbia.

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Increase cerebral blood flow or increase
in venous pressure :
 Venous sinus thrombosis,
 Heart failure, or obstruction of
superior mediastinal or jugular veins.
 Systemic Hypertension.

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obstruction to CSF flow and/or absorption :
 Hydrocephalus (blockage in ventricles or
subarachnoid space at base of brain,
e.g., by Arnold-Chiari malformation).
 Extensive meningeal disease (e.g.,
infectious, carcinomatous, granulomatous,
or hemorrhagic).
 Obstruction in cerebral convexities and
superior sagittal sinus (decreased
absorption).

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Pathophysiology
Head Injury/ Intra cranial Mass/ Brain
swelling/ brain edema
Increase intracranial pressure due to
increase in brain tissue size or pressure.

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Displacement of CSF in to the spinal
canal ( Evident by altered level of
consciousness )
Further increasing in Intracranial
pressure.

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Decrease cerebral blood flow through
vasoconstriction of cerebral blood
vessels.
( Evident by changes in EEG, altered
cerebral metabolism, cerebral acidosis,
brain hypoxia and brain tissue
ischemia)

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Further increasing in Intracranial
pressure.
Herniation of the brain tissue.
( Evident by vasomotor, respiratory and
cardiovascular center actions)

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Death

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Clinical Manifestations :
1. Altered level of consiousness.
2. Changes in speech.
3. Cltered pupillary reactivity.
4. Changes motor and sensory
activities.
5. Headache.
6. Vomiting with no or little nausea.

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Clinical Manifestations :
7. Blured or double vision
8. Papiiledema
9. Bradycardia
10.Cheyne-strokes respiration
11.Hyperthermia
12.Brain Death

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Diagnsotic Study :
 X- ray Skull.
 C.T. Scan of brain.
 MRI.
 Transcranial Doppler.
 EEG.
 Invasive ICP monitoring.

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Management of Increase
intracranial pressure :
( A) Medical Management :
 The main goal of medical management
are to maintain cerebral oxygenation,
to decrease ICP, to maintain optimal
neurological function, and to ready the
patient for rehabilitation.

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 Maintain cerebral Oxygenation :
– Oxygen inhalation to keep the PaO2
between 90-100 mm of Hg.
– Endotrachial intubation.
– Steroid to reduce cerebral edema.

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 Decrease Intracranial pressure :
– Osmotic diuretics.
– Hyperventilation.
– Slight head elevation.
– Drain CSF

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 Maintain cerebral perfusion :
– Limit intra vascular fluid.
– Vasoactive medication.
– Barbiturates.

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 Reducing fever :
– Antipyretic medication.

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B. Nursing Management :
 Assessment
– LOC
– Lethargy and change in LOC first
signs; restlessness
– Glasgow Coma Scale
– Vital signs
– Late sign
– Headache

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– Pupillary changes
– Check pupil reaction, size, conjugate
(paired; working together) .
– Vomiting.
– Evaluation of motor and sensory
functions.
– Monitoring of ICP

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Ineffective airway clearance related to
diminished protective reflexes (Cough,
gag)
 Nursing Intervention: Maintaining a
patent airway.
– Frequent suction. (with caution)
– 100% oxygen given before and after suctioning.
– Prevent suctioning more than 15 sec.
– Discourage coughing.
– Auscultate lung field..
– Elevate head of the bed.

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Evaluation :
 Evident by patent airway, breath
sound clear, breath regularly, attain
oxygen saturation, no secretions.

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Ineffective breathing pattern
related to neurological
dysfunctions.
Nursing Intervention : Achieving an
adequate breathing pattern.
– Monitored frequently for respiratory
irregularity.
– Monitored PaO2 and PaCO2.

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 Evaluation :
Evident by regular breathing, maintain
oxygen saturation.

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Ineffective cerebral perfusion
related to effect of ICP.
Nursing Intervention : Optimizing cerebral tissue
perfusion
– Elevate Head end 30 degrees with head in neutral
position.
– Cervical collar if needed to keep head neutral.
– Avoid extreme hip flexion.
– Avoid Valsalva maneuvers – ask client to exhale when
being moved or turned
– Avoid isometric exercises that increase SBP.
– Preoxygenate and hyperventilate prior to suctioning.
– Space nursing interventions.
– Avoid emotional distress and frequent arousal from sleep.
– Note abdominal distension.

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Evaluation :
 Evident by Oriented to time, place and
person, follow verbal commands,
improve glasgow coma scale score.

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Deficient fluid volume
related to fluid restriction.
Nursing Intervention : Maintain
Negative fluid balance.
– Monitor skin turgor, mucous membranes,
serum and urine osmolality
– Monitor IVF carefully.
– Observe for CHF and pulmonary edema.
– Good oral hygiene, monitor I&O.

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 Evaluation :
Evident by Optimal urine output,
demonstrate serum and urine
osmolality value within acceptable
range.

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Risk for infection related
to ICP monitoring system.
Nursing Intervention : Preventing infection.
– Change sterile dressing aseptically.
– Aseptic technique must be adapted when
managing system and changing the ventricular
drainage bag.
– Check the drainage for cloudiness and blood.
– Watch for sign of infection viz fever, chills, neck
rigidity etc.
– Administered prescribed antibiotics.

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 Evaluation :
Evident by No fever, No signs of
infection at catheter site and no
purulent discharge from intracranial
monitoring devices.

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Complications :
 Herniation of brain.
 Diabetes insipidus.
 Death.