Intra cranial pressure


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Deepa Merin Kuriakose
Govt.College of Nursing
Kottayam, Kerala, India

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Intra cranial pressure

  1. 1. WELCOME
  2. 2. MANAGEMENT OF INCREASED INTRA CRANIAL PRESSURE Deepa Merin Kuriakose 1st Semester MSc Nursing Medical College, Kottayam
  3. 3. INTRODUCTION Increased ICP is a life-threatening situation that results from an increase in any or all of the three components (Brain Tissue, Blood, CSF) of the skull. Cerebral edema is an important factor contributing to increased ICP The rigid cranial vault contains Brain Tissue (1400 gm), Blood (150 ml) and CSF (150 ml). The volume and pressure of these three components are usually in a state of equilibrium because it is a closed space, If one component enlarges, the other must compress and after spatial compensation is exhausted, with relatively small increase in volume, the intra cranial pressure will increase. With increased intra cranial pressure, blood flow and oxygen delivery may be compromised and secondary injury occurs. Normal ICP ranges from 0-15 mmHg with the use of pressure transdueer. A sustained pressure above upper limit is considered abnormal.
  4. 4. ETIOLOGY 1. Conditions that increase brain volume.Space Occupying Masses (Hematomas,Abscesses, Tumors, Anessysm) Cerebral Edema (Head Injury) 2. Conditions that increase blood volume. 3. Obstructions of Venom Outflow
  5. 5. PATHOPHYSIOLOGY It is directly proportional to cerebral edema. Vasegenic edema is the most common type of edema seen in patients with cerebrovascular problems and trauma. It predominantly affects the white matter, causes extracellular fluid accumulation, increasing the brain bulk and elevating ICP Decrease regional CBF  Decrease CPP  Increase CO2  Decrease O2  Increase acidosis from the products of cell metabolism  Vasodilation  Increase CBF  Increase CBV  Increase ICP  Possible impairment of Local autoregulation.
  6. 6. CHEMICAL FEATURES Cushing’s Response (Cushing’s Reflex): Is a comparatory response designed to provide adequate CPP in the presence of rising ICP. 1. A rise in the systolic ICP 2. Widening of the pulse pressure 3. Brady Cardia
  7. 7. CRUSHING’S TRIAD At a certain volume or pressure the brain’s ability to autoregulate becomes in effective and begins ineffective and decompensation begins. The crushing triad includes (a grave sign) 1. Brady Cardia 2. Hyper tension and 3. Bradyprea (Abnormal respiratory pattern)
  8. 8. EARLY FINDINGS 1. Deterioration in the level of consciousness 2. Pupillary Diffusion 3. Visual Abnormalities 4. Determination of Motor Function 5. Headache 6. Vomiting 7. Changes in Vital Signs (Altered B.P. and Pulse)
  10. 10. MEDICAL MANAGEMENT  Respiratory Support  Oxygen  Airway Support  Hyperventilation  Decreased PCO2  35 to 28 mmHg. Vasoconstriction of the cerebral arteries, Reduced CBF and increased venous return from the brain. A High CO2 level increases ICP
  11. 11. Corticosteroids Blood Pressure Medication Antipyretics and Muscle Relaxants Anticonvulsants I/V Fluids Medications for ICP
  12. 12. Surgical Intervention of ICP V.P.Shunt :- Shunts CSF from the ventricles into the periforeum. Implementation Post Procedure :- Position the client supine and turn from back to non operative side. Monitor for signs of increasing ICP resulting from shunt failure. Monitor for signs of infusion C.S.F. Drainage : Ventricular Drainage Surgery : Remove haematoma, tumor, abscess, removal or debulking of the lesion.
  13. 13. MONOTORING ICP The purpose of ICP monitoring are to identify increased pressure early in its course (before cerebral damage occurs), to quantify the degree of elevation, to initiate appropriate treatment, to provide access to CSF for sampling and drainage and to evaluate the effectiveness of treatment.
  14. 14. Different Approaches of ICP Monitoring Intraventricular catheter Subarachroid bolt/screw Epidural or Subdural Catheter or Sensor Fiberoptic Transducer Tipped Catheter
  15. 15. ICP PRESSURE WAVES A (Plateau) Waves B Waves C Waves
  17. 17. Neurological Assesment Establishing and Maintaining a Patent Airway Positioning and Moving Patients Monitor urinary out put and specific gravity Ventricular Drainage Interpret the ICP waves and be alert about atypical readings General Nursing Management
  18. 18. Nursing Care Plan
  19. 19. Client is bedridden, client is not able to cough effectively GCSL8 Client Immobile Client is not able to perform ADL Client in a comatosed stage Increased ICP, R/T, cerebral edema
  20. 20. CONCLUSION Besides the carefully planned physical care provided, patients with increased ICP, the nurse must also be aware of the psychological well being of the patients and their families. There is a need for supports, information and education of both patients and families. The nurse should asses the family members desire and need to assist in providing care for the patient and allow for their participation as appropriate.
  21. 21. Thank You Deepa Merin Kuriakose 1st Semester MSc Nursing Medical College, Kottayam