Craniotomy A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated. During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue Decompressive craniectomy  It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure. Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.  Infections Tumors Stroke Aneurysm Epilepsy Seizures Hydrocephalus Hypertensive brain injury Hypoxemia Meningitis Due to etiological factors Components of ICP is disturbed- brain tissue, CSF, blood volume An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components. When this volume-pressure relationship becomes unbalanced, ICP increases. 

1. CHIRAYU COLLEGE OF NURSING, BHOPAL
SUBJECT- MEDICAL SURGICAL NURSING
TOPIC- INCREASED INTRACRANIAL PRESSURE
PREPARED BY
MR. MIGRON RUBIN
LECTURER

2. INTRODUCTION
• ICP is the pressure exerted by the contents inside the cranial vault-the brain
tissue (gray and white matter), CSF, and the blood volume.

3. DEFINITION
• Increased intracranial pressure is defined as cerebrospinal fluid pressure
greater than 15 mm Hg.

4. ETIOLOGY
• Infections
• Tumors
• Stroke
• Aneurysm
• Epilepsy
• Seizures
• Hydrocephalus
• Hypertensive brain injury
• Hypoxemia
• Meningitis

5. PATHOPHYSIOLOGY
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal
decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.

6. CLINICAL MANIFESTATIONS
• Headache
• Nausea
• Vomiting
• Increased blood pressure
• Decreased mental abilities
• Confusion
• Double vision
• Pupils that don’t respond to changes in light
• Shallow breathing
• Seizures
• Loss of consciousness
• Coma

7. DIAGNOSTIC EVALUATION
• Medical history and physical exam including a neurological exam to test
senses, balance and mental status
• Lumbar puncture
• CT Scan
• MRI

8. COMPLICATION
• Seizures
• Stroke
• Neurological damage
• Death

9. MANAGEMENT
• I. MEDICAL MANAGEMENT
• A. PHARMACOLOGICAL MANAGEMENT
• Corticosteroids- Dexamethasone
• Osmotic diuretic- Mannitol
• Analgesics
• Anti-epileptic drugs- Diazepam, Clonazepam
• Barbiturate therapy- It will offset ICP lowering effect on cerebral perfusion pressure.

10. • B. NON- PHARMACOLOGICAL MANAGEMENT
• Elevating head of bed to improve venous drainage.
• Oxygenation and ventilation to keep Pao2 >100, PaCo2 30-35
• NMB reduces ICP by avoiding coughing.

11. • II. SURGICAL MANAGEMENT
• DECOMPRESSIVE CRANIOTOMY

12. • III. DIETARY MANAGEMENT
• A limit intake of salt.
• A limit your intake of fats.
• Avoid red meat and processed meats like pork, bacon and beef.
• Foods that are rich in vitamin A may have an adverse impact on intracranial hypertension

13. • IV. NURSING MANAGEMENT
• ASSESSMENT
• 1. Change in LOC - drowsiness, lethargy
• 2. Early behavioral changes: restlessness, irritability, confusion, and apathy
• 3. Falling score on the GCS
a. Change in orientation: disorientation to time, place, or person
b. Difficulty or inability to follow commands
c. Difficulty or inability in verbalization or in responsiveness to auditory stimuli
d. Change in response to painful stimuli (eg, purposeful to inappropriate or absent responses)
e. Posturing (abnormal flexion or extension)
• Changes in vital signs caused by pressure on brain stem.

14. • NURSING DIAGNOSIS- Ineffective cerebral tissue perfusion related to increased ICP as
evidenced by decreased LOC, sluggish pupil response, papilledema, and posturing
INTERVENTIONS
-Keep head of bed slightly elevated and the head in midline (straight).
- Avoid extreme hip flexion.
-Avoid range-of-motion (ROM) exercises until ICP approaches normal
- Administer reduced fluid volumes at an even rate for 24 hours. Give diuretics as
prescribed; note client's response to therapy.
- Hyperventilate the mechanically ventilated client
- Keep suctioning brief, without exceeding 10-15 seconds per pass of the catheter.

15. • Risk for ineffective breathing pattern and ineffective airway clearance related to
diminished LOC and herniation of the brain stem secondary to increased ICP
• INTERVENTIONS
- Attach a pulse oximeter
- insert an oral airway if client is comatose.
- Administer oxygen.
- For mechanically ventilated clients, ensure that the ventilator delivers the prescribed tidal
volume at the ordered rate.
- Suction

16. • Risk for infection related to impaired skin and tissue integrity secondary to surgery,
invasive diagnostic or monitoring procedures, or original head injury
INTERVENTIONS
• - Keep wounds clean and dry.
- Use aseptic technique when handling any part of the intracranial monitoring device or
changing a dressing applied after surgery.
- Administer antibiotic therapy, if prescribed.

17. • Risk for impaired skin integrity related to low capillary blood flow secondary to
pressure and inactivity
INTERVENTIONS
- Tilt or turn client from side to side every 2 hours.
- Avoid friction by using a lift sheet.
- Use a pressure-relieving mattress or mechanical bed for clients whose position
cannot be readily changed.
- Keep skin clean and dry.

18. SUMMARY
• We have discussed about definition, etiology ,pathophysiology, clinical manifestation,
diagnostic evaluation & management of increased ICP