Increased Intracranial Pressure

Front 1

cytotoxic ( Cellular) Edema

Back 1

Cytotoxic edema Occurs as a result of hypoxia. Result is abnormal accumulation of fluid within the cells and a decrease in extracellular fluid.

Front 2

Explain the effect of poor ventilation in regards to ICP

Back 2

Poor ventilation will precipitate acidosis, or an increase in the PaC02. Carbon dioxide has a vadodilating effect on the cerebral arteries, which increases cerebrovascular blood flow and increases ICP. Clients should be ventilated to a normocapnic satate to prevent cyclic vasodilation, which increases intracranial pressure.

Front 3

State the causes of cerebral edema

Back 3

toxic exposure, blunt trauma, fluid and electrolyte imbalance.

Front 4

what can cause intracranial hemorrhage

Back 4

epidural or subdural bleeding ( closed head injuries, or ruptured blood vessels)

Front 5

Clinical manifestations of ICP

Back 5

Changes in LOC
Papilledema
Pupillary changes
Impaired eye movment

Posturing: Decerebrate, Decorticate, flaccid

Decreased Motor function: changes in motor ability, posturing.

Headache

Seizures: Impaired sensory and motor function

Changes in Vital signs: Increased systolic BP
Decreased Pulse
Altered respiratory pattern
Vomiting
Changes in speech

In infants:
Cranial suture separation
Increased Head circumference
High Pitched Cry

Front 6

Increasing Intracranial Pressure In Adults

Back 6

Adult:

Early: Restless, irritable, lethargic

Intermediate: Unequal pupil response, projectile vomiting, vital signs change.

Late: Decreased level of consciousness, decreased reflexes, hypoventilation, dilated pupils, posturing

Front 7

Increasing Intracranial Pressure in Infant/Children

Back 7

Early: Poor feeding, tense fontanel, h/a, n/v, increased pitch of cry, unsteady gait.

Intermediate ( younger than 18 months) : Increased head circumference, altered consciousness, bulging fontanel, shrill cry, severe headache, blurred vision, stiff neck.

Front 8

When Cushings triad occurs, increased ICP is well established. Describe s/s of cushings triad.

Back 8

Cushings Triad : Increasing systolic pressure, with increased pulse pressure, decreased pulse rate, cheyne stokes respirations.

Front 9

Ipsilateral

Back 9

pupillary changes occurring on the same side as a cerebral lesion

Front 10

Contralateral

Back 10

Pupillary changes occurring on the side opposite a cerebral lesion.

Front 11

Treatment of ICP

Back 11

IV and oral fluids to maintain normal fluid volume status if mean arterial pressure is low to normal. Often, normal saline solution is fluid of choice; 5% dextrose in water potentiates cerebral edema.
Placement of ventriculoperitoneal shunt during decompression surgery.

Front 12

Medications for ICP

Back 12

osmotic diuretic corticosteroids, anticonvulsants, antihypertensives.

Front 13

What positioning is needed for ICP

Back 13

Maintain HOB in semi-fowlers position to promote venous drainage and respiratory function. t

Front 14

If client with increased ICP develops hypovolemic shock, what position would you NOT place them in?

Back 14

DO not place them in Trendelenburg position

Front 15

Nursing Inverventions for ICP

Back 15

Monitor urine osmolarity and specific gravity
Evaluate intake and output; in response to diuretics, as correlated with changes in daily weight; for complications of diabetes insipidus.
Maintain intake evenly during therapeutic treatment.
In infants, measure frontal occipital circumference to evaluate increase in size of the head.
Maintain head and spinal column in midline position, goal is to maintain respiratory function.

Front 16

Home Care, during client and family teaching, What observations need to be reported to MD

Back 16

1. Changes in vision
2. Increased drainage from incision area or clear drainage in the ears.
3. Abrupt changes in sleeping patterns or irritability
4. Headache that does not respond to medications
5. changes in coordination, disorientation
6. slurred speech, unusual behavior
7. seizure activity, vomiting.