INCREASED INTRACRANIAL PRESSURE

1. INCREASED INTRACRANIAL PRESSURE

2. MEANIING INCREASED INTRACRANIAL PRESSURE IS A RISE IN THE PRESSURE INSIDE THE SKULL THAT CAN RESULTS FROM OR CAUSE BRAIN INJURY.

3. ETIOLOGY • ANY LESION (SPACE-OCCUPYING LESIONS) • CEREBRAL EDEMA : CONDITIONS ASSOCIATED WITH CEREBRAL EDEMA ARE:- • MASS LESIONS • NEOPLASMS (PRIMARY AND METERIALISTIC) • ABSCESS, HYDROCEPHALUS • HEMORRHAGE (INTRACEREBRAL AND EXTRACEREBRAL HEMATOMA)

4. HEAD INJURIES (HEMORRHAGE, CONTUSION, POST TRAUMATIC BRAIN SWELLING) • BRAIN SURGERY • BRAIN INFECTION • VASCULAR INSULT: • INFARCTION (THROMBOLIC AND EMBOLIC) • VENOUS THROMBOSIS • ANOXIC AND ISCHEMIC EPISODES

5. TOXIC OR METABOLIC ENCEPHALOPHATIC CONDITIONS • LEAD INTOXICATION • RENAL FAILURE AND LIVER FAILURE • REYE’S SYNDROME: SWELLING IN LIVER AND BRAIN • OTHER CONTRIBUTORY FACTORS: • HYPERCAPNIA: ELEVATED CARBON DIOXIDE (CO2) LEVEL IN THE BLOOD • HYPOXEMIA • CEREBRAL VASODIALATORY AGENTS (ALOTHANE, ANTIHISTAMINE)

6. VALSALVA MANUOEVER: THE ACTION OF ATTEMPTING TO EXHALE WITH NOSTRILS AND MOUTH • BODY POSITIONING (PRONE, FLEXION OF NECK, EXREME HIP FLEXION) • ISOMETRIC MUSCLE CONTRACTION • COUGHING OR SNEEZING • RAPID EYE MOVEMENT SLEEP • EMOTIONAL UPSETS • NOXIOUS STIMULI: ACTUALLY OR POTENTIALLY TISSUE DAMAGING EVENT • AROUSAL FROM SLEEP • CLUSTERING OF ACTIONS

7. RISE IN PRESSURE OF CEREBROSPINAL FLUID • BRAIN TUMOR • BLEEDING INTO BRAIN OR FLUID AROUND THE BRAIN • SWELLING WITHIN THE BRAIN • ENCEPHALITS • MENINGITIS • STROKE

8. SYMPTOMS INFANTS: • DROWSINESS • SEPARATED SUTURE ON THE SKULL • BULGING OF THE SOFT SPOT ON TOP OF THE HEAD (BULGING FONTANELLE) • VOMITING

9. OLDER CHILDREN AND ADULTS: • BEHAVIOR CHANGES • DECREASED CONSCIOUSNESS • HEADACHE • LETHARGY • NEUROLOGICAL SYMPTOMS: WEAKNESS, NUMBNESS, EYE MOVEMENT PROBLEMS AND DOUBLE VISION • SEIZURE • VOMITING • SLOW PULSE

10. DIAGNOSTIC EVALUATIONS • HISTORY COLLECTION • PHYSICAL EXAMINATION • VITAL SIGNS • NEUROLOGIC CHECKUPS • BLOOD TEST: CBC, COAGULATION PROFILE, ELECTROLYTES CREATININE, ABGS AND AMMONIA LEVEL • DRUG AND TOXICOLOGY SCREENING

11. CSF PROTEIN, CELLS AND GLUCOSE • ECG • ICP MEASUREMENT • SKULL, CHEST AND SPINAL • MRI • CT SCAN, EEG • LUMBAR PUNCTURE • ANGIOGRAPHY

12. COMPLICATION • DEATH • PERMANENT NEUROLOGICAL PROBLES • REVERSIBLE NEUROLOGICAL PROBLES • SEIZURE • STROKE

13. MANAGEMENT • EMERGENCY CARE IN ICU • MONITOR VITAL SIGNS • ABC • DRAINING OF CEREBROSPINAL FLUID HELPS IN LOWER THE PRESSURE • MEDICATIONS TO DECREASE THE SWELLING • REMOVAL OF PART OF THE SKULL • SYMPTOMATIC TREATMENT

14. NURSING MANAGEMENT • HISTORY COLLECTION: CAUSES, SYMPTOMS • MAINTAIN AIRWAY • MONITOR VITAL SIGNS • ADMINISTER O2 • IV FLUIDS • ADMINISTER THIAMINE: ALCOHOLIC AND MALNOURISHED PATIENT • ADMINISTER 50% DEXTROSE IF BLOOD GLUCOSE <60 mg/dl • PREPARE FOR IV INSULINE ADMINISTRATION OF GLUCOSE >400 mg/dl • PREVENT ASPIRATION

15. MONITOR CONSCIOUSNESS • GLASGOW COMA SCALE • ELEVATION OF HEAD END OF BED TO 30 DEGREES WITH HEAD IN A NEUTRAL POSITION TO FACILITATE REDUCTION OF CEREBRAL EDEMA • MAINTAIN NORMOTHERMIA • ADEQUATE SEDATION • MAINTAIN CPP >70 mm Hg • MAINTAINANCE OF SYSTOLIC ARTERIAL PRESSURE BETWEEN 100 AND 160 mm Hg.

16. MEDICATION • OSMOTIC DIURETICS (MANNITOL) • LOOP DIURETICS FURSOMIDE (LASIX) • CORTICOSTEROIDS (METHYLPREDNISONE, DEXAMETHOSONE) • ICP MONITORING

17. THANK YOU…