Increased Intracranial Pressure
Cushing’s Triad
- Widened pulse pressure (high systolic/low diastolic)
- Irregular breathing
- Bradycardia
Symptoms
- Headaches, nausea, vomiting, lethargy, irritability, seizures, visual & mental status changes.
- Infants: bulging fontanelle or a high-pitched cry.
- Signs of herniation: ↓ LOC, bradycardia, and pupillary changes. ↑BP & respiratory rate.
Treatment
Initial management may include elevating the head of the bed, ensuring adequate oxygenation and ventilation, and decreasing stimulation. Drugs like mannitol or hypertonic saline may be administered to decrease cerebral edema and intracranial pressure.
In cases of hydrocephalus, a surgical intervention like a shunt may be necessary to drain excess cerebrospinal fluid and decrease ICP.
Case Study: Increased Intracranial Pressure
A 14-year-old female client who was involved in a motor vehicle accident arrived at the emergency department with signs of increased intracranial pressure. She shows an altered level of consciousness, pupillary dilation, and respiratory difficulty.
What is the most likely cause of increased intracranial pressure in this patient?
Cerebral edema is a swelling in the brain due to the accumulation of excess fluid. This can lead to an increase in intracranial pressure, resulting in signs of altered consciousness, pupil dilation, and respiratory difficulty, which was observed in the patient. Brain trauma causes cerebral edema.
What is the priority nursing intervention for a patient with increased intracranial pressure?
Elevating the patient's head of the bed to 15-30 degrees promotes venous drainage, which can help to reduce intracranial pressure. Always think what is the fastest intervention that would improve the client's condition!
The nurse anticipates that the physician will order which of the following medications to decrease intracranial pressure?
Mannitol is an osmotic diuretic that helps to reduce intracranial pressure by drawing fluid out of the brain cells.