Nursing Care Plan (NCP) & Interventions for Increased Intracranial Pressure (ICP)

Overview of Nursing Care Plan for Increased Intracranial Pressure (ICP)

Think of your skull as a box that holds your brain, blood, and spinal fluid. There’s only so much room in this box. Increased Intracranial Pressure (ICP) happens when there’s too much pressure inside this ‘box.’

This can happen for a few reasons:

1. Too much fluid: Sometimes, your body makes too much spinal fluid (the fluid that cushions your brain), or it doesn’t drain properly. It’s like having too much water in a water balloon – it starts to stretch and put pressure on the brain.
2. Swelling: If your brain gets swollen, maybe because of an injury or illness, it can take up more space inside your skull. It’s like when you sprain your ankle, and it swells up, but in your skull, there’s no extra room for swelling.
3. Blood: If there’s bleeding inside the skull, like from a head injury, that extra blood can increase the pressure.

Increased ICP is serious because it can prevent blood from flowing properly to your brain, which causes brain damage if it’s not treated.

Symptoms might include a severe headache, nausea, vomiting, drowsiness, and problems with vision. In severe cases, it could lead to unconsciousness.

Pathophysiology of Increased Intracranial Pressure (ICP)

• • What is Increased Intracranial Pressure (ICP)?
  • • • It’s when there’s too much pressure inside your skull. Think of it like too much air in a balloon, pressing on everything inside.
  • Why Does it Happen?
  • • • It can be caused by things like head injuries, brain tumors, swelling of the brain (cerebral edema), or bleeding inside the head.
      • Inside your skull, there’s your brain, blood, and a special fluid called cerebrospinal fluid. If there’s too much of any of these, the pressure goes up.
  • What Does the Brain Do to Handle Extra Pressure?
  • • • Your brain tries to fix this by moving some of the cerebrospinal fluid to your spinal canal, or by adjusting the amount of blood inside your skull.
      • But sometimes, these fixes aren’t enough, and the pressure keeps rising.
  • Why is High ICP a Problem?
  • • • If the pressure gets too high, it can stop blood from flowing properly to your brain or squeeze parts of your brain, which can cause those parts of the brain to stop working properly or even die from lack of perfusion.
  • What Do Nurses Need to Do?
  • • It’s important for nurses to understand all this to help patients with high ICP.
    • They need to know the right ways to lower the pressure, like giving certain medicines or other treatments, to keep the brain safe.

Etiology

• • What Causes Increased ICP?
  • • • It’s caused by different things that make pressure go up inside your skull.
  • Head Injuries:
  • • • Things like concussions or serious head injuries can cause swelling and bleeding in the brain, which increases pressure.
  • Bleeding Inside the Skull:
  • • • If blood vessels in the brain burst (like from an aneurysm), the leaked blood can raise the pressure.
  • Brain Tumors:
  • • • Tumors can grow in or near the brain, taking up space and pushing against brain tissue. This can block fluid flow and increase pressure.
  • Infections:
  • • • Brain infections like meningitis or encephalitis can make the brain swell, leading to higher pressure.
  • Too Much Fluid:
  • • • Hydrocephalus is when there’s too much cerebrospinal fluid in the brain. This extra fluid can cause pressure to build up.
  • Why Nurses Need to Know This:
  • • Understanding these causes helps nurses figure out the best way to help. Each cause might need a different type of care to reduce pressure and prevent more brain problems.

Desired Outcome

• Main Goal:
  • To maintain normal ICP (7 – 15 mmHg) and keep the brain healthy.
• Key Objectives:
  • Keep ICP in Check: Make sure the pressure inside the skull stays at a safe level (7 – 15 mmHg).
  • Ensure Adequate Cerebral Perfusion: The brain needs enough blood flow to work right, so it’s important to monitor this.
  • Avoid Complications from Increased ICP: Prevent issues like brain herniation, where parts of the brain get pushed into places they shouldn’t be.
• Monitoring and Detection:
  • Watch for changes in how the patient’s brain is working, like if they become less conscious or their vital signs change.
  • Be quick to react if these signs show the pressure might be going up.
• Treatment and Teamwork:
  • Adjust treatments as needed, based on careful monitoring.
  • Work closely with doctors and other healthcare professionals to make the best decisions for the patient.
• Overall Aim:
  • To keep the patient’s brain functioning well and improve their overall health and well-being.

Increased Intracranial Pressure (ICP) Nursing Care Plan

Assessment for Increased Intracranial Pressure (ICP)

• Neurological Assessment:
  • Conduct a thorough neurological assessment, including assessments of consciousness, level of alertness, pupillary response, and motor function. Monitor for any signs of neurological deterioration, such as changes in responsiveness or focal deficits.
• Vital Signs Monitoring:
  • Continuously monitor vital signs, including blood pressure, heart rate, and respiratory rate, to detect any deviations that may indicate changes in intracranial pressure. Pay close attention to alterations in respiratory patterns, as irregularities may affect ICP.
• Pupillary Assessment:
  • Assess pupil size, symmetry, and reactivity to light. Anisocoria (difference in pupil size between left and right)  or sluggish pupil response may indicate neurological compromise and increased ICP.
• Glasgow Coma Scale (GCS):
  • Utilize the Glasgow Coma Scale to quantify the level of consciousness. Frequent GCS assessments help track changes in neurological status and guide interventions.
• Cerebrospinal Fluid (CSF) Drainage:
  • If applicable, monitor cerebrospinal fluid drainage systems for intracranial pressure control. Evaluate the clarity, color, and volume of drained fluid, and assess the insertion site for signs of infection or malfunction.
• Headache Assessment:
  • Assess the presence, intensity, and characteristics of headaches, as they can be indicative of increased intracranial pressure. Document any changes in headache patterns or associated symptoms.
• Respiratory Assessment:
  • Evaluate respiratory status, emphasizing the assessment of oxygen saturation, respiratory rate, and the presence of abnormal breathing patterns. Respiratory distress may exacerbate increased ICP.
• Diagnostic Imaging:
  • Review diagnostic imaging studies, such as CT scans or MRIs, to identify the underlying cause of increased intracranial pressure, such as tumors, hemorrhages, or edema.
• Fluid and Electrolyte Balance:
  • Monitor fluid and electrolyte balance closely, as imbalances can contribute to cerebral edema. Assess serum sodium levels, and aim for euvolemic fluid status to prevent fluctuations in intracranial pressure.
• Pain Assessment:
  • Evaluate the patient’s pain levels and response to pain management interventions. Effective pain control can contribute to overall comfort and may indirectly impact intracranial pressure.
• Collaboration with Monitoring Devices:
  • Collaborate with the use of intracranial pressure monitoring devices, if applicable, to directly measure and manage intracranial pressure. Ensure proper functioning and interpretation of device readings.

Nursing Interventions for Increased ICP

• Frequent neuro checks (q1h)

• Monitor Temperature and hemodynamics, including MAP and CPP

• Avoid sedatives or CNS depressants if possible

• Administer ordered medications:

• Prepare patient for surgical intervention
  • Craniectomy
  • External Ventricular Drain

• Level and Zero EVD to tragus (external auditory meatus of the ear). Maintain open per orders (i.e. open at 10 cm H2O)

• Monitor Electrolytes and Urine Output

• Patient positioning interventions to minimize ICP:
  • Maintain HOB 30-45°
  • Decrease stimuli
  • Avoid valsalva maneuvers

   

  Maintain HOB 30-45°

  • HOB < 30 = increased blood flow to brain → Increased ICP
  • HOB > 45 = increased intrathoracic pressure → decreased venous outflow from brain → increased ICP

  Decrease stimuli

  Agitation or stress can cause increased ICP

  Avoid valsalva maneuvers

  Coughing or bearing down can cause increased ICP

References

• https://emedicine.medscape.com/article/1829950-overview