Increased intracranial pressure (ICP) nursing, pathophysiology, NCLEX, treatment, and symptoms NCLEX review.

Increased intracranial pressure occurs when the inside of the skull experiences increased pressure. This is a medical emergency!

How is ICP created? Intracranial pressure is the pressure created by the cerebrospinal fluid and brain tissue/blood within the skull. It can be measured in the lateral ventricles with an external ventricular drain (ventriculostomy).

What is a normal intracranial pressure (ICP)? 5-15 mmHg (greater than 20 mmHg…needs treatment)

Pathophysiology of increased intracranial pressure: The human skull is very hard and is limited on how much it can expand when something inside the skull experiences a change that leads to increased pressure exerted within the skull.

Inside the skull are three structures that can alter intracranial pressure: brain, cerebrospinal fluid (CSF), and blood.

The Monro-Kellie hypothesis deals with how ICP is affected by CSF, brain's blood, and tissue that works to maintain cerebral perfusion pressure (CPP). In a nutshell, this hypothesis says that when the volume of one of these structures increases than the others will have to decrease their volume to compensate for the increased intracranial pressure.

Intracranial pressure fluctuates and this depends on many factors like: the person’s body temperature, oxygenation status, especially CO2 and O2 levels, body position, arterial and venous pressure, anything that increases intra-abdominal or thoracic pressure (vomiting, bearing down).

Cerebral perfusion pressure is important when dealing with intracranial pressure. A normal CPP is 60-100 mmHg.

When CPP (pressure that pushes the blood to the brain) falls too low the brain is not perfused and brains tissue dies.

How is CPP calculated?
CPP= MAP - ICP (see video on how to calculate cerebral perfusion pressure)

Symptoms of increased intracranial pressure: mental status changes (EARLIEST), cushing's triad, vomiting, headache, decorticate or decerebrate posturing, optic and oculomotor nerve damage, abnormal doll's eye, seizures etc.

Nursing care for increased ICP includes monitoring and preventing further increases in intracranial pressure, administering drugs such as Mannitol, anticonvulsants, corticosteroids etc. See video for a mnemonic on the nursing interventions for increased ICP.

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