ICP Basics
Normal adult ICP values
What is... 5–15 mm Hg
The earliest and most sensitive indicator of increasing intracranial pressure.
What is... a change in level of consciousness?
The most dangerous complication of severe increased ICP.
What is... brain herniation?
The two hyperosmolar therapies commonly used to decrease cerebral edema and ICP.
What are... mannitol and hypertonic saline?
The device that can both measure ICP and drain CSF.
What is... an external ventricular drain (EVD)?
The 3 things inside the rigid adult skull
What are... Brain tissue, blood, and CSF.
Early neurologic changes that can occur with increasing ICP, including restlessness, confusion, headache, vomiting, and decreased responsiveness.
What are... early signs of increased ICP?
Neurologic findings that can warn of brain herniation, including rapidly decreasing LOC, a new nonreactive pupil, and abnormal posturing.
What are... signs of impending brain herniation?
The type of medication mannitol is.
What is... an osmotic diuretic?
The important difference between an EVD and an intraparenchymal ICP monitor.
What is... an EVD measures ICP and drains CSF, while an intraparenchymal monitor measures ICP only
The formula that calculates cerebral perfusion pressure.
What is... CPP = MAP − ICP
The neurologic findings the nurse should continuously trend to detect deterioration.
What are... LOC/GCS, pupil responses, motor responses, and vital signs?
The priority response when a patient develops a rapidly decreasing LOC and a new nonreactive pupil.
What is... immediate emergency intervention and escalation of care?
These assessments are especially important when administering mannitol.
What are... blood pressure, urine output, renal function, electrolytes, and serum osmolality?
The urgent imaging study commonly used to identify hemorrhage, edema, hydrocephalus, mass effect, or herniation.
What is... a noncontrast CT of the head?
CPP range that is generally targeted in severe TBI?
What is.. About 60–70 mm Hg.
The three findings that make up Cushing's triad.
What are... widened pulse pressure, bradycardia, and irregular respirations?
The reason hypotension is especially dangerous in a patient with increased ICP.
What is... decreased MAP leading to decreased CPP and decreased cerebral perfusion
The way hypertonic saline decreases cerebral edema.
What is pulling water out of swollen brain tissue?
The reason lumbar puncture should generally be avoided when markedly increased ICP or a mass lesion is suspected.
What is... the risk of brain herniation?
The result when the brain can no longer compensate for increasing volume inside the rigid skull.
What is... a rapid increase in ICP?
The dangerous condition suggested by Cushing's triad and other severe neurologic changes.
What is... severe increased ICP with possible brain herniation?
This procedure should NOT be performed when increased ICP is suspected because removing CSF can cause a dangerous pressure shift and brain herniation.
What is... a lumbar puncture (LP)?
These values should be closely monitored when administering hypertonic saline.
What are... serum sodium, serum osmolality, and fluid status?
The EVD safety principle involving the drainage height and system settings.
What is... never independently changing the prescribed EVD settings or drainage level?