Nursing: Signs Of Increased Intracranial Pressure And Its Treatment Critical Thinking Sample
Nursing: Signs of increase intracranial pressure and its treatment
Intracranial pressure is defined as pressure between the skill and brain tissue. Cerebrospinal fluid (CSF) pressure escalates and is measured in determining the extent of this rise in volume initiating the pressure increase. There are numerous mechanisms the human body adapts to regulate intracranial pressure. Cerebral spinal fluid pressures measures about 1 mmHg in normal adults, but the production and absorption vary among individuals. However, variations in cerebrospinal fluid pressure creates abrupt intrathoracic pressure, especially, during coughing when simultaneously intraabdominal pressure also increases. Importantly, alterations in intracranial pressure are due to volume changes occurring in the chambers of the brain (Romner & Grände, 2013).
Traumatic brain injury seriously increases intracranial pressure and can be identified as one of the most frequent causes of a persistent rise. From a pathophysiological perspective the cranium, vertebral column along with the very rigid dura create a sturdy container. Injury creates alterations in these structures that form this container. Subsequently, there is an increase in substances circulating within the brain occurs. These include blood and ultimately cerebral spinal fluid, which increases intracranial pressure. Significantly, according to the Monro-Kellie doctrine a scientific relationship is established among these components forming the container whereby changes in one affects the other (Romner & Grände, 2013).
However, when increases in brain volume are small no significant immediate increase in ICP occurs. The brain has the ability of displacing CSF into the spinal canal. The falx cerebri stretches between hemispheres. The tentorium expands between the cerebellums the hemispheres. When the ICP levels are increased to about 25 mmHg failure of intracranial compliance can ultimately occur due to frequent small increases in brain volume leading to significant increase in intracranial pressure (Romner & Grände, 2013).
Signs of increased intracranial Pressure
According to scientific research signs, of intracranial pressure could be insidious. They include vomiting without nausea, headache, ocular palsies, back pain, altered consciousness, papilledema. When signs of protracted papilledema are manifested the visual disturbances become obvious. Also, signs of optic atrophy with ultimate blindness become evident. Headaches often happen during the morning hours awaking the person from his/her sleep. This is due to a brain, which is inadequately supplied with oxygen. Cerebral edema worsens during sleeping hours. These headaches become worse if patients cough, sneeze or bend over ( Mollan, Markey & Benzimra, 2014).
Behavioral changes are also manifested as patients seem less alert and may become forgetful not recalling time and place accurately. These observations subscribe to a mass effect of signs. Others include marked dilatation of the pupil and Cushing's triad, which is manifested by an increase in systolic blood pressure, abnormal respiration and widening of pulse pressure. In severe instances Cheyne Stokes respiration occurs as a complication of altered physiology. Patients whose blood pressure is within the normal range remain conscious while the intracranial pressure is elevated. Importantly, unconsciousness occurs only when ICP levels are 40–50 mmHg and over. At this level cerebral percussion decrease, which results in unconsciousness (Mollan et.al, 2014).
Papilledema (swelling of the optic disk) is a reliable sign of an increase in intracranial pressure. However, vision may not be affected as in other conditions where intracranial pressure is not the primary cause of this irregularity. Ocular palsies also known as ocularmotor nerve palsy is a condition whereby the third cranial nerves or branches of it become damages due to prolonged increases in intracranial pressure. Therefore, it becomes difficult to maintain normal eye alignment if watching straight ahead (Mollan et.al, 2014).
Seizures can also occur as a sign of increase in intracranial pressure either due to brain injury or disease states such as meningitis. Signs that become manifested are due to increased fliud in the brain, which forces the pressure to rise. It signifies an accompanying rise in cerebrospinal fluid and circulating fluid in brain cavities. Consequently, people with high blood pressure ought to be evaluated for increases intracranial pressure because high blood pressure is a sign of increased intra cranial pressure. Vision irregularities are always founds as a sign in increased intracranial pressure. Double vision is always a feature which implies some more serious developments within the central nervous system as it relates to optic nerve function (Mollan et.al, 2014).
Treatment of increased intracranial pressure
Treatment of increased intracranial pressure varies with the severity and cause of the rise in pressure. In most cases it is caused by trauma or severe hypertension. The treatment goal is reducing intracranial pressure because this could present as an emergency. Treatment could be a medical intervention as well as surgical if complications occur. In medical management considerations are towards treating the underlying causes also before focusing on a broad spectrum of approach reducing of intracranial pressure bypassing the etiology. This is the short term strategy (Olson, Lewis, Bader & Bautista, 2013).
Patients who have acquired increased in intracranial pressure due to head injury the aBC nursing management guide is always applicable to their care by first maintaining a clear patent airway, especially, if he/she is unconscious. Next is the assessment of respiratory patterns since breathing is a sign of increased intracranial pressure. While the patient is administered medication the initial signs of increased intracranial pressure might not have subsided immediately. As such, respiratory dysfunctions can still prevail (Olson et.al, 2013).
Adequate blood oxygen levels are the next urgent management criterion in head injury interventions. Consequently, doctor may order frequent blood gas levels to be taken during the first twenty four hours of admitting to a clinical setting. If carbon dioxide levels increase, complications can occur such as dilation of cerebral blood vessels further increasing intracranial pressure. Besides, brain cells are required to produce energy for bodily functions (Olson et.al, 2013).
Patients who are hospitalized may need to have their blood pressure increased artificially. This is to facilitate improvement in percussion, remove brain swelling and increase CPP. However, while this practice is highly recommended, most physicians are reluctant to engage in the practice because it is believed that blood pressure is a mechanism the body utilizes to force blood to the brain. When cerebral blood flow decrease becomes necessary physicians prefer to utilize drugs such as calcium channel blockers and intravenous manitol (Olson et.al, 2013).
Surgical interventions in severe increases in increased intracranial pressure are. They encompass drainage of fluid from the brain through creating shunts/drains that allow fluid to pass from one chamber of the brain to another. Craniotomies are also conducted to remove hematomas that are formed in the brain. This surgical procedure is performed to decrease intracranial pressure (Olson et.al, 2013).
Increases in intracranial pressure could be a medical emergency if it is caused by an accident, stroke or any other underlying cause. Signs are obvious and paplliedema is a sure sign that increased intracranial pressure is evident. Treatment interventions vary with the cause, but from a nursing perspective the ABC protocol is upheld in both nursing and medical management.
Mollan, S. Markey, K., &James D Benzimra, J. (2014). A practical approach to, diagnosis,
Olson, D. Lewis, L. Bader, M., & Bautista, C. (2013). Significant Practice Pattern Variations
Associated With Intracranial Pressure Monitoring. Journal of Neuroscience Nursing,
Romner, B., & Grände, P (2013). Traumatic brain injury: Intracranial pressure monitoring in
traumatic brain injury. Nature Reviews Neurology 9, 185-186
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