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

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Increased Intracranial Pressure (ICP) Interventions (Picmonic)
Increased Intracranial Pressure (ICP) Assessment (Picmonic)

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In this lesson today, we're going to take a look at the care plan for increased intracranial pressure, also known as ICP. In this lesson, we will briefly take a look at the pathophysiology and etiology of increased ICP. We're also going to take a look at additional things that would be included in an ICP care plan, like subjective and objective data that your patient may present with as well as the necessary nursing interventions and rationales. 


Increased ICP is defined by an increase in pressure in the skull caused by an increase in the volume of brain tissue, blood, cerebrospinal fluid, or by the presence of a space occupying lesion. The increased pressure compresses brain tissue, which causes damage to the neurons leading to neuron changes, eventual herniation and brain death. Causes include cerebral edema, hemorrhage, hydrocephalus, hypertension, cerebral visa, dilation, a tumor, or a mass.


The desired outcome is to minimize ICP, to prevent any damage to nerve tissue and prevent long-term neurological deficits. Okay, so let's take a look at some of the subjective and objective data that your patient with increased ICP may present with. Remember, subjective data are going to be things that are based on your patient's opinions or feelings. These things might include confusion or memory loss. 


Objective data includes altered level of consciousness, pupil changes, but Babinski reflex, posturing, seizures, Cushing's triad, which indicates impending herniation and includes abnormal respirations, a wide pulse pressure and bradycardia. We will also see an elevated temperature in these patients.  


Okay, so let's jump into some of the nursing interventions for increased ICP. Complete neuro checks every hour as neurological changes related to increased ICP may be subtle or rapid, so  Frequent detailed neuro checks allow changes to be recognized quickly. Interventions can be initiated in elevated temperatures, sometimes as high as 104 is common with increased ICP because of the loss of autonomic regulation. Be sure to monitor your patient's temperature, also monitoring hemodynamics to assess for Cushing's triad and to evaluate cerebral perfusion pressure, which is the difference between mean arterial pressure and intracranial pressure. 


For patients with increased ICP, sedatives and CNS depressions need to be avoided because they can alter neurotrax checks. Common order medications include osmotic diuretics like mannitol, and hypertonic saline to decrease edema and corticosteroids to decrease inflammation. In some cases, it might be necessary to prepare the patient for a surgical intervention, like a craniectomy. This will remove a portion of the skull to allow space for swelling or placement of an external ventricular drain in the event of an elevated ICP. 


The EVD or external ventricular drain should be leveled to the tray, to be approximately in line with the fourth ventricle of the brain. Any increase in ICP above seven to eight would cause cerebrospinal fluid to drain because 10 centimeters of water correlates to approximately seven to eight millimeters of mercury ICP. If that EVD is not leveled properly, too much or too little cerebrospinal fluid could drain and too little drainage could cause increased ICP and possible brain herniation. Because of medications given to manage ICP like mannitol, it is important to monitor electrolytes and urine output. Mannitol and hypertonic saline can increase sodium levels, which could cause fluctuation in sodium levels, which could lead to seizures. Urine output should be monitored to verify diuresis. There are certain interventions that are utilized to minimize ICP, like maintaining the head of the bed between 30 and 45 degrees. Below 30 and above 45 can both increase ICP. You also want to decrease stimuli as agitation can increase ICP in your patient, and avoid Valsalva maneuvers because coughing and bearing down can increase ICP also. 


Here is a look at the completed care plan for increased ICP. Let's do a quick review. Increased ICP occurs when there is an increase in pressure in the brain cavity or skull, which compresses the brain tissue and leads to neuron changes and damage. Subjective data includes confusion and memory loss. Objective data includes altered LOC, pupil changes, Babinski reflex, seizures, Cushing's triad, posturing, and elevated temperature. Provide frequent neuro checks every hour to decrease complications. Monitor your patient's temperature, their hemodynamics, electrolytes and their urine output. Avoid sedatives and CNS depressants to prevent alterations in your neuro checks. Administer osmotic diuretics and corticosteroids. Level and zero your EVD.   Perform interventions like keeping the head of the bed at between 30 and 45 degrees, and decreasing stimuli to prevent increases in ICP. Finally prepare the patient for a craniectomy or EVD placement if necessary.


We love you guys. That is it for this lesson on the care plan for increased ICP. Go out and be your best self today and as always, happy nursing!

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