V. Medical Management
Increased ICP is a true emergency and must be treated promptly. Immediate management involves decreasing cerebral edema, lowering the volume of CSF and decreasing blood volume while maintaining cerebral perfusion.
• Osmotic diuretics and corticosteroids are administered, fluid is restricted, CSF is drained, patient is hyperventilated, fever is controlled (using antipyretics, hypothermia blanket
• Chlorpromazine [Thorazine] to control shivering and cellular metabolic demands.
• If patient does not respond to conventional treatment, cellular metabolic demands may be reduced by administering high doses of barbiturates or administering pharmacologic paralyzing agents.
• Patient requires care in a critical care unit.
• Additional modalities may include electrical stimulation applied to the face to prevent muscle atrophy, or surgical exploration of the facial nerve.
• Surgery may be performed if a tumor is suspected, for surgical decompression of the facial nerve, and for surgical rehabilitation of a paralyzed face.
VI. Nursing Diagnosis
• Ineffective airway clearance related to accumulation of secretions secondary to depressed level of responsiveness
• Ineffective cerebral tissue perfusion related to effects of increased ICP
• Ineffective breathing patterns related to neurologic dysfunction (brain stem compression, structural displacement)
• Risk for fluid volume deficit related to dehydration procedures
• Risk for infection related to ICP monitoring system
VII. Nursing Management
Maintain a patent airway. Suction as needed and position the client to prevent airway obstruction.
Monitor neurologic status, including vital signs, level of consciousness (LOC), oculomotor nerve function, and motor and sensory status.
Prevent infection by using sterile technique for wound care, insertion of the ICP monitoring device and by keeping the monitoring system intact.
Provide safety measures when administering sedatives and analgesics that may depress respiration and decrease LOC
-Reduce or eliminate noxious stimuli
-Elevate the head of the bed 30 degrees
-Hyperoxygenate the client before suctioning
Manage hyperthermia
-Provide only minimal bed coverings and clothing
-Use a hypothermia blanket; avoid rapid cooling
-Administer antipyretics as prescribed
-Force fluids unless contraindicated
Maintain fluid and electrolyte balance
-Monitor the client’s skin turgor, mucous membranes, serum and urine osmolarity for signs of dehydration
-Monitor strict intake and output through an indwelling Foley catheter. Use a urometer if necessary.
Promote measures to prevent complications.
-Institute measures to prevent Valsalva maneuver (e.g. straining, coughing, constipation) because of increased ICP.
-Institute seizure precautions
-Monitor for complications of ICP, which include brain-stem herniation, diabetes insipidus and syndrome of inappropriate antidiuretic hormone.
Help orient the client and reduce confusion
-Reduce external stimuli
-Provide for adequate rest
-Give simple directions
-Provide familiar objects in the client’s environment.