1. INCREASED INTRACRANIAL PRESSURE http://www. youtube. com/watch

2. BRAIN ANATOMY http://www. youtube. com/watch

3. CSF http://www.youtube.com/watch?v=K9BYEO9725k

4. DEFINITION http://www.youtube.com/watch?v=Uy_W5hMKKbE
The cranium is a closed cavity filled with contents that are virtually noncompressible.
Rapid or prolonged increases in an intracranial pressure present a serious threat to life.
This increased pressure may result from edema, bleeding, trauma, or space-occupying lesions.

5. DEFINITION
Once the pressure exceeds the accommodation point, the brain will herniate through weak points (for example, the foramen magnum).
Irreversible neurological damage or death will result.

6. SIGNS & SYMPTOMS May occur over a period of minutes, hours, or days.
Change in level of consciousness.
May occur over a period of minutes, hours, or days.
Characterized by a diminished response to environmental stimuli.
Responsiveness ranges from alert and oriented to no response to stimuli.
Confusion, restlessness, disorientation, and drowsiness may be signs of an impending change.

7. SIGNS & SYMPTOMS Headache
Increases in severity with coughing, sneezing, or straining at stool.
Vomiting

8. SIGNS & SYMPTOMS Papilledema/pupil changes.
Edema and pressure of both the optic nerve and the oculomotor nerve at the point at which they enter the globe is caused by venous congestion resulting from increased intracranial pressure.
Pupil on the affected side may be nonreactive.
Pupils may be unequal, dilated, pinpoint, or nonreactive.

9. SIGNS & SYMPTOMS
Elevation of blood pressure with a widened pulse pressure.
Decreased pulse rate (may be increased initially).
Decreased respiratory rate (may be irregular).

10. Nursing Management Monitor vital signs closely
Accurately assess and document neurological status
Evaluation of alterations of consciousness is crucial since symptoms progress rapidly.

11. Nursing Management Maintain patent airway
Intubation and hyperventilation may be indicated to provide adequate cerebral perfusion of oxygenated blood and decrease carbon dioxide induced vascular spasm
If patient is not intubated, position the patient on his side to decrease the possibility of airway occlusion
use oral or nasopharyngeal airway, prn
Be aware that stimulation of coughing when suctioning increases intracranial pressure and may precipitate seizure activity.

12. Nursing Management Administer medications as ordered
Mannital (osmotic diuretic, to decrease cerebral edema)
Corticosteroids (to reduce cerebral edema)
Dilantin (as a precautionary measure to prevent seizure activity)
Antibiotics.

13. Nursing Management Elevate head of bed (30º)
Promotes return of venous blood.
Under no circumstances should patient's head be lower than the body.

14. Nursing Management Administer hypertonic I.V. solutions as ordered
Dextrose in water (hypotonic) crosses the blood-brain barrier and increase cerebral edema and intracranial pressure
Fluids will be restricted to reduce intracranial pressure
Accurate intake and output records must be kept.

15. Nursing Management Protect patient from injury should seizures occur
Pad side rails
Secure a tongue blade to the head of the bed for easy access.

16. Nursing Management Maintain normal body temperature
Intracranial bleeding is frequently accompanied by increases in body temperature that are resistant to antipyretic agents
Monitor rectal temperature frequently
Place patient on hypothermia blanket, as ordered, for temperature over 102ºF.

17. Patient Education
Family members of patients who return home following injury to the head should be instructed to return the patient to the hospital if any of the following problems occur:
Fever greater than 100ºF.
Pulse less than 50 beats per minute.
Vomiting
Slurred speech
Dizziness
Blurred or double vision
Unequal pupil size
Blood or fluid discharge from ears or nose
Increased sleepiness
Inability to move extremities
Convulsions
Unconsciousness