MSN-Ed, BSN, RN
Any acute condition that affects vital organs like the brain, heart, and lungs requires extensive and ongoing assessments and monitoring. While a nurse may not care for patients with increased intracranial pressure (ICP) directly, many patients of all age groups are at risk of developing this condition due to pre-existing conditions. Early recognition of this condition is key.
Increased Intracranial Pressure (ICP) is a condition in which the pressure in the brain has increased. ICP can be due to an increase in the fluid surrounding the brain or pressure within the brain itself. This can be caused by brain tumors or bleeding within or surrounding the brain. ICP can damage structures in the brain or spinal cord which can impede blood flow to other parts of the brain which can be life-threatening.
Genetic disorders, pre-existing medical conditions, and lifestyle can play a role in the development of increased ICP. For example, a brain aneurysm is a risk factor for increased ICP that is associated with family history, arterial disorders, untreated high blood pressure, and smoking. While brain aneurysms occur mostly in adults between age 30 and 60, they can occur in anyone at any age.
Increased ICP can be fatal if misdiagnosed or left untreated. When nurses know the signs to look for, patient outcomes may be improved.
Common conditions that can cause increased ICP:
While signs and symptoms of increased ICP may vary based on age, a change in neurological status is consistent across age groups. Since this is a condition of the brain, there may be changes in a patient’s alertness, mentation, and overall behavior.
Clinical manifestations in infants:
Clinical manifestations in children and adults:
When first hearing the term ‘increased ICP’, a headache may come to mind. The real question is, ‘what differentiates a bad headache from a headache caused by increased ICP?’
For nurses, focused assessments are crucial in the prevention of disease progression. A cluster of signs and symptoms in combination with a detailed patient history may give a clue as to whether a patient’s headache is non-threatening or one that is associated with a potentially life-threatening condition, like increased ICP.
While neurological screening tools like the Glasgow Coma Scale may be useful for determining a patient’s mental alertness, critical thinking, and assessment skills are arguably the most valuable tools nurses have when caring for patients. Screening tools are intended to simply guide the nurse’s assessment.
As a medical surgical nurse, I frequently cared for patients at risk for increased ICP. In the mornings, I would perform initial head-to-toe assessments for all of my patients. However, as the shift progressed, my patients’ conditions often changed, prompting the need for continually focused assessments.
Something as simple as a patient’s report of increased pain led to my completing a focused pain assessment. Where is the pain and where did it originate? How bad is the pain? When did the pain start to get worse? What were you doing before the pain started? After obtaining subjective data, I would gather objective data – vital signs, observing for physical signs of pain, assessing the location of pain, etc.
When caring for patients with increased ICP or those at risk (recent seizure, head injury, high blood pressure, history of brain aneurysm, etc.), it is vital for the nurse to take note of any reported or observed symptoms and investigate further.
One symptom alone does not always paint the clearest picture. If there is a concern, nurses should address it with the physician and other members of the healthcare team.
When it is determined that a patient has increased ICP, an MRI or CT scan can help to diagnose the cause. A spinal tap (or lumbar puncture) may be used to determine the extent of the pressure. Patients with increased ICP will be monitored closely in the intensive care unit.
Nurses will frequently monitor the patient’s vital signs and neurological status. Treatment may include ventilation, medications to reduce brain swelling, and procedural drainage of cerebral spinal fluid to relieve pressure.
Removal of part of the skull to allow for pressure relief may be indicated. Clinicians will also treat the cause of the increased ICP episode. If left untreated, increased ICP can lead to vision loss and death.
Increased ICP can have devastating effects on patients and their families. While this condition is usually unpreventable, early detection can prevent further progression. When suspecting increased ICP, nurses should advocate for patients, particularly those at risk, by performing focused assessments and reporting findings to the physician.
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