Intracranial pressure

The narcotic antitussives are used cautiously in patients with head injury and increased intracranial pressure, acute abdominal disorders, convulsive disorders, hepatic or renal impairment, prostatic hypertrophy, and asthma or other respiratory conditions. 

When a patient taking mannitol for increased intracranial pressure is being assessed, which of the following finding would be most important for the nurse to report ... 

Cbnvulsions, steroid-induced catatonia, increased intracranial pressure with papilledema (usually after treatment is discontinued), vertigo, headache, neuritis or paresthesia, steroid psychosis, insomnia... 

The energy substrates are contraindicated in patients with hypersensitivity to any component of the solution. Dextrose solutions are contraindicated in patients with diabetic coma with excessively high blood sugar. Concentrated dextrose solutions are contraindicated in patients with increased intracranial pressure, delirium tremens (if patient is dehydrated), hepatic coma, or glucose-galactose malabsorption syndrome Alcohol dextrose solutions are contraindicated in patients with epilepsy, urinary tract infections, alcoholism, and diabetic coma... 

MONITORING OF INTRACRANIAL PRESSURE IN ISCHEMIC STROKE PATIENTS... 

Rosner MJ, Coley IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. J Neurosurg 1986 65(5) 636-641. 

Fan JY. Effect of backrest position on intracranial pressure and cerebral perfusion pressure in individuals with brain injury a systematic review. J Neurosci Nurs 2004 36(5) 278-288. 

Meixensberger J, Baunach S, Amschler J, Dings J, Roosen K. Influence of body position on tissue-po2> cerebral perfusion pressure and intracranial pressure in patients with acute brain injury. Neurol Res 1997 19(3) 249-253. 

Goldberg RN, Joshi A, Moscoso P, Castillo T. The effect of head position on intracranial pressure in the neonate. Crit Care Med 1983 11(6) 428 30. 

Prank JL. Large hemispheric infarction, deterioration, and intracranial pressure. Neurology 1995 45(7) 1286-1290. 

Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke 1998 29(8) 1550-1555. 

Baldauf J, Oertel J, Gaab MR, Schroeder HW. Endoscopic third ventriculostomy for occlusive hydrocephalus caused hy cerehellar infarction. Neurosurgery 2006 59(3) 539-544. Schwab S, Aschoff A, Spranger M, Albert F, Hacke W. The value of intracranial pressure monitoring in acute hemispheric stroke. Neurology 1996 47(2) 393-398. 

Lyons MK, Meyer FB. Cerebrospinal fluid physiology and the management of increased intracranial pressure. Mayo Clinic Proc 1990 65(5) 684—707. 

Lang EW. Chestnut RM. Intracranial pressure monitoring and management. Neurosurg Clin North Am 1994 5 573-605. 

Crutchfield JS, Narayan RK, Robertson CS, Michael LH. Evaluation of a fiberoptic intracranial pressure monitor. J Neurosurg 1990 72(3) 482-487. 

Vries JK, Becker DP, Young HE. A subarachnoid screw for monitoring intracranial pressure technical note. J Neurosurg 1973 39(3) 416-419. 

BP 160/90 mmHg or MAP of 110 mmHg if there is no evidence or suspicion of elevated intracranial pressure. Time to achieve not well delineated (possibly within... 

Management of Intracranial Hypertension (Intracranial Pressure >20 mmHg)... 

Sodium nitroprusside 0.25-10 mcg/kg/minute as IV infusion11 Immediate 1-2 minutes Nausea, vomiting, muscle twitching, sweating, thiocyanate and cyanide intoxication Most hypertensive emergencies use with caution with high intracranial pressure or azotemia... 

Acute complications of stroke include cerebral edema, increased intracranial pressure, seizures, and hemorrhagic conversion. In the acute setting, several supportive interventions and treatments to prevent acute complications should be initiated. 

ASA, aspirin BP, blood pressure Hb, hemoglobin Hct, hematocrit ICP, intracranial pressure ICU, intensive care unit INR, International Normalized Ratio SAH, subarachnoid hemorrhage t-PA, tissue plasminogen activator. 

Children treated with GH replacement therapy rarely experience significant adverse effects, whereas adults are more susceptible to dose-related adverse effects. Treatment with GH may mask underlying hypothyroidism. GH-induced symptoms, such as edema, arthralgia, myalgia, and carpal tunnel syndrome, are common and necessitate dose reductions in up to 40% of adults. Benign increases in intracranial pressure may occur with GH therapy and generally are reversible with discontinuation of treatment. Often, GH therapy can be restarted with smaller doses without symptom recurrence. 

Acute neurologic events, such as stroke, will require hospitalization and close monitoring. Patients should have physical and neurologic examinations every 2 hours.27 Acute treatment may include exchange transfusion or simple transfusion to maintain hemoglobin at around 10 g/dL (100 g/L or 6.2 mmol/L) and HbS concentration at less than 30%. Patients with a history of seizure may need anticonvulsants, and interventions for increased intracranial pressure should be initiated if necessary. Children with a history of stroke should be initiated on chronic transfusion therapy. Adults presenting with ischemic stroke should be considered for thrombolytic therapy if it has been less than 3 hours since the onset of symptoms.6,27... 

---