Increased ICP: NCLEX Priorities
Increased ICP signs (Cushing's triad), management (HOB, mannitol, hyperventilation), pitfalls.
Increased intracranial pressure is neuro emergency. NCLEX tests recognition (Cushing's triad) and management.
Recognition
Cushing's triad: bradycardia, HTN with widened pulse pressure, irregular respirations. Late sign. Earlier: change in LOC, pupillary changes, vomiting.
Management
HOB 30°, head midline (jugular venous return). Avoid Valsalva (no straining, no neck flexion). Maintain CO2 35-40. Hyperosmolar therapy (mannitol, hypertonic saline). Sedation, analgesia.
Avoid
Hypotension (drops CPP). Hypoxemia. Hyperthermia. Hypoglycemia. Suctioning >15 sec (transiently raises ICP).
Cerebral perfusion pressure (CPP)
CPP = MAP - ICP. Goal: CPP >60-70. Treat hypotension aggressively.
Frequently asked
Why HOB 30°?
Promotes venous drainage from brain. Lowers ICP.
Steroids for ICP?
Not for traumatic ICP. Useful for tumor edema.
Quick check
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