Causes of ICP
Hydrocephalus. Abnormal amount of fluid accumulates in the ventricles of the brain.
INTERNAL NON COMMUNICATING
Blockage--the CSF can not get to the subarachnoid space. Causes: malformations, neoplasms, infections, trauma.
Obstruction in the subarachnoid cistern at the base of the brain or in the space.
No blockage! Fluid paths are open….but not absorbed.
Early signs= increased head circumference. Bulging fontanels. Cranial sutures separated. Signs of ICP.
Late signs= Cracked pot head….;}….which is of course Macewen’s sign! Setting sun sign, arched back (opisthtonus) frontal bossing.
Treatment= correction of cause of obstruction. Ventricular shunting.
VP= ventriculoperitoneal= method of choice.
Older versions= ventriculpleural, ventriculoatrial.
Problems= infection…tubing issues, replacements
POST OP Nsg CARE
Position on unoperated side to prevent the pressure on shunt valve. Keep flat….prevent rapid reduction of fluid….to fast the cerebral cortex can pull away from the dura and produce a subdural Hematoma.
Gradually raise the head of bed as ordered.
Shunt obstruction will need to return to OR.
Infection---IV and Intraventricular antibiotics.
Infection of the pia mater…arachnoid membrane…and CSF fills the subarachnoid space. Because of bacteria, virus, or fungal organism. The organisms can get there by…..nasal pharynx, lumbar puncture, penetrating wounds, fractures, spina bifida.
S & S
Neonate= hypothermia or fever….not eating, poor muscle tone.
Infants= fever, high pitch cry, headache, bulging fontanel.
Children/Adolescents= fever, photophobia, headache, nuchal rigid, +Kernigs, + Brudzinski’s signs.
All= Irritable, Seizures, vomiting.
Pressure is measured--the normal is 0-15mmHg. Increased ICP is greater than 15mmHg.
The CSF is sent to the lab…Grain Stain to identify the shape of the organism…Blood cell count--increased WBC…Glucose--decrease in glucose….Protein--increase in protein…within the hour…C and S will take longer….
Antibiotics AFTER sending CSF to the lab…penicillin, cephalosporins, vancomycin alone or with Rifampin. Dexamethasone given 15-20 min before the first dose and q 6 hours for next 4 days.
Isolation for first 24 hours of antibiotics
Control seizures, fever, strict I & O to avoid edema…..
Shhhh….no pillow! Seizure precautions, be careful with the neck…VS, neuro checks, LOC q 1-2 hours. NPO if decreased LOC.
If you are exposed the CDC recommends treatment with Rifampin.
Rifampin side effects: n/v/d…headache, dizzy orange urine, contact lenses will turn orange, Cannot be given to pregnant women. Or Tx w/ Cipro or rocephin.