Intracranial hypertension: monitoring and nursing assessment.

Richard Arbour is a staff nurse and clinical researcher in the medical intensive care unit at Albert Einstein Healthcare Network, Philadelphia, Pa. Intracranial hypertension can lead to potentially catastrophic consequences, including permanent neurological damage and disability. Intracranial hypertension may be due to central nervous system infection, brain edema, cerebral hemorrhage or ischemic injury, or brain trauma. Traumatic brain injury is a major cause of morbidity and mortality; it accounted for 50 000 deaths in 1998. Fatality may not result from the immediate traumatic or hemorrhagic injury; rather, progressive damage to brain tissue may develop over time. Brain damage becomes even more progressive if intracranial hypertension is a consequence of injury. Astute nursing assessment and early, aggressive resuscitation of critically ill patients may prolong life. With brain trauma, the initial injury can be avoided only by using primary prevention strategies. Rapid control of fluctuations and elevations in intracranial pressure (ICP) may increase the potential for optimal functional recovery. In this article, I provide an overview of intracranial physiology and assessment findings specific to intracranial hypertension. Assessment findings reflect underlying pathophysiology in response to injury. These features are typically the first ones nurses consider in evaluating patients. I also review ICP monitoring and waveform analysis as central in caring for patients with intracranial hypertension.