Relation of nursing activities to increases in intracranial pressure

Increased intracranial pressure (ICP), a frequent finding in head trauma and other cerebral pathology, poses a serious threat to patients' prognosis and recovery. While considerable attention has been given to medical therapies used in reducing ICP, only recently has nursing looked at the effect care specific activities may have. In this descriptive and observational study of nine patients with cranial pathology and a Richmond bolt for measuring ICP, findings confirmed that nursing activities and environmental factors are associated with pressure increases. Respiratory care activities (mean 12.7 mmHg) and repositioning (mean 12.6 mmHg) resulted in the highest increases while lesser increases were associated with doing neuro-assessments (mean 7.2 mmHg) and spontaneous movements (mean 7.9 mmHg) of the patient. When the conversation was directed to the patient, the pressure increased in 33 of the 86 observations (mean 8.6 mmHg), in 21 of the 35 conversations about the patient, the mean pressure increase was 9.03 mmHg. Because many activities occurred simultaneously, it was difficult to derive the extent of elevation associated with a specific activity. Findings from this study and studies by other nurse researchers suggest actions nurses can use to minimize pressure increases. Many areas for further study exist.