Editing Anatomy and Physiology (section)

=== Intracranial Pressure ===

The '''Monro-Kellie doctrine''' states that the skull is a fixed container holding brain tissue, blood, and cerebrospinal fluid. An increase in any one component must be offset by a decrease in another or intracranial pressure rises. Normal intracranial pressure in an adult is approximately 5 to 15 mmHg.

Early signs of increasing intracranial pressure: a change in level of consciousness (the earliest and most sensitive sign), restlessness, headache, and pupillary changes. Late signs: '''Cushing triad''' of widening pulse pressure with rising systolic pressure, bradycardia, and irregular respirations, along with posturing and fixed dilated pupils.

'''Nursing application:''' Elevate the head of the bed about 30 degrees with the head midline to promote venous drainage, avoid hip flexion, avoid neck flexion or rotation, cluster care to limit stimulation, and prevent Valsalva maneuvers such as straining, coughing, and vomiting. Suction only briefly and as needed. Hypotonic fluids are avoided because they worsen cerebral edema.