Critical care of the child with increased intracranial pressure.

The nursing care of children with increased intracranial pressure is extremely complex. For children with intracranial pressure monitoring devices in place or for those who are maintained on a barbiturate coma regimen, the nurse must have extensive knowledge regarding the proper operation of the complex equipment that is helping to maintain the child's life. However, no matter how sophisticated the monitoring equipment or no matter what new research protocol is being followed, the child's life is dependent upon the nurse providing care. If the nurse fails to interpret the clinical findings correctly and does not notify the physician promptly, the child may suffer permanent neurologic dysfunction. Furthermore, the nurse must be cognizant of nursing actions--routine activities such as changing the child's position--that could have a dramatic effect on the child's intracranial pressure. Given time, expert nursing care, a multidisciplinary rehabilitation team, and a supportive family, many children who have severely increased intracranial pressures survive the insult without sustaining severe neurologic dysfunction.