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ce·re·bral com·pres·sion(serĕ-brăl kŏm-preshŏn)
The condition is marked by alterations of consciousness, nausea and vomiting, limb paralysis, and cranial nerve deficits. It may present as, or progress to, brain death. See: Glasgow Coma Scale
The patient is closely assessed for signs and symptoms of increased intracranial pressure, respiratory distress, convulsions, bleeding from the ears or nose, or drainage of cerebrospinal fluid from the ears or nose (which most probably indicates a fracture). Neurological status is monitored for any alterations in level of consciousness, pupillary signs, ocular movements, verbal response, sensory and motor function (including voluntary and involuntary movements), or behavioral and mental capabilities; and vital signs are assessed, esp. respiratory patterns. Any signs of deterioration are documented and reported. Seizure precautions are maintained.
Insertion of an intracranial pressure (ICP) monitoring device permits monitoring of cerebral perfusion and draining of cerebrospinal fluid to decrease ICP and reduce intracranial volume. A brain scan may help to determine the cause. Hyperventilation reduces Paco2, causing cerebral blood vessels to constrict, thus lessening blood volume within the cranium and lowering ICP. Osmotic diuretics and hypertonic saline solutions also help to move fluid out of the brain and into the intravascular space. If these therapies fail, decompressive craniectomy, high-dose barbiturate therapy, and aggressive therapeutic hyperventilation may be instituted. All general patient care concerns apply. In addition, the patient requires aggressive pulmonary care to prevent respiratory complications; enteral or parenteral nutrition to maintain a normoglycemic state, meet hypermetabolic energy requirements, and prevent protein calorie malnutrition; and careful assessment for coagulopathies and gastrointestinal bleeding and prophylaxis for deep vein thrombosis. Physical and occupational therapists help to prevent musculoskeletal complications. Special mattresses, careful repositioning, and regular skin care help prevent skin breakdown.