Page 252 - Critical Care Nursing Demystified

Chapter 5 CARE OF THE PATIENT WITH NEUROLOGICAL NEEDS 237

The nurse should also look for trends in waveforms to identify changes in the
intracranial pressure waves, which are further described as follows:

Plateau wave Identifies advanced intracranial hypertension on a
(A wave) – between trending strip, which is crucial for the nurse to observe
50 and 100 mm Hg because the wave will not change on the monitor and
the actual rise in ICP will only be evident for a short
time. Opportunities for rapid interventions to reduce ICP
can be missed.
Saw-tooth wave Represents respirations and blood pressure and warns
(B wave) – of risks of increased ICP and impaired intracranial com-
<50 mm Hg pliance.
C wave – Small, rhythmic waves that correlate normal blood
16–20 mm Hg pressure and respiratory changes. Its clinical impor-
tance is not really understood.

All of the information provided from the waveform monitoring system will
determine if changes in the types of interventions are necessary to achieve the
best patient outcomes for a successful recovery.

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Plateau waves indicate increased ICP. Protocols and orders to reduce ICP should be
instituted immediately or brain death can result!

100

75 A (plateau) wave
mm Hg 50

B waves
25 C waves

0 5 10 15 20
Trend recording in minutes

FIGURE 5–6 • ICP waveforms.