Increased Intracranial Pressure

What are normal ICP levels?

-5-15 mmHg (adults) and -3-7 mmHg (kids) -1.5-6 mmHg (infants)

What is the Licox monitor?

-A way to measure brain oxygenation.

What is CPP?

-Cerebral Perfusion Pressure. -It is required for the heart to provide the brain with blood. -It is calculated by subtracting the ICP from the MAP. -Normal CPP is 50-100 mmHg. -If levels fall below 50 mmHg, compensatory mechanisms may not occur, and cerebral brain flow will decrease as CPP decreases.

What are everyday activities that increase ICP?

-Coughing -Bending -Sneezing -Straining -They are not harmful typically but sustained increased pressure will result in damage to the brain tissue.

What are the types of ICP monitoring systems?

-Epidural probe (does not allow for CSF drainage). -Subarachnoid bolt or screw (does not allow for CSF drainage). -Intraventricular catheter (the preferred technique, and is the most reliable as well as accurate). This technique also allows for drainage of CSF fluid when ICP is elevated.

The nurse should initiate which nonpharmacologic therapy early in hospitalization for clients who have sustained paralysis due to a disruption in intracranial​ regulation? 1. Physical 2. Occupational 3. Psychological 4.Speech

1. Physical The nurse should initiate a physical therapy referral for clients who have sustained paralysis early in the hospital admission. This therapy will generally continue after discharge.​ Speech, psychological, and occupational therapy may also be​ needed, but physical therapy is the most important to initiate early for this client.

The nurse is caring for a client with increased intracranial pressure secondary to a brain tumor. Which position should the nurse place the client in to help decrease intracranial​ pressure? 1. High Fowler​ 2. Semi-Fowler 3. Left lateral recumbent 4. Fowler

2. Semi-Fowler The client with increased intracranial pressure should be placed in the​ semi-Fowler position​ (30 degrees​ elevation) to decrease pressure.

What non-pharmacologic treatments are there for IICP?

ICP monitoring: -A way to monitor pressures that is critical to preserving brain function and preventing secondary brain damage. -Should be maintained between 50 and 100 mmHg. -If it falls below 50, cerebral blood flow may decrease. -If a patient's condition is salvageable, and they have a Glasgow coma scale score of 8 or lower they should be monitored. -A patient should also be monitored if they have a normal CT scan but two or more of the following: 1. unilateral or bilateral motor posturing. 2. systolic BP less than 90 mmHg 3. age greater than 40.

What medications are used for IICP?

Osmotic diuretics (mannitol) -The most commonly used medication for IICP. -They work by increasing the osmolarity of the blood, thereby drawing water out of the edematous brain tissue and into the vascular system to be removed by the kidneys. Loop Diuretics: -Are prescribed for some patients with IICP. -They inhibit sodium and chloride reabsorption at the ascending loop of henry. -This causes a reduction in the rate of CSF production. -ex: furosemide, ethacrynic Antipyretics -Are used alone or in combination with a hypothermia blanket to treat hyperthermia. -Hyperthermia increases the cerebral metabolic rate and exacerbates IICP. Antiseizure drugs -Often required to manage seizure activity associated with brain injury and IICP especially if there is damage to the temporal lobe. Antihypertensives -Beta-blockers are used if the patient's MAP is high. ex: metoprolol, propranolol Vasopressors -Are used if the patient's MAP is low. ex: norepinephrine, GI Prophylaxis with IV -Often used because patients with IICP are at risk for stress ulcers and gastritis. ex: -H2 receptor antagonists (ranitidine, famotidine) or PPIs (omeprazole) IV fluids -Are necessary to maintain the patient's fluid and electrolyte balance and vascular volume. -Hypotonic fluids should be AVOIDED (1/2, 1/4, 1/3 NS) Total Parenteral Nutrition -Only if enteral feeding is not possible.

What is the pathophysiology of IICP

-Also called intracranial hypertension. -Sustained elevated pressure in the cranial cavity (15 mmHg or higher in adults) -Cerebral edema is the most frequent cause of sustained increases in the ICP. -Other causes are head injuries, hydrocephalus, brain tumors, CNS infections, intracranial hemorrhage, TBI, metabolic encephalopathy, cysts, and status epilepticus. -The skull is normally filled with the brain (85%), CSF (5%), and blood (10%). -A state of dynamic balance exists between the three. -If the volume of any of these increases, the volume of another has to decrease. -This relationship balance is called the Monro-Kellie hypothesis. -Blood or CSF will normally shift into the spinal column in an effort to maintain a near-constant ICP. -When the capacity for the body to compensate for IICP is exceeded, intracranial hypertension develops.

A client experiences fractures of the left leg and a traumatic brain injury in a dirt bike accident and is admitted to the intensive care unit. Which assessment finding indicates increased intracranial pressure​ (IICP)? 1. Oliguria 2. Irritability 3. Hypotension 4. Nausea

2. Irritability Irritability may indicate that the client is experiencing an increase in intracranial​ pressure, especially if associated with additional signs of​ bradycardia, increased systolic​ pressure, increased pulse​ pressure, vomiting,​ headache, lethargy, and change in mental status. Nausea does not accompany the vomiting associated with increased intracranial pressure. Hypotension and oliguria are not associated with increased intracranial pressure.

The healthcare provider ordered diagnostic tests for a client with suspected increased intracranial pressure​ (IICP). Which tests should the nurse expect to show signs of IICP and help confirm the diagnosis and possible treatment​ needed?​(Select all that​ apply.) 1. Chest​ x-ray 2. Serum osmolality 3. Arterial blood gases​ (ABGs) 4. CT scan 5. Stool guaiac test

2. Serum osmolality 3. Arterial blood gases​ (ABGs) 4. CT scan Some tests taken in clients with an intracranial hematoma will be expected to be​ normal: a chest​ x-ray and a stool guaiac test. Other​ tests, such as a​ CT, arterial blood​ gases, and serum osmolality can often produce valuable information about the cause of IICP and the treatment.

The nurse is reviewing the intracranial pressure​ (ICP) readings for a child with a brain tumor. Which reading should the nurse interpret as normal for the​ child? 1. 12 mmHg 2. 8 mmHg 3. 3 mmHg 4. 1 mmHg​

3. 3 mmHg Normal ICP readings for a child are between 3 and 7​ mmHg; thus, 3 mmHg would be considered a normal reading.

What are the risk factors for IICP?

-Any factor that increases the risk for trauma increases the risk for cerebral trauma. -Not wearing protective equipment (helmets, seat belts) -Using the phone while driving. -Medications -Poor nutrition -Illness such as meningitis -Drug and alcohol abuse.

How do you prevent IICP?

-Learning ways to prevent cerebral trauma. -Wear protective equipment. -Learn how to prevent trauma. -Not using the phone while driving. -Not using recreational drugs or alcohol

Which intervention should the nurse initiate secondary to a change in the level of consciousness​ (LOC) for a client experiencing increased intracranial pressure​ (IICP)? (Select all that​ apply.) 1. Assess​ LOC, pupillary​ response, and neurologic status 2. Implement seizure precautions 3. Maintain the head of the bed at 30 degrees 4. Monitor​ ICP/cerebral perfusion pressure​ (CCP) as indicated 5. Encourage the family to visit and keep the client engaged in as normal activities as possible

1. Assess​ LOC, pupillary​ response, and neurologic status 2. Implement seizure precautions 3. Maintain the head of the bed at 30 degrees 4. Monitor​ ICP/cerebral perfusion pressure​ (CCP) as indicated For the client with​ IICP, the nurse should monitor​ ICP/CCP as​ indicated, implement precautions for​ seizures, maintain the head of the bed at 30​ degrees, and assess​ LOC, pupillary​ response, and neurologic status.

A nurse in the emergency department is providing care for a client who has increased intracranial pressure​ (IICP) from a traumatic brain injury from a motor vehicle crash. The nurse anticipates orders for which diagnostic tests in the care of this​ client?​(Select all that​ apply.) 1. CT of the head 2. Intracranial pressure monitor 3. Electromyogram 4. Cardiac monitoring 5. ABGs

1. CT of the head 2. Intracranial pressure monitor 4. Cardiac monitoring 5. ABGs An intracranial pressure monitor will give information about intracranial pressure. This information can be used to manage the medications and fluids for this client. A CT of the head will give information about possible hemorrhage and diffuse axonal injuries. Cardiac monitoring would be essential to monitor cardiac rate and rhythm. Arterial blood gases give information about oxygen and carbon dioxide levels in the blood. This information is used to manage artificial airways and mechanical ventilation. Electromyography is used to measure skeletal muscle activity. It would not be used in the diagnosis of a client with traumatic brain injury.

A nurse is providing care for a client with a traumatic head injury. The nurse should monitor the client for which manifestations consistent with increased intracranial​ pressure?​(Select all that​ apply.) 1. Headache 2. Drowsiness 3. Increased heart rate 4. Double vision 5. Blurred vision

1. Headache 2. Drowsiness 4. Double vision 5. Blurred vision Double vision and blurred vision can occur with IICP. Headache is common with IICP. Drowsiness can occur with IICP. The client may also report other generalized manifestations such as dizziness. The heart rate generally decreases with IICP.

A nurse in the emergency department is providing care for a client diagnosed with increased intracranial pressure​ (IICP). The client is experiencing a decreasing level of consciousness. Which collaborative treatment would the nurse question for this​ client? 1. Place client on mechanical ventilator to increase oxygen and eliminate carbon dioxide 2. Intubate the client with an endotracheal tube 3. Administer intravenous​ 0.45% saline infusion. 4. Administer intravenous mannitol.

3. Administer intravenous​ 0.45% saline infusion. The nurse would not administer hypotonic intravenous fluids for this client. Hypotonic fluids will cause water to move into the brain cells. This will increase intracranial pressure. The other interventions are expected and appropriate for clients with IICP.

The client has an increase in intracranial pressure caused by an increase in capillary permeability. The nurse should recognize this as which type of cerebral​ edema? 1. Bacterial 2. Cytotoxic 3. Vasogenic 4. Hormonal

3. Vasogenic Vasogenic cerebral edema is caused by an increase in capillary permeability of cerebral vessels. Retained fluid in the neurons and endothelial cells associated with sodium and water retention is the cause of cytotoxic cerebral edema. Hormonal and bacterial are not types of cerebral edema.

The nurse is providing a​ community-based teaching course to a group of high school parents concerning brain injury. Which participant statement indicates accurate understanding of the population most at risk for traumatic brain injury​ (TBI)? 1. ​"TBIs most commonly occur in men between the ages of 18 and 25 years of​ age."​ 2. "Due to their age and the high number of falls and​ injuries, toddlers and children have higher levels of​ TBIs." 3. ​"They are most common in the very young ​(0dash-4 ​years) or old​ (65 years and​ above)."​ 4. "TBIs are common across the​ lifespan, affecting men and women fairly​ equally."

3. ​"They are most common in the very young ​(0dash-4 ​years) or old​ (65 years and​ above)."​ TBIs predominantly affect the very young​(0-4 years) or older adults​ (65 years or​ older); thus, this is an accurate statement. They affect men and boys more commonly than​ females; thus, the statement that men and women are affected equally is not accurate. They do not most commonly occur in men between the ages of 18 and 25 years of age. While TBI injuries are high among​ toddlers, they are not high for children.

The nurse is assessing a client who leads an​ active, healthy lifestyle. The client has no history of chronic health​ conditions, but is seeking health care due to visual changes and occasional headaches over the past few weeks. Upon​ assessment, which question should the nurse ask the​ client?" 1. "Have you noticed an increase in ​thirst?" 2. "Do you feel nauseated after ​eating?" 3. "Are you having trouble moving your ​bowels?" 4. "Are your headaches worse upon rising in the ​morning?

4. "Are your headaches worse upon rising in the ​morning? With increased intracranial​ pressure, headaches are noted to be worse in the morning and with position changes. Projectile vomiting may​ occur, but nausea is not present. Thirst does not increase for clients with IICP. Clients with IICP typically do not experience constipation or trouble with bowel movements.

The nurse is providing discharge teaching to an older adult. Which information should the nurse include in the session to help the older adult avoid development of​ IICP?​ 1. "Be sure to check your blood sugar more frequently than previously to manage your​ diabetes."​ 2. "With any early signs of​ infection, be sure to call your healthcare​ provider."​ 3. "You should stop driving and exchange your license for a​ non-driver identification​ card." 4. ​"Make sure to use your walker as we​ discussed."

4. ​"Make sure to use your walker as we​ discussed." ​Falls are the most common cause of IICP in older​ adults; thus, the nurse should ensure that the client implements strategies such as using a walker to prevent falls.​ Infections, motor vehicle​ crashes, and the presence of other illnesses also can lead to IICP in the older​ adult, but they are not the most common causes of IICP.

The nurse is discussing the multiple medications with the family of a client diagnosed with increased intracranial pressure​ (IICP). The family member asks why the client is being given a gastric acid reducer. Which response by the nurse provides the correct ​explanation? 1. ​"A gastric acid reducer helps to protect the inner lining of the stomach from​ ulcer-producing effects." 2. ​"We use a gastric acid reducer to adhere to ulcer sites and protect them from​ acids, bile​ salts, and​ enzymes."​ 3. "Since they are not​ eating, we use a gastric acid reducer to neutralize the acid in their​ stomach." 4. ​"There is a higher risk for stress​ ulcers; therefore, we use an acid reducer to block gastric​ secretion."

4. ​"There is a higher risk for stress​ ulcers; therefore, we use an acid reducer to block gastric​ secretion." Clients with IICP have a higher risk of stress gastritis and​ ulcers; thus, histamine H2 antagonists or proton pump inhibitors are used prophylactically to block​ histamine-induced gastric secretion.​ Antacids, not gastric acid​ reducers, neutralize acid in the stomach. Gastric acid reducers do not adhere to ulcer sites and protect them from​ acids, bile​ salts, and enzymes. A gastric acid reducer does not directly protect the inner lining of the​ stomach; it blocks​ histamine-induced gastric secretion.

What is compliance?

The relationship between the volume of the intracranial components and ICP.

What diagnostics are used for ICP?

-CT or MRI: generally the initial test used to identify possible causes and to evaluate therapeutic options. -Serum Osmolality: is ordered and monitored. -ABGs are ordered and monitored to give ideas about oxygen and CO2. -Electroencephalography (EEG) may be used to monitor the depth of a coma or to diagnose brain death. -Transcranial Doppler (TCD) is used to measure cerebral blood flow velocity. It is helpful in diagnosing and following patients who have vasospasms related to cerebral hemorrhage.

What are the manifestations of ICP

-Decreased LOC EARLY confusion, restlessness, lethargy, disorientation, first to time, then place and person. LATE comatose, with not response to painful stimuli. -Pupillary dysfunction: sluggish response to light. -Oculomotor dysfunction: inability to move eyes upward, ptosis (drooping) of the eyelid. -Visual abnormalities: decreased acuity, blurred vision, diplopia. -Motor Impairment EARLY: hemiparesis or hemiplegia of the contralateral side. LATE: decorticate or decerebrate posturing; flaccidity -Headache (worse in morning or with position changes) -Projectile vomiting without nausea. -Cushing triad (irregular respiration, widening pulse pressure, bradycardia). -Respiration: altered patterns related to brain function. -Temperature: may be significantly elevated. -Hypertension

Pregnancy and the elderly

-Elderly are more prone to falls that can result in IICP. -Elderly take medicines that increase their risk for falls and trauma. -Sensory loss and instability can increase the risk for accidents. -Increased BP from HTN may damage blood vessels, especially in the brain, causing them to be more fragile and increasing the risk for hemorrhage. -Undiagnosed or poorly controlled arrhythmia.

What are nursing interventions to reduce ICP?

-Provide supplemental oxygen -Administer acetaminophen to decrease fever -Suction to clear airways for no more than 10 seconds per pass. -Monitor LOC -Maintain alignment of the head and neck to avoid hyperextension or exaggerated neck flexion. -Avoid laying the patient prone. -Elevate the head of the bed. -If the patient is alert, assist them with moving up in bed (do not ask them to push with heels or hands against the footboards or restraints). -Help to maintain regular bowel movements (stool softeners) if needed. -Use the crede method (press on bladder with hands) to help empty bladder. -Maintain fluid limitations if prescribed. Restricting fluids helps to reduce cerebral edema.

What type of surgery is done for IICP?

-Infarcted or necrotic tissue may be resected to reduce brain mass. -Drainage catheter or shunt may be placed laterally via a burr hole into a ventricle to drain extra CSF. -Permanent shunt is placed for those with chronic IICP that is caused by hydrocephalus. -Shunts divert CSF only if the ICP rises past a certain level. -The shunt is placed in a ventricle of the brain and empties into the peritoneal cavity (most common), atria of the heart, or the pleural cavity.

How do you reduce the risk for infections?

-Keep dressings over the catheter dry, and change dessings every 24-48 hours. Wet dressing promote bacteria growth. -Monitor insertion site for leaking CSF, drainage, or infection. -Use aseptic technique when in contact with drainage device, and look for loose connections. -Ensure that the device is properly functioning. Look for kinks along the lines.

What are factors that increase the risk for infection during ICP monitoring?

-Open head trauma or neurosurgery. -Intracranial hemorrhage. -The use of an intraventricular catheter. -ICP monitoring for longer than 3-5 days. -Using an open system or frequent irrigation. -Older adults are also at increased risk because of impaired immune defenses.

Mechanical ventilation

-Patients with IICP often require mechanical ventilation. -This option should only be used until another means to decrease ICP can be found (surgical, medication). -Mechanical ventilation is used to maintain partial pressure of oxygen (100 mmHg) and co2 (35 mmHg). -Maintaining theses partial pressures helps to prevent hypercapnia and hypoxemia.

What other therapies can be used with IICP?

-Physical therapy to prevent muscle atrophy while the patient is bed bound or unconscious. -Occupational therapy can help the patient to regain motor skills necessary for ADLs that may have been lost. -Respiratory therapy is necessary if the patient had mechanical ventilation. -Speech therapy may be needed if the patient needs to learn how to talk or eat following damage to these parts of the brain.

How do you reduce environmental stimulation?

-Plan nursing care that activities are not clustered together. Multiple activities can increase ICP. -Provide a quiet environment and avoid activities that jar the bed. -Maintain a calm and reassuring manner. -Educate the family to avoid exciting or unpleasant conversations around the patient.

Pregnancy and IICP

-The act of being pregnant does not directly affect ICP. -Idiopathic intracranial hypertension (IIH) exists and if an obese women with IIH gets pregnant, neurology and obstetrics need to work together to ensure safety. -The patient can usually have a normal vaginal delivery. -For these women, pregnancy weight gain should be on the lower end (5-9kg) (11-20lbs).

Children and IICP

-The earlier the delivery (10 weeks and earlier) and the smaller the newborn, the higher the risk of intravascular hemorrhage (IVH). -All infants born at 30 weeks or sooner should have a cranial ultrasound to assess for the presence of IVH. -IVH may lead to IICP. -IICP is relieved by a lumbar puncture or inserting a shunt system. MANIFESTATIONS: -decreased muscle tone, labile vital signs, apnea, lethargy, and/or seizure activity. -Bulging fontanelles, separated sutures, drowsiness, or vomiting. -Headaches, weakness, eye movement disturbances, behavioral changes, decreased LOC. RISK FACTORS -Falling, abuse, bumping their head (poor head control, or depth perception). -School-age children: bicycle riding, swimming, or activity-related accidents. -Adolescents; car crashes, addiction behavior, trauma from violence.

How do you measure brain oxygenation?

-With the use of a jugular bulb oxygen saturation (SjvO2) that is connected to a fiber-optic catheter inserted into the jugular vein. -Normal SjvO2 is 55-69%. -A reading below 55% can be an early indicator of ischemia long before clinical symptoms appear. -A Licox monitor is another way to measure brain oxygenation. -Includes information about oxygen status and temperature status in the brain tissue itself.

Which intravenous fluid prescription noted by the nurse in orders for a client being treated for increased intracranial pressure​ (IICP) should the nurse contact the healthcare provider about for​ clarification? 1. 1/2 normal saline 2. Lactated Ringer​ 3. 3% saline 4. ​0.9% saline​

1. 1/2 normal saline Fluid management for the client with IICP includes the use of isotonic or slightly hypertonic solutions. Hypotonic fluids should be avoided because they can cause an increase in cerebral edema and serum osmolarity. Thus the nurse would question the order for 1/2 normal saline. The other solutions are either isotonic or slightly hypertonic.

A client is to be discharged from the hospital first thing in the morning.​ However, overnight the client developed symptoms of​ "not being able to see​ well." The client also cannot move either the left arm or the left leg to get out of bed. What is the priority response by the​ nurse? 1. Assess the client​'s vital signs 2. Assist the client to dress for discharge 3. Instruct the client on the use of assistive devices to assist in mobility 4. Ask the client if he has a family history of strokes

1. Assess the client​'s vital signs The change in assessment should signal the nurse to follow the nursing process and assess the client further. Although family history is​ important, it is not the priority in this situation. These symptoms are consistent with worsening condition and possible increased intracranial pressure. Continuing with the tasks associated with discharge would not be appropriate.

The client is being treated for increased intracranial pressure​ (IICP). Which of these manifestations should indicate to the nurse that the outcomes are being met for this​ client?​(Select all that​ apply.) 1. No redness or drainage at site of intraventricular catheter 2. Intracranial pressure​ = 14 mmHg 3. Blood pressure​ = 118/76 4. Verbalizes need to increase stimuli 5. Lethargic

1. No redness or drainage at the site of an intraventricular catheter 2. Intracranial pressure​ = 14 mmHg 3. Blood pressure​ = 118/76 The client should maintain ICP of less than< 20 mmHg. The blood pressure should be normal. Client and significant others will verbalize the reasons​ for, and how to​ maintain, a​ low-stimuli environment, not high stimuli. The client will remain free of infection including redness and drainage at the sites of insertion. The client will maintain adequate cerebral​ perfusion, and the level of consciousness should return to normal and not be lethargic.

A nurse in the intensive care unit is providing care for a client with increased intracranial pressure​ (IICP). The nurse monitors the client for which manifestations of​ IICP?​(Select all that​ apply.) 1. Projectile vomiting 2. Decreased level of consciousness 3. Dilated pupils 4. Increased heart rate 5. Decreased blood pressure

1. Projectile vomiting 2. Decreased level of consciousness 3. Dilated pupils Projectile vomiting is a manifestation of increased intracranial pressure. This is caused by pressure on the brainstem from swollen brain tissue. Dilated pupils are a manifestation of increased intracranial pressure. This is caused by pressure on the cranial nerves and vision pathways within the brain. A decreased level of consciousness is a manifestation of increased intracranial pressure. This is caused by pressure on the cerebral cortex and decreased oxygenation of the brain tissues. Increased intracranial pressure causes increased blood​ pressure, especially the systolic blood pressure. This worsens until there is a wide difference between the systolic blood pressure and the diastolic blood pressure. Increased intracranial pressure causes lowered heart rate. This is caused by the​ body's attempt to compensate for increased blood pressure.

A nurse in the intensive care unit is providing care for a client with increased intracranial pressure from a traumatic brain injury. The client has a fever of 102 ​°F. Which interventions will the nurse use to promote normal intracranial​ pressure?​(Select all that​ apply.) 1. Provide supplemental oxygen 2. Administer acetaminophen per order 3. Flex the neck to open the airway 4. Suction for no more than 10 seconds per pass 5. Monitor level of consciousness

1. Provide supplemental oxygen 2. Administer acetaminophen per order 4. Suction for no more than 10 seconds per pass 5. Monitor level of consciousness Hyperthermia increases intracranial pressure. Hyperthermia also affects hypothalamic function in clients with increased intracranial​ pressure; therefore, administering an antipyretic medication is appropriate. Prolonged suctioning can increase intracranial pressure. It also causes decreased oxygen levels. Increased intracranial pressure can cause irregular and ineffective respirations. Supplemental oxygen helps prevent hypoxia. It also helps prevent excess carbon​ dioxide, which is a vasodilator. A decreased level of consciousness can be a manifestation of pressure on the cerebral cortex. It can also be a manifestation of decreased oxygen levels in the brain. Flexing the neck increases intracranial pressure by preventing blood return from the brain. The head and neck must be kept in a neutral position.

A client with a traumatic brain injury is intubated and placed on mechanical ventilation. Which measurement should the nurse use to evaluate the effectiveness of these respiratory​ interventions? 1. Motor and sensory function 2. Cranial nerve function 3. Glasgow Coma Scale score 4. Arterial blood gas results

4. Arterial blood gas results A client with an alteration in level of consciousness​ (LOC) may be unable to maintain an open airway and engage in spontaneous respiration. The client may need endotracheal intubation or mechanical ventilation. Arterial blood gases are used to guide the effectiveness of ventilation. Glasgow Coma Scale​ score, cranial nerve​ function, and motor and sensory function are used to determine the effect of intracranial pressure on body functioning.

The nurse is monitoring a client with increased intracranial pressure who is experiencing status epilepticus. Which intervention has the highest priority for this​ client? 1. Contacting the provider for orders 2. Administering a solution of​ 50% dextrose 3. Administering diazepam intravenously 4. Establishing and maintaining an airway

4. Establishing and maintaining an airway In management of status​ epilepticus, the highest priority is to establish and maintain an airway. Contacting the provider for orders would not take priority over establishing and maintaining an airway. Diazepam and a solution of​ 50% dextrose would be administered intravenously as a​ first-line agent but would not be the highest priority.

A client with increased intracranial pressure​ (IICP) is also hyponatremic. Which intravenous medication should the nurse anticipate administering to address fluid​ removal? 1. Corticosteroid 2. Proton pump inhibitor 3. Antiepileptic 4. Osmotic diuretic

4. Osmotic diuretic Osmotic diuretics are used in clients with IICP to promote water excretion and to address hyponatremia. Proton pump inhibitors protect the gastrointestinal tract. Corticosteroids increase mortality in the IICP client and are not administered. Anti-epileptic drugs prevent seizure activity.

The spouse of a client who has increased intracranial pressure​ (IICP) asks the nurse what is happening in her​ husband's brain. Based on the​ pathophysiology, which is the best response by the​ nurse?​ 1. "There must be a tumor causing the increase in pressure we are​ seeing."​ 2. "Your husband's low blood pressure is causing the brain to have too much fluid in​ it."​ 3. "The blood flow to the brain has increased and is causing an increased​ pressure."​ 4."Something in the​ brain, its​ blood, or surrounding fluid is off balance and has caused an increased​ pressure."

4."Something in the​ brain, its​ blood, or surrounding fluid is off balance and has caused an increased​ pressure." Three components make up the​ pressure-volume equilibrium, the​ brain, the​ blood, and the cerebrospinal fluid. Any of these components can change and affect the other two and cause an imbalance and resulting increase in pressure. Low blood pressure and increased blood flow to the brain would not affect the pressure in the brain and cause it to increase. Tumors may be involved but without knowing the​ facts, the nurse should not mention this.