Editing Medical-Surgical Nursing (section)

=== Increased Intracranial Pressure ===

The skull is a fixed space, so any increase in brain tissue, blood, or cerebrospinal fluid raises pressure. The earliest and most sensitive sign of increased intracranial pressure is a change in level of consciousness, including restlessness, irritability, or confusion. Additional findings are headache, vomiting that may be projectile, pupillary changes with a sluggish or fixed and dilated pupil, and papilledema.

Cushing triad is a late and ominous sign of impending herniation: rising systolic blood pressure with a widening pulse pressure, bradycardia, and irregular respirations.

Nursing interventions: elevate the head of the bed about thirty degrees unless contraindicated, keep the head in neutral midline alignment to promote venous drainage, avoid hip flexion and neck flexion, prevent Valsalva by treating constipation and avoiding straining, cluster care to limit stimulation, keep suctioning brief and preoxygenate, control fever and pain, and administer osmotic diuretics such as mannitol as ordered. Avoid hypotonic fluids.