A 25-year-old has sustained a head injury from a motor vehicle accident. The nurse notes that his intracranial pressure (ICP) is elevating. Which of the following interventions should the nurse perform to decrease his ICP?
• Positioning the patient's neck in a neutral alignment to avoid flexion and elevating the HOB will lower ICP by increasing venous return.
• Administering mannitol, an osmotic diuretic, will decrease the cerebral edema in the brain, and therefore ICP. Mannitol makes the blood serum hypertonic, which pulls fluid from the intracellular (and intracranial) space to balance it out. This, in turn, increases the osmotic pressure of the glomerular filtrate, inhibiting reabsorption of water and electrolytes, so the patient eliminates excess fluid through urination. The therapeutic effect is decreased cerebral edema and decreased intracranial pressure.
• Too much activity causes an increase in blood pressure, cerebral blood flow, and ICP. Elevations of an already high ICP can further elevate the ICP and lead to cerebral ischemia. It is prudent for the nurse to space out activities to allow the patient's ICP to return to a safe level.
• Assessing pupil reactivity can help
• Putting a patient in Trendelenburg obstructs venous return and increases ICP.
• Suctioning decreases O2, increases CO2, and partially obstructs the airway. All of these will increase ICP.