The nurse is caring for a patient brought to the emergency department after an automobile accident. The patient is fully conscious. What early signs of increased intracranial pressure (ICP) should the nurse be alert for?
a. Bradycardia
b. Hypothermia
c. Decreased level of consciousness
d. Pinpoint pupils
ANS: C
Initial symptoms of increased ICP include restlessness, irritability, and decreased level of consciousness, because cerebral cortex function is impaired. If not intubated, the patient may hyperventilate, causing vasoconstriction as the body attempts to compensate. As the pressure increases, the oculomotor nerve may be compressed on the side of the impairment. Compression of the outermost fibers of the oculomotor nerve results in diminished reactivity and dilation of the pupil. As the fibers become increasingly compressed, the pupil stops reacting to light. If the compression continues, and the brain tissue exerts pressure on the opposite side of the brain from the injury, both pupils become fixed and dilated. Hypothermia is not a sign of IICP. Vital sign changes are a late indication of increasing ICP.
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