A client has signs of increased ICP. Which of the following is an early indicator of deterioration in the client’s condition?
A. Widening pulse pressure
B. Decrease in the pulse rate
C. Dilated, fixed pupil
D. Decrease in LOC
Correct Answer: D. Decrease in LOC
A decrease in the client’s LOC is an early indicator of deterioration of the client’s neurological status. Changes in LOC, such as restlessness and irritability, may be subtle. Clinical suspicion for intracranial hypertension should be raised if a patient presents with the following signs and symptoms: headaches, vomiting, and altered mental status varying from drowsiness to coma.
Option A: Cerebral perfusion pressure (CPP) is the pressure gradient between mean arterial pressure (MAP) and intracranial pressure (CPP = MAP – ICP). CPP = MAP – CVP if central venous pressure is higher than intracranial pressure. CPP target for adults following severe traumatic brain injury is recommended at greater than 60 to 70 mm Hg, and a minimum CPP greater than 40 mm Hg is recommended for infants, with very limited data on normal CPP targets for children in between.
Option B: High blood pressure causes reflex bradycardia and brain stem compromise affecting respiration. Ultimately the contents of the cranium are displaced downwards due to the high ICP, causing a phenomenon known as herniation which can be potentially fatal.
Option C: Dilated, fixed pupils occur later if the increased ICP is not treated. A funduscopic exam can reveal papilledema which is a tell-tale sign of raised ICP as the cerebrospinal fluid is in continuity with the fluid around the optic nerve.
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