Which of the following medical treatments should the nurse anticipate administering to a client with increased intracranial pressure due to brain hemorrhage, except?
A. acetaminophen (Tylenol)
B. dexamethasone (Decadron)
C. mannitol (Osmitrol)
D. phenytoin (Dilantin)
E. nitroglycerin (Nitrostat)
Correct Answer: E. nitroglycerin (Nitrostat)
Decreasing blood pressure is essential to prevent exacerbation of intracerebral bleeding. However, BP medication such as nitroglycerin is avoided due to its vasodilating effects that increase cerebral blood volume and thus increases intracranial pressure.
Option A: Acetaminophen, an antipyretic, prevents increased temperature. A decrease in temperature reduces metabolism, cerebral blood flow, thus decreasing intracranial pressure. It also relieve headache.
Option B: Dexamethasone, a corticosteroids, decreases intracranial pressure by stabilizing the cell membrane and decreases the leakiness in the blood-brain-barrier.
Option C: Mannitol, an osmotic diuretic, lowers intracranial pressure by increasing intravascular pressure to draw fluid from the interstitial spaces and from the brain cells.
Option D: Phenytoin, an anticonvulsant, is given as prophylaxis to prevent seizures. Seizures increase metabolic rate and cerebral blood flow, and volume that may result in increased intracranial pressure.
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