Raised intracranial pressure

Early signs: change in level of consciousness, headache, vomiting without nausea, restlessness, pupillary changes. Late signs, Cushing triad: rising systolic pressure with widening pulse pressure, bradycardia, irregular breathing. These signal imminent herniation. Nursing measures: head of bed at 30 degrees, head in neutral alignment, avoid neck flexion and hip flexion, avoid clustering stimulating care, prevent straining and coughing, keep the room calm, treat fever and pain. A new unilateral dilated sluggish pupil is an emergency.

Clinical content reviewed by Ducamelle Louis, Registered Nurse