Cushing's triad (hypertension with widened pulse pressure, bradycardia, irregular respirations) is a late sign of severely increased intracranial pressure (ICP) indicating brainstem compression. Earlier signs include: decreasing level of consciousness (most sensitive indicator); headache; vomiting; pupillary changes (unequal, sluggish, dilated); motor changes (weakness, posturing); and vital sign changes (Cushing's triad is ominous). ICP monitoring may be used in critical care. Nursing interventions: maintain head midline elevation 30 degrees; avoid neck flexion/rotation; limit suctioning; prevent Valsalva maneuvers; administer medications (osmotic diuretics, sedatives, anticonvulsants); monitor neurological status frequently using Glasgow Coma Scale; and minimize environmental stimuli. Causes include: traumatic brain injury; stroke; tumors; hydrocephalus; infection; and metabolic disorders. Early recognition and intervention are crucial to prevent herniation and permanent damage. Nurses play key roles in serial assessment and implementing measures to reduce ICP.

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Zambia

• Naomi Miselo – 31 pts

• Visual Pathway Lesions
• Positive and Negative Symptoms
• Hallucinations and Delusions
• Antipsychotic Medications
• Emergency: Environmental Emergencies