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Topic overview
Identify early and late signs of increased ICP and distinguish from normal post-operative findings
Clinical reasoning
For Increased Intracranial Pressure, connect the assessment cue to the immediate risk before selecting an action for PN. Start with stability, ABCs, neurologic change, medication risk, infection risk, and scope of practice. Then decide whether the safest next step is assess, intervene, escalate, teach, or evaluate response.
Patient safety implications
A missed priority in Increased Intracranial Pressure can delay recognition of deterioration or allow preventable harm to continue. Protect the client first by verifying abnormal cues, using ordered precautions, escalating unstable findings, and reassessing after intervention.
Example application
In a Increased Intracranial Pressure item, explain the first cue you noticed, the complication it predicts, the nursing action within scope, and the finding that proves the response worked.
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