What is the nurse's priority action when intracranial pressure readings are increasing in a patient with a ventriculostomy?

What is the nurse's priority action when intracranial pressure readings are increasing in a patient with a ventriculostomy?

• A. Position client on the right side
• B. Call the primary healthcare provider
• C. Lower the head of the bed immediately
• D. Hyperventilate client with a bag valve mask

Answer: (D)

When intracranial pressure is rising, the quickest way to lower it is to reduce cerebral blood volume by lowering PaCO2, which causes cerebral vasoconstriction. Hyperventilating the patient with a bag-valve mask temporarily lowers PaCO2 to about 30–35 mmHg, leading to vasoconstriction of cerebral vessels and a rapid, short-term drop in ICP. This is especially appropriate in a patient with a ventriculostomy, where the goal is to quickly decrease pressure to protect brain tissue while other interventions are arranged.

Other actions don’t address the immediate physiologic driver of the rise. Positioning the patient on the side or lowering the head of the bed can impede venous drainage or increase ICP. While contacting the physician is important, it does not acutely reduce ICP. Remember, hyperventilation is a temporary measure and should be used with careful monitoring of CO2, oxygenation, and ICP.