Final answer:
In a care plan created by a nurse for a client at risk of increased ICP, disorientation and restlessness should be monitored as an early sign.
Step-by-step explanation:
The nurse has created a plan of care for a client at risk of increased intracranial pressure (ICP). An early sign of increased ICP that should be monitored is disorientation and restlessness. While other signs like projectile vomiting, decreased pulse and respirations, and loss of corneal reflex may occur, disorientation and restlessness often present earlier as the pressure within the skull increases. These symptoms may indicate that the brain is becoming compressed and are a sign that immediate medical intervention may be required
.The nurse has created a plan of care for a client who is at risk for increased ICP. One early sign of increased ICP that should be monitored is disorientation and restlessness. These symptoms can indicate an altered level of consciousness, which is a potential sign of increased pressure within the skull.