Final answer:
Initial nursing measures for elevated ICP include head elevation and maintaining head/neck position, along with medications and avoiding certain activities. Osmotic diuretics, hypertonic saline, or surgical intervention may be next steps if ICP persists. Early signs of high ICP are headache and vomiting, while late signs involve Cushing's triad.
Step-by-step explanation:
To address the issue of elevated intracranial pressure (ICP), a multi-faceted approach is necessary. Initial nursing measures to treat an ICP of 28 mmHg may include elevating the head of the bed to promote venous drainage, maintaining head and neck in a neutral position to prevent jugular vein compression, administering analgesics and sedatives to reduce metabolic demand, and avoiding activities that can abruptly increase ICP, such as suctioning or agitation.
Pharmacologically, osmotic diuretics like mannitol may be used to decrease ICP by drawing fluid out of the brain tissue. Hypertonic saline can also be an option to reduce swelling. Barbiturate-induced coma may be considered if ICP remains high despite other treatments. Surgically, a decompressive craniectomy may be necessary to allow brain tissue to expand without being compressed.
Early signs of increased ICP include headache, vomiting, and altered level of consciousness, while late signs can be reflected in the Cushing's triad: irregular breathing, bradycardia, and hypertension, indicating a grave prognosis.