A patient is received in post operative ward. After sometimes suddenly his vitals changed blood pressure 110/60 mm hg to 140/60 mm hg, pulse rate 76 per minute to 88 per minute, respiration rate 18 per minute to 24 per minute and decreased consciousness from stupor to drowsy then which clinical finding suggest to increased ICP?

1. A

   Blood pressure 110/60 mm Hg to 140/60 mm Hg

2. B

   Pulse rate 76 per minute to 88 per minute

3. C

   Respiration rate 18 per minute to 24 per minute

4. D

   Decreased consciousness from stupor to drowsy

Appeared in: NORCET 3 - 2022 (Shift-2)

Explanation

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• The change in blood pressure from 110/60 mmHg to 140/60 mmHg indicates a widening pulse pressure (from 50 mmHg to 80 mmHg).
• A widening pulse pressure, characterized by a rising systolic blood pressure with a stable or falling diastolic pressure, is a classic component of Cushing's triad.
• Cushing's triad (widening pulse pressure, bradycardia, irregular respirations) is a critical late sign of severely increased intracranial pressure, signaling impending brainstem herniation.

Why Other Options Were Wrong

• Option B: The pulse rate increased from 76 to 88 bpm (tachycardia). This is the opposite of the expected sign. Cushing's response to increased ICP involves reflex bradycardia (a slow heart rate) due to stimulation of the vagus nerve.
• Option C: The respiratory rate increased from 18 to 24 breaths/minute (tachypnea). Increased ICP puts pressure on the brainstem's respiratory centers, typically causing irregular breathing patterns (like Cheyne-Stokes) or bradypnea (abnormally slow breathing), not simple tachypnea.
• Option D: The description 'from stupor to drowsy' indicates an improvement in the level of consciousness (LOC). A sign of increasing ICP is a deterioration in LOC (e.g., from alert to lethargic, or from drowsy to stupor). While an altered LOC is the earliest sign of increased ICP, the direction of change described here is inconsistent with a worsening condition.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Recognition of clinical signs of increased intracranial pressure (ICP), specifically Cushing's triad helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Recognizing Cushing's triad is a critical nursing skill, as it indicates a neurological emergency requiring immediate intervention to prevent brain herniation and death.
• Nurses must perform frequent and accurate neurological assessments (including vitals, GCS, and pupillary response) in at-risk patients, such as those with head trauma or post-neurosurgery, to detect these changes early.
• What if? If the patient's blood pressure dropped to 90/50 mmHg and the heart rate increased to 120 bpm, the priority concern would shift from increased ICP to hypovolemic or septic shock, requiring fluid resuscitation and investigation for bleeding or infection.

How to Approach the Question

• First, identify the core of the question: which of the given changes is a sign of increased ICP.
• Recall the classic signs of increased intracranial pressure (ICP), specifically the late signs known as Cushing's triad: 1) widening pulse pressure (hypertension), 2) bradycardia, and 3) irregular respirations.
• Analyze each option systematically. Calculate the pulse pressure for the blood pressure option (Systolic BP - Diastolic BP).
• Compare the patient's vital sign changes to the classic signs of Cushing's triad.
• The patient's BP shows a widened pulse pressure (110-60=50 vs 140-60=80), which matches. The pulse and respiration changes are opposite to the expected findings. The change in consciousness is an improvement, not a deterioration.
• Conclude that the blood pressure change is the only finding consistent with increased ICP among the choices.

Concept Tested & Keywords

• Concept Tested: Recognition of clinical signs of increased intracranial pressure (ICP), specifically Cushing's triad.
• Stem keywords: post operative, vitals changed, increased ICP, blood pressure, pulse rate, respiration rate, consciousness
• Lead-in keywords: which clinical finding suggest
• Clinical cues: Sudden change in vitals in a post-operative patient suggests a potential complication like increased ICP.
• Negative lead-in flag: false

Question ID

QKMT4Si8KKDS92QQ6taNc_

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 pp. 30-32, 38-40