Early vs. Late Signs of Increased Intracranial Pressure (ICP) – Nursing Rationale:
Paediatric MCQ Question :
A mother arrives at an emergency department with her 5-year-old child and states that the child fell off a bunk bed. A head injury is suspected, and the nurse checks the child’s airway status and assesses the child for early and late signs of increased intracranial pressure (ICP). Which is a late sign of increased ICP?
A. Nausea
B. Irritability
C. Headache
D. Bradycardia
Show Answer
Answer is: D. Bradycardia ✔
Rationale/Explanation:
Rationale:
🏥 Option 1: Nausea ❌ (Early Sign)
- Nausea and vomiting are early indicators of increased ICP.
- They occur due to pressure on the brainstem and irritation of the vomiting center in the medulla.
- While concerning, nausea alone does not indicate a late-stage deterioration.
🏥 Option 2: Irritability ❌ (Early Sign)
- Increased ICP initially affects mental status, leading to behavioral changes like restlessness, irritability, and confusion.
- This occurs due to cerebral edema and impaired oxygenation to brain tissues.
- It is one of the first warning signs in children with head injuries.
🏥 Option 3: Headache ❌ (Early Sign)
- Headache is a common early symptom as pressure builds inside the skull.
- It worsens over time, especially in the morning or when changing positions.
- However, headache alone is not considered a late sign of ICP increase.
🚨 Option 4: Bradycardia ✅ (Late Sign – Correct Answer)
- As ICP increases significantly, the brainstem is affected, leading to Cushing’s Triad:
🔹 Bradycardia (Slow Heart Rate)
🔹 Irregular Respirations
🔹 Widening Pulse Pressure (High Systolic, Low Diastolic BP) - Bradycardia is a serious late sign, indicating severe brain swelling and impending brain herniation.
💡 Key Takeaway:
Early recognition of ICP signs is critical! Bradycardia signals late-stage deterioration, requiring immediate emergency intervention. 🚑
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