A patient with cerebral edema has serum sodium 115 mEq/L and decreasing LOC with headache. Which order should the nurse accomplish first?

• A. Administer acetaminophen (Tylenol) 650 mg orally.
• B. Administer 5% hypertonic saline intravenously.
• C. Draw blood for arterial blood gases (ABGs).
• D. Send patient to radiology for computed tomography (CT) of the head.

Answer: (B)

The priority concept is rapidly reducing cerebral edema to prevent or treat rising intracranial pressure in the setting of severe hyponatremia. Administering hypertonic saline intravenously is the best choice because raising the extracellular osmolality pulls water out of swollen brain tissue into the vascular space, reducing edema and lowering ICP, which can quickly improve the patient’s level of consciousness and symptoms. Acetaminophen would not affect brain edema. Drawing arterial blood gases is important for broader management but does not reverse the edema promptly. A CT scan helps diagnose the cause but does not treat the acute swelling. Thus, giving hypertonic saline addresses the immediate, life-threatening issue of cerebral edema with hyponatremia.