A patient with head injury has a blood pressure of 92/50 mm Hg and an intracranial pressure (ICP) of 18 mm Hg. Which action by the nurse is most appropriate?

• A. Document and continue to monitor the parameters.
• B. Elevate the head of the patient’s bed.
• C. Notify the health care provider about the assessments.
• D. Check the patient’s pupillary response to light.

Answer: (C)

The main idea is cerebral perfusion pressure. CPP is the driving force for blood flow to the brain and is calculated roughly as MAP minus ICP. In this scenario, the patient’s blood pressure is low (MAP around 64) and the ICP is elevated at 18. That gives a CPP of about 46 mmHg, which is below the level needed to adequately perfuse brain tissue (usually aiming for 60–70 mmHg). This places the brain at risk for ischemia and requires prompt medical intervention.

Thus, the most appropriate action is to notify the health care provider so orders can be given to improve perfusion and control ICP (for example, fluid management, vasopressor support, or other treatments as indicated). Merely documenting and continuing to monitor does not address the potential perfusion deficit. Elevating the head of the bed can help reduce ICP but, in a hypotensive patient, may further compromise cerebral perfusion until BP is stabilized. Checking the pupillary response is important for assessing neurologic status, but it does not address the urgent need to restore adequate CPP, which is why notifying the provider is the best immediate step.