A patient with increased intracranial pressure is being monitored with a fiberoptic catheter. Which order should be treated as a priority?

• A. Take a complete set of vital signs.
• B. Perform hourly neurologic checks.
• C. Administer the prescribed mannitol (Osmitrol).
• D. Give an H2-receptor blocker.

Answer: (C)

When intracranial pressure is elevated, the immediate goal is to lower it to protect brain tissue and maintain cerebral perfusion. Administering the prescribed mannitol accomplishes this rapidly by creating an osmotic gradient that draws fluid out of swollen brain tissue into the vascular space, reducing edema and lowering ICP within minutes to an hour. This direct, fast-acting intervention addresses the life-threatening aspect of the situation, making it the priority over routine assessments or non–ICP-related medications. Ongoing vital signs and neurologic checks remain important for monitoring, and an H2-receptor blocker does not influence intracranial dynamics, so it is not the priority in this acute moment. Be aware, after the ICP has begun to be controlled, to monitor for potential side effects of mannitol such as hypotension, dehydration, and changes in renal function.