The nurse recognizes the presence of Cushing's triad in the patient with

• A. Increased pulse, irregular respiration, increased BP
• B. Decreased pulse, irregular respiration, increased pulse pressure
• C. Increased pulse, decreased respiration, increased pulse pressure
• D. Decreased pulse, increased respiration, decreased systolic BP

Answer: (B)

Cushing's triad signals rising intracranial pressure with brainstem involvement. It presents as bradycardia (decreased pulse), irregular or abnormal respirations, and a widened pulse pressure (increased pulse pressure, meaning systolic pressure is elevated with relatively higher diastolic pressure or a large gap between them).

This pattern occurs because the brainstem is under pressure. The body raises systolic blood pressure in an attempt to maintain cerebral perfusion, the heart rate slows via baroreceptor reflex, and the brainstem dysfunction causes irregular breathing. Seeing a decreased pulse, irregular respirations, and an increased pulse pressure is a classic, late sign of dangerous ICP elevation, demanding immediate evaluation and intervention to prevent brain herniation.