The nurse is caring for a patient admitted to the intensive care unit with a subarachnoid bleed. Vital signs are as follows: blood pressure (BP) 120/74 mm Hg, pulse 70 beats/min, and respirations 16 breaths/min. Several hours later, the patient requests help to have a bowel movement. The patient refuses a bedpan and asks to use a bathroom. When told that this is not possible, the patient becomes angry and belligerent and starts yelling at the nurse. Vital signs are now BP 160/60 mm Hg, pulse 48 beats/min, and respirations 12 breaths/min. The neurosurgeon has been paged but has not yet responded. With which of the following actions should the LPN anticipate assisting the RN?

Question

Quizplus · Accepted Answer

The patient is exhibiting signs of increased intracranial pressure (ICP) with a decrease in pulse and respirations, and an increase in blood pressure. Allowing the patient to get up and walk around could exacerbate the ICP and potentially cause harm to the patient. Waiting for the neurosurgeon to call back may take too much time and the patient’s condition may worsen. Paging security to restrain the patient is not necessary at this time and may further agitate the patient. Administering a sedative can help to decrease anxiety and agitation in the patient, which can decrease ICP and help to prevent further harm. As a result, administering an as-needed dose of a sedative that is ordered is the best choice.

The Nurse Is Caring for a Patient Admitted to the Intensive