A nurse in the emergency department is caring for a client who had a seizure and became unresponsive after stating they had a sudden, severe headache. The client's vital signs are as follows: blood pressure of 198/110 mm Hg, pulse of 82/min, respirations of 24/min, and a temperature of 38.2° C (100.8° F). Which of the following neurological disorders should the nurse suspect?

Choice A reason: Hypophosphatemia refers to an abnormally low level of phosphate in the blood. The normal range for serum phosphate in adults is typically around 2.5 to 4.5 mg/dL. In the context of acute kidney injury (AKI), the kidneys’ ability to excrete phosphate is impaired, which can actually lead to hyperphosphatemia, not hypophosphatemia. Therefore, while phosphate levels are important to monitor in AKI, hypophosphatemia is not typically expected.

Choice B reason: Hypercalcemia is characterized by an elevated level of calcium in the blood, with the normal range being approximately 8.5 to 10.2 mg/dL. AKI can sometimes be associated with hypercalcemia, particularly if there is extensive tissue breakdown or rhabdomyolysis. However, it is not as commonly expected as hyperkalemia. Hypercalcemia in AKI is more often secondary to other underlying conditions rather than a direct result of the kidney injury itself.

Choice C reason: Hyperkalemia is a common electrolyte imbalance in AKI and refers to a high level of potassium in the blood. The normal range for serum potassium is about 3.5 to 5.0 mEq/L. In AKI, the kidneys’ ability to excrete potassium is compromised, leading to an accumulation of potassium in the blood. This can be life-threatening, causing cardiac dysrhythmias and muscle weakness. Hyperkalemia is a key concern in AKI management and is often expected in this condition. While all the listed electrolyte imbalances can occur in various clinical scenarios, hyperkalemia is the most commonly expected electrolyte disturbance in a patient with acute kidney injury. It is crucial for healthcare providers to monitor and manage electrolyte levels carefully in AKI to prevent complications.

Choice D reason: Hypernatremia means an elevated sodium level in the blood, with the normal range being 135 to 145 mEq/L. While sodium balance can be affected in AKI, hypernatremia is not typically expected. It is more commonly associated with conditions that cause a loss of water or an intake of sodium, such as diabetes insipidus or excessive salt ingestion. In AKI, the focus is often on managing fluid overload rather than sodium excess.

Choice A: Tachypnea Tachypnea, or rapid breathing, is not typically a direct sign of increased ICP. While it can be associated with various medical conditions, it is not specifically indicative of increased ICP. However, it’s important to note that breathing patterns can change with advanced ICP changes, but these are usually characterized by irregularities rather than just increased rate. Increased intracranial pressure (ICP) is a critical condition that can occur after a traumatic brain injury (TBI). It results from the brain tissue’s response to injury, leading to swelling or bleeding within the skull. The skull is a rigid structure, so any increase in content, such as blood or edema, can lead to an increase in pressure.

Choice B: Hypotension Hypotension, or low blood pressure, is generally not associated with increased ICP. In fact, one of the signs of increased ICP is Cushing’s triad, which includes hypertension (high blood pressure), bradycardia (slow heart rate), and irregular respirations. Therefore, hypotension would not be a typical manifestation of increased ICP.

Choice C: Decreased level of consciousness A decreased level of consciousness is a hallmark sign of increased ICP. As pressure within the skull increases, it can lead to compression of the brain tissue and disruption of cerebral blood flow. This can manifest as changes in alertness, drowsiness, confusion, and in severe cases, loss of consciousness1. when monitoring a client who has sustained a TBI, the nurse should be vigilant for signs of increased ICP, with a decreased level of consciousness being a primary indicator. Other signs may include headache, nausea, vomiting, and changes in pupil size or reactivity. It is crucial to identify and treat increased ICP promptly to prevent further brain injury and potential long-term consequences.

Choice D: Bilateral weakness of extremities While bilateral weakness can be a sign of neurological damage, it is not specific to increased ICP. Increased ICP is more likely to cause global effects on consciousness and brain function rather than isolated weakness in limbs unless there is focal brain injury causing raised ICP.