A nurse is teaching a group of students the main structures that play a role with altering intracranial pressure. Which of the following structures should the nurse include? Select all that apply

A cerebral angiogram is a diagnostic imaging procedure that uses iodinated contrast dye and fluoroscopy to visualize cerebral blood flow. Prior to the procedure, the nurse must assess for conditions that could pose a risk or require modification of care, such as pregnancy, bleeding risk from anticoagulants, or allergies to contrast agents. Some client-reported statements, especially those related to contrast dye sensitivity and anticoagulation, require immediate provider notification.

Rationale for Correct Answers:

A. “I think I may be pregnant.”: Exposure to radiation and contrast dye during a cerebral angiogram may pose potential harm to a developing fetus. This possibility should be investigated and reported before proceeding.

B. “I take Coumadin.”: Warfarin is an anticoagulant that increases the client’s risk for bleeding during the procedure. The provider must evaluate coagulation status and possibly pause or adjust therapy.

D. “I am allergic to shrimp.”: Although a seafood allergy does not automatically mean an iodine allergy, a history of shrimp allergy may be associated with contrast dye sensitivity. The provider should assess further and consider premedication to prevent a hypersensitivity reaction.

Rationale for Incorrect Answers:
C. “I take antihypertensive medication.”: Antihypertensive medications are generally safe and may even be beneficial for clients undergoing angiography. There is no need to stop these medications unless directed by the provider.
E. “I am allergic to latex.”: Latex allergy is important to document, but it is not a specific concern related to angiography with contrast dye. Latex-free equipment is widely available, and this allergy does not require cancellation or modification of the procedure itself.

Key Takeaways:
• Always report possible pregnancy, use of anticoagulants, and contrast dye allergy risks before cerebral angiography.
• Latex allergy, while relevant, does not pose a direct risk during contrast administration.
• Routine medications like antihypertensives are generally not contraindicated unless otherwise instructed.

Hyperthermia, or elevated body temperature, is a concerning finding in clients with increased intracranial pressure (ICP). It may result from damage to the hypothalamus, the brain's temperature-regulating center, especially in traumatic brain injury, hemorrhagic stroke, or central nervous system infections. Elevated temperature can increase cerebral metabolic demand, which in turn raises cerebral blood flow and worsens ICP.

Rationale for Correct Answer:
C. Cooling interventions help control fever, which can worsen ICP by increasing cerebral metabolism and blood flow.

Rationale for Incorrect Answers:

A. Vasopressors are not appropriate unless the patient is in shock. BP is low but not severely, and raising BP can worsen cerebral edema.

B. Oxygen is within normal range (95%), so additional oxygen is not necessary.

D. Suctioning can increase ICP transiently and should be used cautiously and only when airway clearance is needed.