[Verified Answer]: The client has just returned from a STAT…

The client has just returned from a STAT CT scan. The nurse reassesses the client and finds that he is now obtunded and confused and he localizes to pain. The client opens eyes to painful stimuli. GCS is 11. Vital signs are T 38.5°C (101.3° F), P 66/min, R 12/ min, BP 155/75 mmHg, and SpOz 88% on 2L NC. The client’s pupils are round. The right pupil is 3mm in diameter and reacts to light while the left pupil is 5mm in diameter and is sluggish to light. Results of CT the scan reveals a subdural hematoma that overlays the posterior frontal lobe and part of the temporal lobe. A midline shift of 5mm is present. The provider determines that emergency surgery is indicated. The client is admitted to the ICU following emergency evacuation of a subdural hematoma via burr hole and placement of a subarachnoid bolt to monitor ICP. The client was extubated in the OR and is sleepy but answers questions appropriately and is orientated x 3. Glasgow Coma Scale score is 13. Client can move all extremities when asked to do so. Pupils are equal and reactive; however, the left pupil is more sluggish. Vital signs are T 37.5°C (99.5° F), P 68/min, R 16/ min, BP 100/60 mmHg, and SpO 97% on 4L NC. The client rates head pain as a 5 on a scale of 0 to 10. During the hour after admission the nurse checks the client’s ICP every 15 minutes and notes that the client’s ICP has increased consistently and is now registering 22 mmHg. The nurse notifies the provider and receives a prescription for mannitol 20% 1 gram IV STAT. The nurse quickly obtains the medication from the pharmacy and prepares to administer the medication. 3 hours later the nurse enters the client’s room and finds the client hard to arouse. The client’s vital signs are T 39.2°C (102.5° F), P 56/min, R 12/ min and irregular, BP 172/70 mmHg ICP is now 25 mmHg, Glasgow Coma Scale score is 5, and left pupil is fixed and 8 mmg.