A nurse is caring for a client who is experiencing Cushing’s triad following a subdural hematoma. Which of the following medications should the nurse plan to administer?
A.
Albumin 25%
B.
Dextran 70
C.
Mannitol 25%
D.
Hydroxyethyl starch
The correct answer and Explanation is :
The correct answer is C. Mannitol 25%.
Explanation:
Cushing’s triad is characterized by hypertension, bradycardia, and irregular or abnormal respirations, and it typically indicates increased intracranial pressure (ICP), which is a critical condition often associated with traumatic brain injuries, such as a subdural hematoma. The management of elevated ICP focuses on reducing brain swelling and maintaining adequate cerebral perfusion.
Mannitol is an osmotic diuretic that is commonly used in the management of increased ICP. It works by creating an osmotic gradient that draws fluid from the brain tissue into the vascular space, effectively reducing cerebral edema. By lowering ICP, mannitol can help to stabilize the patient’s condition, potentially alleviating the effects of Cushing’s triad. The 25% formulation of mannitol is often administered intravenously, and careful monitoring of fluid balance and renal function is essential during treatment.
Rationale for Other Options:
- A. Albumin 25%: While albumin can be used for volume expansion and to manage hypovolemic states, it does not specifically address elevated ICP and cerebral edema, making it less appropriate in this situation.
- B. Dextran 70: Dextran is another volume expander, but like albumin, it does not have the specific action of reducing cerebral edema and is not indicated for the management of increased ICP.
- D. Hydroxyethyl starch: Similar to dextran and albumin, hydroxyethyl starch is a colloid used for volume replacement. It does not exert an osmotic effect on the brain and is not effective for treating increased ICP.
In summary, mannitol is the medication of choice for treating elevated intracranial pressure due to its ability to reduce cerebral edema and improve outcomes in patients exhibiting Cushing’s triad after a subdural hematoma.