Medical Surgical Increased ICP #1

Question

The nurse caring for a client with a brain injury administered mannitol for increased intracranial pressure. Which is the most important for the nurse to monitor following administration of mannitol?

Answers

  1. Intake and output.
    • Rationale:

      This answer is correct because since mannitol is a diuretic, the excessive fluid in the brain is eliminated through the kidneys as urinary output. While on mannitol, the urinary output is generally more than the input. The nurse should monitor the client for intake and output. The goal with this therapy is reduction of cerebral edema to restore neurologic function to the client.

  2. Pupillary response.
    • Rationale:

      This answer is not correct because while pupillary responses are important in determining changes in intracranial pressure, the question aims at interventions post-administration of an osmotic diuretic. The most important, initial priority is the assessment of intake and output. Then, as fluid is removed (as reflected by increased output), the neurologic improvement should follow (improved pupillary responses).

  3. Changes in pulse pressure
    • Rationale:

      This answer is not correct because while changes in pulse pressure are important to monitor for determining changes in intracranial pressure, the question aims at interventions post administration of an osmotic diuretic. The most important, initial priority is the assessment of intake and output. Then, as fluid is removed (as reflected by increased output), the pulse pressure should improve.

  4. Respiratory rate.
    • Rationale:

      This answer is not correct because the question addresses a neurologic problem (increased intracranial pressure), not a problem with the pulmonary system. Other diuretics (loop and thiazide diuretics) are generally used to decrease fluid surrounding the lungs. Then, respiratory rate, intake, and output would be assessed to monitor effectiveness of therapy.

Overview

Mannitol is a diuretic used to decrease intracranial pressure. The nurse should carefully monitor intake and output during mannitol therapy.

Explanation

Learning Outcomes

Mannitol is an osmotic diuretic used to force urine output to decrease intracranial pressure in clients with cerebral edema. Mannitol is also used to increase urine production in clients with acute renal failure and to decrease edema and excessive fluid in the eyes. The osmotic action pulls water from extracellular fluid of the brain. Since mannitol is a diuretic, the excessive fluid in the brain is eliminated through the kidneys as urinary output. While on mannitol, the urinary output is generally more than the input. The nurse should monitor the client for intake and output. The goal with this therapy is reduction of cerebral edema to restore neurologic function to the client.

Test Taking Tip

To help remember that mannitol is an osmotic diuretic, think of mannitol/manatee, which lives near water, and has a large head. Also, the “o” in mannitol can help you remember “osmotic” diuretic.

Video Rationale