A nurse is caring for a client who has increased intracranial pressure. Which of the following actions should the nurse take?

Increased intracranial pressure (ICP) occurs when there is a rise in pressure within the skull due to factors such as trauma, hemorrhage, tumor, or cerebral edema. Because the cranial vault is a fixed space, any increase in brain tissue, cerebrospinal fluid, or blood volume can compromise cerebral perfusion and lead to neurological deterioration. Nursing management focuses on preventing further increases in ICP and maintaining adequate oxygenation and cerebral blood flow. Environmental and physiological stimuli that increase ICP must be minimized. A. Applying a heating blanket is inappropriate because heat can cause vasodilation, which increases cerebral blood flow and may worsen intracranial pressure. In clients with increased ICP, interventions should avoid increasing metabolic demand or cerebral vasodilation. B. Administering laxatives rectally, especially in a manner that stimulates the Valsalva maneuver, can increase intra-abdominal and intrathoracic pressure, which subsequently raises intracranial pressure. Stool softeners or avoidance of straining are preferred to prevent ICP elevation. C. Positioning the head of bed greater than 45° may reduce cerebral perfusion pressure too much and is not the standard recommendation. Typically, the head of bed is elevated to about 30° with the head in neutral alignment to promote venous drainage while maintaining adequate cerebral perfusion. D. Decreasing stimulation in the environment is appropriate because it helps reduce metabolic demand and prevents increases in intracranial pressure. Limiting noise, light, and unnecessary handling reduces agitation and sympathetic stimulation, which can further elevate ICP. This is an essential component of ICP management.