A nurse is caring for a client who is experiencing an increase in intracranial pressure (ICP). The nurse should expect which of the following as an early manifestation of increased ICP?

Increased intracranial pressure (ICP) occurs when there is a rise in pressure within the skull due to factors such as hemorrhage, edema, tumor, or trauma. Because the skull is a fixed space, any increase in its contents can compromise cerebral perfusion and lead to neurological deterioration. Early recognition of changes is critical to prevent brain herniation and irreversible damage. Nurses must identify subtle behavioral and neurological changes that indicate rising ICP. A. Projectile vomiting is a later manifestation of increased ICP and occurs due to stimulation of the vomiting center in the medulla. It is often associated with more advanced intracranial pressure elevation and is not considered an early sign. Therefore, it indicates progression rather than early deterioration. B. Papilledema, or swelling of the optic disc, is a sign of chronic or sustained increased ICP. It develops over time due to increased pressure transmitted along the optic nerve. Because it requires prolonged pressure elevation, it is not an early manifestation. C. Restlessness is an early and subtle sign of increased ICP caused by decreased cerebral oxygenation and early changes in brain function. Patients may become increasingly anxious, irritable, or agitated before more severe neurological deficits develop. This behavioral change is often one of the first indicators of rising intracranial pressure. D. Decorticate posturing is a late and serious manifestation of increased ICP indicating severe brain injury, particularly damage above the brainstem. It reflects significant neurological deterioration and is associated with poor prognosis. Therefore, it is not an early sign but rather an advanced stage finding.