Which of the following actions should the nurse take to manage increased intracranial pressure (ICP) for a client with a closed-head injury? Select all that apply.

Increased intracranial pressure (ICP) following a closed-head injury occurs when brain swelling, bleeding, or impaired cerebrospinal fluid dynamics raise pressure within the rigid skull. This can compromise cerebral perfusion and lead to secondary brain injury if not managed promptly. Nursing interventions focus on reducing stimuli that elevate ICP, maintaining adequate cerebral perfusion, and closely monitoring neurological status for early signs of deterioration. Rationale: A. Suctioning the endotracheal tube frequently is not recommended because it can significantly increase intracranial pressure. Suctioning stimulates coughing and vagal responses, which elevate intrathoracic pressure and subsequently reduce venous return from the brain. It should only be performed when necessary and with preoxygenation and careful technique. B. Positioning the client in high Fowler’s position is inappropriate for managing increased ICP. Excessive elevation may reduce cerebral perfusion pressure in some clients. The optimal position is typically head-of-bed elevation around 30 degrees with neutral head alignment to promote venous drainage without compromising blood flow to the brain. C. Administering a stool softener is important because straining during defecation increases intrathoracic and intracranial pressure through the Valsalva maneuver. Preventing constipation reduces the risk of sudden ICP spikes. Stool softeners help maintain regular, strain-free bowel movements, supporting stable intracranial dynamics. D. Performing frequent neurological assessments is essential for early detection of changes in intracranial pressure. Monitoring level of consciousness, pupil response, and motor function helps identify deterioration before irreversible brain damage occurs. Timely recognition allows for rapid intervention to prevent further neurological decline. E. Decreasing the noise level in the client’s room helps reduce external stimulation that can elevate intracranial pressure. Environmental stimuli such as loud noise, bright lights, and excessive activity can increase cerebral metabolic demand. A calm, low-stimulation environment supports brain rest and helps stabilize ICP.