A nurse is reinforcing teaching to a group of nursing students about possible psychosocial changes a client might have after sustaining a neurologic injury such as increased intracranial pressure. Which of the following psychosocial changes should the nurse include in the teaching?

A. Respiratory rate of 12/min: A respiratory rate of 12/min is within the normal adult range (12-20 breaths per minute). In the context of increased intracranial pressure (ICP), respiratory rate changes might be noted as part of the Cushing's reflex (which is characterized by bradycardia, hypertension, and abnormal respiratory patterns like Cheyne-Stokes or ataxic breathing), but a rate of 12/min on its own is not indicative of a worsening condition. However, if the patient begins to show signs of irregular or abnormal breathing patterns, this would raise concern.

B. Blood pressure of 108/74 mm Hg: This blood pressure is also within the normal range and does not suggest a worsening of intracranial pressure. In fact, ICP can lead to a rise in blood pressure (due to the body's compensatory mechanisms, known as Cushing's triad), along with bradycardia and abnormal respirations. Thus, a stable blood pressure like 108/74 mm Hg is not concerning in this context.

C. Changes to pupil size and shape: Changes in pupil size, shape, or reactivity are significant indicators of worsening intracranial pressure. Unequal pupils (anisocoria), sluggish or absent response to light, and fixed dilated pupils are signs of brainstem compression or damage, which often occur as ICP increases. This could indicate herniation or severe brain injury, which are worsening conditions.

D. Swelling of the optic nerve: Swelling of the optic nerve, or papilledema, is another important sign of increased intracranial pressure. It occurs due to increased pressure within the skull, which causes congestion and swelling of the optic disc. This finding can be seen on fundoscopy and indicates a worsening condition, as it suggests elevated pressure affecting the brain.

E. Decreasing Glasgow Coma scores: A decreasing Glasgow Coma Scale (GCS) score is a critical indicator of worsening neurologic function in a patient with increased ICP. The GCS is used to assess a patient's level of consciousness, and a decreasing score suggests that the brain's function is deteriorating. This can be caused by worsening edema, brain herniation, or other severe neurological impairments associated with elevated ICP.

A. Tau protein: Tau protein is primarily associated with Alzheimer's disease and other tauopathies, not Lewy body dementia.

B. Neurofibrillary tangles: Neurofibrillary tangles are aggregates of hyperphosphorylated tau protein found in Alzheimer's disease, not typically in Lewy body dementia.

C. Alpha-synuclein protein: Lewy bodies, which are abnormal aggregates of alpha-synuclein protein, are a hallmark pathology of Lewy body dementia. These protein aggregates disrupt neuronal function and are responsible for the cognitive, motor, and emotional symptoms seen in Lewy body dementia.

D. Beta-amyloid protein: Beta-amyloid protein is primarily associated with Alzheimer's disease, not Lewy body dementia. It forms plaques in the brain, which contribute to neurodegeneration and cognitive decline in Alzheimer's disease.