High Fowlers and increased ICP?

[randomly]

Hi all.

Was taking a practice test for NCLEX preparation and had a question regarding positioning for a patient with a severe head injury. When looking back at the rationales, it said that the choice "high Fowler's with the client's head in a neutral position" was incorrect because it INCREASES intracranial pressure.

I don't understand how this is true. By any chance, would someone be willing to explain?

[RN59217]

High Fowler's decreases ICP 'cause it allows for drainage by gravity. This is why when someone had an SCI and their blood pressure spikes, the absolute first thing you do is put them in High Fowler's cause of autonomic dysreflexia. Once they're in HF you can check them for urinary retention or fecal impaction. They can stroke out from autonomic dysreflexia. Position them first, then solve the root cause.

[Christy1019, ASN, RN]

Cmoul I think the OP is asking why her practice test would tell her this is the WRONG thing to do.

To the OP, I personally have no idea why that would be contraindicated as I was taught to increase the HOB to decrease ICP, so I tried to look it up and the ONLY thing I could find was that hip flexion greater than 60 degrees can increase intrathoracic pressure and therefore increase ICP. The only way I can relate that to your question is to think that the higher the HOB, the more the hips are flexed. I don't agree with the rationale you were given for your test but here's the link to the site I read...

http://neurosciencenursing.blogspot.com/2012/12/effect-of-patient-positioning-on.html?m=1

[cjdmomma]

What were the other choices, OP? Generally, we would put the bed at semi-fowlers for increased ICP.

[SE_BSN_RN, BSN]

You don't want the bed in high fowlers.....the pressure increases to get the blood up high. Semi-fowlers is the correct positioning.

What do you do when you have a headache? You lie down.....and that helps decrease the pressure.

[keepmovingrn]

Not high fowlers. Semi fowlers.

[RN59217]

Autonomic Dysreflexia: Nursing Care

This says High Fowler's

[kfitzy89]

For ICP (and IOP) you want the bed ideally around 30 degrees (semi-fowler's). Autonomic Dysreflexia is an emergent situation where usually the first action is to place your client in high fowler's position.

[randomly]

Thank you all for your replies.

The correct answer on the site was indeed semi-fowler's. My thought when answering was that the higher HOB elevation would further relieve the pressure.

Definitely doing some reading up on positioning. Thanks again!