nclex question... please read n comment

[jechro.08]

pt. with evacuation of subdural hematoma.. what would you do to reduce the risk of increased ICP:

A. ELEVATE THE HEAD OF THE BED 90 DEGREES

B. SUCTION ONCE A SHIFT

C. ADMINISTER STOOL SOFTNERS

D. ENCOURAGE ORAL FLUID INTAKE

PLEASE give ur answers and valuable rationales..

[Dpadilla]

In exam cram third edition, it says that HOB should be 30 degrees .

[nurseprnRN, BSN, RN]

Possibly true, but where is the reference for higher being worse? I would consider the 30 degrees as a minimum, as in, don't lie the patient down flat.

[demetriagayle]

The answer is C because first the hob should not be elevated so high for a patient who is at risk for ICP, second suctioning is an absolute no because this as well can increase ICP, and lastly don't encourage fluids because it puts the patient at more of a risk to have icp.

[linefrancillon]

i would say A

[nurseprnRN, BSN, RN]

The answer is C because first the hob should not be elevated so high for a patient who is at risk for ICP, second suctioning is an absolute no because this as well can increase ICP, and lastly don't encourage fluids because it puts the patient at more of a risk to have icp.

Please note: "ICP" is the abbreviation for "intracranial pressure." Everyone (well, at least alive ones) has intracranial pressure-- you do, I do, the guy sitting next to you on the bus does. ICP does not mean "increased ICP."

To discuss increased ICP, you have to say, "Increased ICP," for which there is no abbreviation except perhaps that little upgoing arrow.

[Lev, MSN, RN, NP]

First I thought A, but then I saw C and decided it was a better choice. Head elevation is good, but not at 90 degrees. Stool softeners prevent straining which can elevate ICP. B & D are "throwaway" answers.

[Lev, MSN, RN, NP]

Possibly true, but where is the reference for higher being worse? I would consider the 30 degrees as a minimum, as in, don't lie the patient down flat.

Elevation at 15 degrees is beneficial to reduce ICP and 30 degrees is even better. Elevation at 60 degrees or greater and lying the patient flat (0 degrees) can be detrimental.

http://thejns.org/doi/abs/10.3171/jns.1983.59.6.0938

[nurseprnRN, BSN, RN]

From the abstract of this study (thanks for posting it): "To establish if an optimum level of head elevation exists in patients with intracranial hypertension, the authors examined changes in intracranial pressure (ICP), systemic and pulmonary pressures, systemic flows, and intrapulmonary shunt fraction with the patient lying flat, and then with the head elevated at 15°, 30°, and 60°. Cerebral perfusion pressure (CPP) was calculated. The lowest mean ICP was found with elevation of the head to 15° (a fall of −4.5 ± 1.6 mm Hg, p

So, this study showed that raising the head of the bed

15 degrees -> drops ICP by 4.5 +/- 1.g mmHg (p

30 degrees -> drops ICP by 6.1 +/- 3.5 mmHg (p<.0001 significant>

60 degrees -> drops ICP by 3.8 +/- 9.3 mmHg (p

This says that ICP drops the most at 30 degrees, but it does NOT say that it increases if you raise to 60 degrees, just that it doesn't drop as much and there is greater variability in ICP. Also, those numbers may be statistically significant, but they are not necessarily sit-up-and-take-notice clinically important in many cases.

The changes in cerebral perfusion pressure are only noted at the 60 degree height in this abstract. It says lying flat and at 60 degrees may be detrimental due to changes in ICP, CPP, and CO. It says 15 and 30 degrees are most consistent at decreasing ICP. However, there is nothing here that says elevating to 60 degrees is definitely detrimental in terms of ICP alone, just that it's not as good.

[PinayNanayNurse, BSN, RN]

C ​is the answer.

Other answers put the patient at risk for increase intracranial pressure. You can elevate the head up to 30 degrees (only) to improve jugular venous outflow and lowers ICP.

[Lev, MSN, RN, NP]

This says that ICP drops the most at 30 degrees, but it does NOT say that it increases if you raise to 60 degrees, just that it doesn't drop as much and there is greater variability in ICP.

It does say that the ICP increased..."With elevation of the head to 60°, the mean ICP increased to −3.8 ± 9.3 mm Hg of baseline"

[nurseprnRN, BSN, RN]

It does say that the ICP increased..."With elevation of the head to 60° the mean ICP [i']increased[/i] to −3.8 ± 9.3 mm Hg of baseline"

Pay attention to that little "-" (minus sign) before the numbers for each elevation. They refer to the pressures as compared to flat baseline; -3.8 means 3.8 lower than at baseline. It increased from a larger decrease than at 30 degrees but STILL less than baseline pressure at flat. Not the best English for writing up the report but that's what their numbers say.

-3.8 is an increase from -6.1, but neither is an elevation in ICP. Both are lower than the ICP at baseline.

Hope that clarifies the data for you.

[lenini]

You would not elevate the HOB to 90 degrees but to 30-45. Suctioning and fluids would cause ICP to increase. Answer would be C. administer stool softeners.