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..

[cwilli0003]

MY Choice wud be A OR C but i choose C AS , NEUROLOGY PATIENTS ARE NORMALLY NURSED AT 30 DEGREES

[Lev, MSN, RN, NP]

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.

Yes it does. So let's say the ICP was 25 at baseline.

HOB elevated to 15 degrees --> mean ICP decreases to 20.5 mm Hg--> Raise HOB further to 30 degrees --> mean ICP decreases further to 18.9 mm Hg --> Raise HOB further to 60 degrees--> mean ICP increases to 21.2 mm Hg (which is still lower than baseline, but definitely an increase from lowest point of ICP at 30 degrees.) So the verdict is elevate to 30 degrees, but not up to 60 degrees.

[Lev, MSN, RN, NP]

The full study is attached.

jns.1983.59.6.pdf