Neurological Disorders Q 103

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The nurse is positioning the female client with increased intracranial pressure. Which of the following positions would the nurse avoid?

  

     A. Head midline

     B. Head turned to the side

     C. Neck in neutral position

     D. Head of bed elevated 30 to 45 degrees

    

    

Correct Answer: B. Head turned to the side

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The head of the client with increased intracranial pressure should be positioned so the head is in a neutral midline position. The nurse should avoid flexing or extending the client’s neck or turning the head side to side. The head of the bed should be raised to 30 to 45 degrees. Use of proper positions promotes venous drainage from the cranium to keep intracranial pressure down.

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Option A: Elevate the head of the bed to greater than 30 degrees. Keep the neck midline to facilitate venous drainage from the head. Communication regarding indications/risks/contraindications for ICP monitoring or craniotomy needs to be ongoing, particularly with respect to goals of care. Nursing care must pay close attention to changes in neurologic status, any change in vitals such as an increasingly erratic heart rate, development of bradycardia, accurate and equal intake and output when having diuresis, and maintenance of proper blood pressure.

Option C: In patients with raised ICP, it is a common practice to position the patient in bed with the head elevated above the level of the heart. Kenning, et al.,4 reported that elevating the head to 45° or 90° significantly reduced ICP. However, some studies suggest that head elevation may also lower the CPP.

Option D: If a patient is suspected of having an increased ICP, methods to reduce pressure from increasing further include elevating the patient’s head to 30 degrees, keeping their neck in a neutral position, avoiding overhydration, maintaining normal body temperature, and maintaining normal oxygen and carbon dioxide levels.

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