In planning the care for a client who has had a posterior fossa (infratentorial) craniotomy, which of the following is contraindicated when positioning the client?
A. Keeping the client flat on one side or the other.
B. Elevating the head of the bed to 30 degrees.
C. Logrolling or turning as a unit when turning.
D. Keeping the head in a neutral position.
Correct Answer: B. Elevating the head of the bed to 30 degrees.
Elevating the HOB to 30 degrees is contraindicated for infratentorial craniotomies because it could cause herniation of the brain down onto the brainstem and spinal cord, resulting in sudden death. Elevation of the head of the bed to 30 degrees with the head turned to the side opposite of the incision, if not contraindicated by the ICP; is used for supratentorial craniotomies.
Option A: The management of patients with head trauma should always consider C-spine motion restriction. Hold the neck immobile in line with the body, apply a rigid or semi-rigid cervical collar, and (unless the patient is very restless) secure the head to the trolley with sandbags and tape.
Option C: Patients with STBI are at an alarming risk for DVT. This can be minimized with the range-of-motion exercises, pneumatic compression devices, and drugs such as low-molecular-weight heparin if needed. Potential benefits for patients participating in early rehabilitation in the ICU include improved muscle strength, physical function, and quality of life and reduced hospital and ICU length of stay, duration of mechanical ventilation, and hospital costs.
Option D: The patient should be positioned properly with the neck in a neutral position and the head end of the bed elevated to 30°. This facilitates cerebral venous drainage. Head end of the bed should be elevated for patients with CSF, rhinorrhea, and otorrhea. Rigid cervical collars should be loosened or removed to decrease ICP.
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