The nurse should place a patient who sustained a head injury in which position to prevent increased intracranial pressure (ICP)

Question

Question

This question was previously asked in

SGPGI Staff Nurse Official Paper (Held On: 28 Feb, 2024 Shift 1)

Attempt Online

Answer 1

Correct Answer: With the head of the bed elevated at least 30 degrees

Rationale:

Patients who have sustained a head injury are at risk of increased intracranial pressure (ICP), a potentially life-threatening condition caused by swelling, bleeding, or a disruption in cerebrospinal fluid (CSF) dynamics. Proper positioning can help promote venous drainage from the brain and reduce ICP.
Elevating the head of the bed at least 30 degrees helps facilitate venous return from the brain to the heart, reducing the risk of venous congestion and subsequent increases in ICP.
This position also ensures optimal oxygenation by improving respiratory mechanics, which is crucial for maintaining adequate oxygen delivery to the brain and preventing secondary brain injury.
Additionally, keeping the head in a neutral alignment (not flexed or extended) while elevating the bed prevents compression of the jugular veins, further aiding venous drainage.

Explanation of Other Options:

In left Sim’s position

Rationale: Left Sim’s position involves lying on the left side with the lower arm behind the body and the upper leg bent. While this position is helpful for certain situations, such as facilitating drainage in unconscious patients or during enemas, it is not ideal for managing ICP. This position can impede venous drainage from the brain, potentially worsening ICP.

In reverse Trendelenburg

Rationale: Reverse Trendelenburg involves tilting the patient so that the head is higher than the feet. While this might seem similar to elevating the head of the bed, the entire body is inclined, which does not promote optimal venous return from the brain. It is less effective in reducing ICP compared to simply elevating the head of the bed at 30 degrees.

With the head elevated on a small, flat pillow

Rationale: While a small, flat pillow may provide some elevation, it does not achieve the recommended 30-degree head elevation necessary to ensure adequate venous drainage and ICP reduction. Additionally, this position may not consistently maintain the head and neck in a neutral alignment.

Additional Information:

Proper positioning is just one aspect of managing ICP. Other interventions include maintaining normothermia, avoiding activities that increase intrathoracic or intra-abdominal pressure (e.g., straining, coughing), and using medications to reduce swelling or control seizures.
Monitoring the patient for signs of increased ICP, such as changes in consciousness, pupil abnormalities, or worsening headaches, is critical for timely intervention.
It is also important to avoid extreme flexion, extension, or rotation of the neck, as these can compress venous outflow and exacerbate ICP.

Conclusion:

Elevating the head of the bed to at least 30 degrees is the most effective position for reducing ICP in patients with head injuries. This positioning promotes venous drainage, optimizes oxygenation, and helps prevent complications associated with elevated ICP.