EFFECT OF PATIENT POSITIONING ON ICP 1. SUPINE POSITION Use of a prolonged supine position can lead to deterioration in respiratory function and gas exchange, increase arterial partial pressure of carbon dioxide, and decrease arterial partial pressure of oxygen, and thereby contribute to further increases in ICP over time. 2. PRONE POSITION The prone position can be used to improve the oxygenation as well as CPP in patients with traumatic brain injury or SAH. However, this method results in raised ICP, and should be used cautiously in patients with reduced intracranial compliance. Positions like prone is not given to patient as it cause increase intra-abdominal pressure. Clinical condition that contraindicated prone positioning are increased ICP and fractures 3. LATERAL RECUMBENT POSITION This position is contraindicated in patients with increase ICP. Side-lying position is giving with head elevated then it will not do any change in ICP. Positions like Lateral recumbent position without head elevation are not given to increased ICP patient. 4. TRENDELENBERG POSITION Trendelenburg position cause increasing venous congestion within and outside the cranium leading to increased intracranial pressure. Positions like Trendelenburg position is not given to increased ICP patients. 5. REVERSE TRENDELENBERG POSITION The 10-deg reverse Trendelenburg position (RTP) has reduce intracranial pressure (ICP) in neuro traumatized patients. 6. FOWLERS POSITION · Fowler’s position is recommended for the patients with increase in intracranial pressure. · Fowlers Position facilitates venous blood drainage from the brain and decreasing intracranial pressure and venous pressure · The most suitable position that should be given to the patient with increased intracranial pressure is 30 degree head elevated position. · Nurse use 30 degree head elevated position without neck flexion for back care and feeding. · Exercises are given either in the supine or 30 degree head elevated position without the flexion of neck and hip. · Head elevation can decrease intracranial pressure related to increased CSF and/or venous drainage from the intracranial space as a result of gravity; the effect of head elevation on CPP must also be observed because if BP at the head drops to a greater degree than the decrease in intracranial pressure, CPP may actually decrease despite the decrease in intracranial pressure. · Foot rest can be used to patient to prevent sliding of the patient when 30 degree head elevated position is given. 7. POSITION OF HEAD AND NECK 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. Neck flexion compress jugular vein and inhibit venous return, cause central venous engorgement and thus increase intracranial pressure Bed making is done without neck flexion and neck extension. Cervical collars must be fit properly to prevent obstruction of venous drainage from the head. 8. HIP FLEXION Extreme hip flexion can increase intra-abdominal pressure and restrict the movement of diaphragm and respiratory effort. It can cause increase in intracranial pressure. GENERAL ASSESSMENT · Level of consciousness with GCS · Pupillary abnormalities · Motor dysfunction such as hemiplegia · Impaired brainstem reflexes like gag reflex, corneal reflex, swallowing · Alteration in vital signs including respiratory abnormality. · Cushing’s triad( hypertension, bradycardia and irregular respiratory patterns) · Aphasia · Visual disturbances · Headache NURSES RESPONSIBILITY IN POSITIONING PATIENT WITH INTRACRANIAL PRESSURE · Initial assessment of increased intracranial pressure should be done in all patients who are at risk. · Good head and neck alignment maintains jugular venous drainage. Jugular venous drainage promote outflow of blood and CSF from the cranial compartment. · Head of bed elevation to 30 degrees promotes jugular venous drainage (to reduce cerebral blood volume). · Avoid positions that may increase abdominal or intrathoracic pressures such as prone or semi-prone. Higher elevations may increase abdominal pressures or impede cerebral blood flow. · Avoid hip flexion > 30 degrees · Procedures such as back care, mouth care , etc., should be done at head elevated position · Nurse turns the patient passively to avoid isometric muscle contractions and valsalva effect. · Nurse also informs the other health care providers like physiotherapist, dieticians to be caution for the patient. · Nurse must provide a noise free environment to the patient · Nurse always keep the direct light off in order to give patient a dimmable environment · Nurse records the findings of elevated intracranial pressure in the nurses record
Posted on: Sun, 08 Jun 2014 23:30:16 +0000
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