Head end of a hemorrhagic stroke patient is kept?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Medical & Surgical Nursing

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Explanation

The primary goal in positioning a hemorrhagic stroke patient is to manage and reduce intracranial pressure (ICP).
Elevating the head of the bed to 30 degrees uses gravity to promote venous drainage from the brain, which effectively lowers ICP.
This position also helps prevent aspiration, a common and serious complication in patients with neurological impairment.
It strikes a balance, lowering ICP without significantly decreasing cerebral perfusion pressure (the pressure that pushes blood to the brain).

Option A: Keeping the patient's head straight or flat (supine) eliminates the gravitational force needed to help drain venous blood from the brain, which can lead to an increase in intracranial pressure.
Option B: Lowering the head (Trendelenburg position) is strictly contraindicated. It causes a rapid and dangerous increase in intracranial pressure by forcing blood towards the head.
Option D: While the 30-degree elevation is correct, turning the head to a lateral position is harmful. It can compress or kink the jugular veins in the neck, obstructing venous outflow from the brain and causing a rise in ICP.

Clinical Relevance

Nursing practice connection: Use the key finding related to Positioning of a patient with hemorrhagic stroke to manage intracranial pressure to guide bedside assessment, documentation, and the next nursing action.
Proper positioning is a fundamental and non-invasive nursing intervention that has a significant impact on outcomes for patients with increased ICP.
Nurses are responsible for maintaining the correct head-of-bed elevation and ensuring the patient's head remains in a neutral, midline position at all times, including during turning and other care activities.
What if? If a patient with a hemorrhagic stroke suddenly becomes hypotensive (low blood pressure), the priority may shift to maintaining cerebral perfusion. The physician might order the head of the bed to be lowered slightly (e.g., to 15 degrees or flat) to improve blood flow to the brain, but this is a delicate balance and must be done under close monitoring of both blood pressure and ICP.

How to Approach the Question

First, identify the core issue in the question: a patient with a hemorrhagic stroke. This immediately signals that the primary concern is increased intracranial pressure (ICP).
Recall the pathophysiology: bleeding inside the skull increases pressure. Therefore, all interventions should aim to decrease or manage this pressure.
Analyze the options based on their effect on ICP. Think about gravity and blood flow.
Option A (Straight/Flat): Gravity is not helping drain blood from the head. This would likely increase ICP. Eliminate.
Option B (Lowered): This would cause blood to rush to the head, dramatically increasing ICP. This is dangerous. Eliminate.
Option C (Elevated to 30 degrees): This uses gravity to help venous blood drain from the head, which would lower ICP. This is a plausible and standard intervention.

Concept Tested & Keywords

Concept Tested: Positioning of a patient with hemorrhagic stroke to manage intracranial pressure.
Stem keywords: hemorrhagic stroke, head end, patient
Lead-in keywords: is kept
Negative lead-in flag: false

QiAl_u3T-5HqwyqzCNea_1

E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 163-165

E6 Nursing Fundamentals Taylor p. 1070-1072