The nurse would expect which action immediately following the treatment of a cerebral spinal fluid leak in a post-spine-surgery client?
1. Keeping the client flat in bed for 2 hours
2. Raising the head of the bed (HOB) into a Trendelenburg position
3. Administering a bolus of IV fluids
4. Initiating strict isolation policies
Keeping the client flat in bed for 2 hours
Rationale: Keeping the client flat in bed for 2 hours will allow the blood patch repair for the cerebral spinal leak to clot and not migrate to other parts of the spine, thus allowing the seal to be formed to minimize/stop the leaking of cerebral spinal fluids. Raising the HOB will increase the risk of spinal leaking and increase the risk of spinal headache as the fluid is pulled by gravity to the lower areas of the spinal column. Administration of increased fluids is not the issue. It could increase the cerebral spinal pressure and increase the risk of rupture of the patch if given too much in a short period of time. Therefore, it is not recommended to give a bolus after a blood patch repair for the spinal leak. Strict isolation is not needed to prevent potential for meningitis from the open wound in the spinal column. Sterile techniques and sterile dressings should minimize that risk. It is not related to the administration of the blood patch for the spinal leak itself.
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