What intervention should the nurse implement to prevent an increase in intracranial pressure (ICP) of a comatose patient who has suffered a closed head injury?
A) Suction the airway every hour and as needed.
B) Elevate the head of the bed 15 to 30 degrees.
C) Turn the patient and change his position every 2 hours.
D) Maintain a well-lit room.
Ans: B
Feedback: To facilitate venous drainage and avoid jugular compression, the nurse should elevate the head of the bed 15 to 30 degrees. Patients with increased ICP tolerate suctioning poorly and shouldn't be suctioned on a regular basis. Turning from side to side increases the risk of jugular compression and rises in ICP, so turning and changing positions should be avoided. The room should be kept quiet and dimly lit.
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