A client who is being observed for signs of increasing intracranial pressure (ICP) after a head injury requires suctioning for copious secretions. The nurse must remember which of the following?
a. Nasal suctioning is prohibited for this client.
b. Suction pressure should be limited to 80 to 100 mm H2O for this client.
c. A vagal response may be elicited from suctioning, resulting in an increased ICP.
d. Free-flow oxygen should be provided when suctioning the client.
A
A client with increased ICP should never have nasal suctioning performed, due to the risk of brain herniation and possible brain injury resulting from suctioning.
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