A nurse is caring for a preterm infant who has intraventricular hemorrhage (IVH).
Which of the following actions should the nurse take to prevent increased intracranial pressure (ICP)?
Elevate the head of the bed to 30 degrees.
Avoid suctioning unless absolutely necessary.
Administer analgesics as prescribed.
All of the above.
The Correct Answer is D
All of the above.
The nurse should take all of the following actions to prevent increased intracranial pressure (ICP) in a preterm infant who has intraventricular hemorrhage (IVH):
• Elevate the head of the bed to 30 degrees. This helps to reduce venous congestion and improve cerebral blood flow.
• Avoid suctioning unless absolutely necessary. Suctioning can cause hypoxia, bradycardia, and increased ICP.
• Administer analgesics as prescribed. Pain can increase blood pressure and ICP.
Choice A is wrong because elevating the head of the bed alone is not enough to prevent increased ICP.
Choice B is wrong because avoiding suctioning alone is not enough to prevent increased ICP.
Choice C is wrong because administering analgesics alone is not enough to prevent increased ICP.
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Related Questions
Correct Answer is C
Explanation
Dextrose 10% in water.This is because parenteral nutrition (PN) is a mixture of nutrients that is given through a central venous catheter (CVC) that goes directly to the heart.PN contains high concentrations of nutrition and calories, and if the PN bag is empty, it needs to be replaced with a solution that has a similar osmolarity to prevent complications such as hypoglycemia (low blood sugar) or phlebitis (inflammation of the vein).Dextrose 10% in water has an osmolarity of about 500 mOsm/L, which is close to the osmolarity of PN solutions.
Choice A is wrong because 0.9% sodium chloride has an osmolarity of about 300 mOsm/L, which is lower than PN solutions and can cause fluid overload and electrolyte imbalance.
Choice B is wrong because lactated Ringer’s has an osmolarity of about 275 mOsm/L, which is also lower than PN solutions and can cause similar problems as 0.9% sodium chloride.
Choice D is wrong because dextrose 5% in water has an osmolarity of about 250 mOsm/L, which is much lower than PN solutions and can cause rapid drop in blood sugar and vein irritation.
Correct Answer is D
Explanation
All of the above.
The nurse should take all of the following actions to prevent increased intracranial pressure (ICP) in a preterm infant who has intraventricular hemorrhage (IVH):
• Elevate the head of the bed to 30 degrees.This helps to reduce venous congestion and improve cerebral blood flow.
• Avoid suctioning unless absolutely necessary.Suctioning can cause hypoxia, bradycardia, and increased ICP.
• Administer analgesics as prescribed.Pain can increase blood pressure and ICP.
Choice A is wrong because elevating the head of the bed alone is not enough to prevent increased ICP.
Choice B is wrong because avoiding suctioning alone is not enough to prevent increased ICP.
Choice C is wrong because administering analgesics alone is not enough to prevent increased ICP.
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