A nurse is reinforcing teaching to a group of nursing students about possible psychosocial changes a client might have after sustaining a neurologic injury such as increased intracranial pressure. Which of the following psychosocial changes should the nurse include in the teaching?

A. Administer pain medication as needed. Rationale: Pain management is essential for clients with traumatic brain injury (TBI) to ensure their comfort and to prevent agitation or increased intracranial pressure (ICP) due to pain. Administering pain medication as needed helps alleviate discomfort and promotes rest, which supports the client's recovery.

B. Maintain ventriculostomy at the correct position. Rationale: Ventriculostomy, also known as an external ventricular drain (EVD), is a critical component of managing intracranial pressure (ICP) in clients with traumatic brain injury. Maintaining the ventriculostomy at the correct position ensures accurate monitoring and drainage of cerebrospinal fluid (CSF), which helps control ICP levels and prevents complications such as cerebral edema.

C. Maintain the neck in the midline position. Rationale: Keeping the neck in a midline position is essential for clients with traumatic brain injury to prevent further injury to the cervical spine. Proper alignment of the neck helps maintain spinal stability and reduces the risk of exacerbating any existing spinal cord injury, which may coexist with the traumatic brain injury.

D. Elevate the head of the bed to 30 degrees. Rationale: Elevating the head of the bed to 30 degrees is recommended for clients with traumatic brain injury to promote cerebral venous drainage and reduce intracranial pressure (ICP). This position helps optimize cerebral perfusion and minimizes the risk of cerebral edema, which can occur with increased ICP.

E. Maintain enteral feedings. Rationale: Nutritional support is crucial for clients with traumatic brain injury to support healing and recovery. Enteral feedings, such as tube feedings, may be necessary if the client is unable to consume adequate nutrition orally due to impaired swallowing or altered consciousness. Providing enteral feedings ensures the client receives essential nutrients to support tissue repair and prevent malnutrition-related complications during the recovery process.

A. Hypovolemic shock: Hypovolemic shock occurs due to a significant decrease in circulating blood volume, leading to inadequate tissue perfusion. Blood loss, such as that experienced by the client in the scenario, is a common cause of hypovolemic shock. The decrease in blood pressure observed over time is consistent with the compensatory mechanisms of hypovolemic shock, where the body attempts to maintain perfusion to vital organs despite decreased blood volume.

B. Septic shock: Septic shock results from a systemic inflammatory response to infection, leading to vasodilation, increased capillary permeability, and maldistribution of blood flow. While infection can lead to hypovolemia in some cases, the scenario does not provide evidence of infection or systemic inflammatory response as the cause of shock.

C. Obstructive shock: Obstructive shock occurs when there is obstruction to blood flow within the cardiovascular system, such as in cases of pulmonary embolism, cardiac tamponade, or tension pneumothorax. There is no evidence in the scenario to suggest an obstruction to blood flow as the cause of the client's shock.

D. Neurogenic shock: Neurogenic shock results from loss of sympathetic tone leading to vasodilation and relative hypovolemia. It is often associated with spinal cord injury or severe head injury. While neurogenic shock can lead to hypotension, the scenario does not indicate any neurological injury or insult as the cause of the client's shock.