A patient is admitted to the ED (emergency department) with an intracranial problem. Upon arrival the RN (registered nurse) immediately ensures that the head of the bed is elevated at 35 degrees. Identify the pathophysiological rational for this intervention?

26. A patient is admitted to the emergency department (ED) following an overdose of acetaminophen (Tylenol) and is diagnosed with cirrhosis. Which laboratory finding is consistent with the diagnosis?

1. elevated serum protein hyperproteinemia
2. decreased serum liver enzymes (ALT).
3. elevated number of platelets thrombocytosis)
4. decreased level of clotting factors.

Correct answer:

A. Elevated serum protein hyperproteinemia: In cirrhosis, serum protein levels, particularly albumin, are often decreased due to impaired liver synthesis.

B. Decreased serum liver enzymes (ALT): In cirrhosis, liver enzyme levels such as ALT (alanine aminotransferase) are typically elevated due to liver damage and inflammation.

C. Elevated number of platelets (thrombocytosis): Cirrhosis often leads to thrombocytopenia (decreased platelet count) due to splenomegaly and decreased production of thrombopoietin.

D. Decreased level of clotting factors: The liver synthesizes most clotting factors, and in cirrhosis, the production of these factors is impaired, leading to decreased levels and increased bleeding risk.

A. Elevating the head of the bed promotes venous return and helps increase the ICP: This is incorrect. Elevation of the head of the bed helps to decrease intracranial pressure (ICP) by promoting venous drainage rather than increasing it.

B. Elevation of the head of the bed aids in maintaining cerebral perfusion: Elevating the head of the bed helps to decrease ICP, which in turn aids in maintaining adequate cerebral perfusion pressure.

C. Elevation of the head of the bed will increase intracranial pressure (ICP): This is incorrect. Elevation of the head of the bed is intended to reduce ICP, not increase it.

D. The nurse should keep the head of the bed flat to ensure adequate arterial circulation: This is incorrect. Keeping the head of the bed flat can increase ICP, which is counterproductive in managing intracranial pressure.