Prescribed: Begin propofol IV infusion at 9 mL/hr

Available: propofol 1000 mg/100 mL

Patient's weight: 75 kg

Calculate how many mcg/kg/min the patient is receiving? Record your answer to whole number.

A. Remove the bite block and perform oral hygiene every 2 hours: While oral hygiene is important to reduce bacterial colonization and prevent ventilator-associated pneumonia, removing the bite block does not directly prevent aspiration and may risk ET tube displacement. Oral care alone is insufficient to address aspiration risk during tube feeding.

B. Use chest physiotherapy to allow secretions to be suctioned: Chest physiotherapy helps mobilize pulmonary secretions but does not prevent aspiration of gastric contents from the oropharynx or stomach. Suctioning may be necessary if secretions accumulate, but it is not a primary preventative measure for aspiration during feeding.

C. Maintain cuff pressure to prevent gastric secretions from entering trachea: Proper ET tube cuff inflation helps reduce microaspiration of oropharyngeal secretions but does not completely prevent reflux of gastric contents. Cuff pressure maintenance is important, yet positioning remains a more effective intervention to minimize aspiration risk during enteral feeding.

D. Keep head of bed elevated at least 30-45 degrees: Elevating the head of the bed reduces the risk of aspiration by using gravity to minimize reflux of gastric contents into the oropharynx and trachea. This intervention is evidence-based, simple, and highly effective in patients with enteral feedings and an ET tube.

A. Keep the head of the bed elevated to 30 degrees: Elevating the head of the bed promotes venous drainage from the brain, reducing intracranial pressure (ICP) caused by cerebral edema. Proper head positioning is a noninvasive, evidence-based intervention to prevent further neurologic compromise while maintaining cerebral perfusion.

B. Position the patient with knees and hips flexed: Flexing the hips and knees can increase intra-abdominal and intrathoracic pressure, which may impair venous return from the brain and exacerbate elevated ICP. For patients with cerebral edema, supine or semi-Fowler positions with slight head elevation are preferred.

C. Administer pain medications at frequent intervals: Pain control is important in head injury management, but excessive sedation or overuse of opioids can mask neurologic changes and alter the assessment of ICP. Analgesics should be administered judiciously and as indicated, not at fixed frequent intervals.

D. Encourage coughing and deep breathing: While deep breathing prevents atelectasis, coughing increases intrathoracic and intracranial pressure, which can worsen cerebral edema. Pulmonary hygiene must be balanced with interventions to minimize ICP, such as gentle suctioning and controlled ventilatory support if needed.