Your patient is scheduled to undergo a bronchoscopy at the bedside.
Which of the following should the Registered Nurse anticipate?

Choice A rationale

Encouraging extensive family visitation in the context of impending demise, while emotionally supportive, does not directly address the physiological mechanisms of intracranial pressure reduction. Increased stimulation and emotional distress can paradoxically elevate ICP by increasing cerebral metabolic demand and blood flow, which is counterproductive to managing an acute neurological crisis.

Choice B rationale

Maintaining the patient's neck in a midline and neutral position is crucial to facilitate optimal venous outflow from the brain. Compression or kinking of the jugular veins due to neck rotation or flexion can impede cerebral venous drainage, leading to an increase in cerebral blood volume and subsequently elevated intracranial pressure.

Choice C rationale

Administering stool softeners helps prevent straining during defecation, a maneuver known as the Valsalva maneuver. The Valsalva maneuver increases intrathoracic and intra-abdominal pressure, which in turn transiently increases central venous pressure and impedes cerebral venous outflow, thereby elevating intracranial pressure.

Choice D rationale

Keeping room curtains open to maximize natural light can increase environmental stimulation, potentially leading to increased cerebral activity and metabolic demand. This heightened activity can result in increased cerebral blood flow and volume, which can contribute to elevated intracranial pressure in a neurologically compromised patient.

Choice E rationale

Elevating the head of the bed (HOB) to 30 degrees promotes venous drainage from the brain by utilizing gravity. This position helps to reduce cerebral blood volume, thereby decreasing intracranial pressure. It also aids in preventing aspiration while maintaining cerebral perfusion pressure.

Choice A rationale

Placing an NG tube could potentially worsen a basilar skull fracture or cause further injury by penetrating the cranial vault if the cribriform plate is compromised. This intervention is contraindicated when clear fluid, possibly cerebrospinal fluid, is draining from the nose, indicating a potential breach in the dura mater.

Choice B rationale

Testing the clear fluid for the presence of glucose is a critical diagnostic step. Cerebrospinal fluid (CSF) contains glucose, whereas nasal secretions do not. A positive glucose test strongly indicates a CSF leak, which is a significant complication of facial trauma that requires specific management to prevent intracranial infection. Normal CSF glucose ranges from 40 to 70 mg/dL.

Choice C rationale

Encouraging coughing and deep breathing would increase intrathoracic and intracranial pressure, which could exacerbate a CSF leak and potentially introduce pathogens into the intracranial space. This action should be avoided as it poses a risk for further neurological complications such as meningitis.

Choice D rationale

Placing a mustache dressing on the patient might absorb the drainage but does not address the underlying issue of a potential CSF leak. Furthermore, applying pressure or occluding the nares could impede the free flow of CSF, potentially leading to a build-up of pressure and increasing the risk of retrograde infection into the central nervous system.