# A nurse is caring for a patient with viral encephalitis who is experiencing increased intracranial pressure. Which nursing intervention should be the priority?

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## 문제

A nurse is caring for a patient with viral encephalitis who is experiencing increased intracranial pressure. Which nursing intervention should be the priority?

## 보기

1. Elevate the head of the bed to 30 degrees **✔ 정답**
2. Administer prescribed analgesics for headache relief
3. Encourage frequent position changes to prevent complications
4. Provide emotional support to reduce patient anxiety

**정답: 1**

## 해설

Elevating the head of the bed to 30 degrees is the priority to promote venous drainage and reduce intracranial pressure (ICP). Other interventions are important but do not address the immediate life-threatening concern of increased ICP.

## 심화 해설

Priority Intervention for Increased Intracranial Pressure in Viral Encephalitis

The correct answer is elevating the head of the bed to 30 degrees. In the context of viral encephalitis, the inflammatory process triggers cerebral edema, which leads to a rise in intracranial pressure (ICP). The immediate, non-invasive priority is to optimize venous outflow from the brain to prevent further escalation of pressure and the risk of herniation.

Pathophysiology and Clinical Rationale

Encephalitis, particularly herpetic encephalitis, can cause severe hemorrhagic necrosis and malignant edema that mimics mass lesions or stroke [1][3]. As brain volume increases within the fixed skull, the compensatory mechanisms fail, causing a dangerous rise in ICP. Positioning the patient with the head of the bed elevated to 30 degrees promotes jugular venous drainage, thereby reducing cerebral blood volume and lowering ICP. A prospective observational study on neurocritical patients confirmed that adjusting the head-of-bed angle directly influences cerebral hemodynamics and is a standard intervention for managing intracranial hypertension [2]. Maintaining this angle also ensures the airway is protected and reduces the risk of aspiration, which is critical if the patient has altered consciousness [1].

Why Other Options Are Not the Priority

- Administering prescribed analgesics for headache relief: While headache is a symptom of increased ICP, sedating the patient with analgesics can mask neurological changes and depress the respiratory drive, leading to hypercapnia. Carbon dioxide retention causes cerebral vasodilation, which paradoxically increases ICP further.

- Encouraging frequent position changes: Clustering nursing activities or frequently repositioning the patient can increase intrathoracic and intra-abdominal pressure, impeding venous return from the brain and causing transient spikes in ICP. In the acute phase of cerebral edema, the priority is to minimize these noxious stimuli to keep ICP stable.

- Providing emotional support: While anxiety can elevate blood pressure and ICP, the immediate physiological threat of impaired venous drainage must be corrected first. Non-pharmacological comfort measures are secondary to the physical intervention of head-of-bed elevation in a crisis.

NCLEX-RN Safety Link

The urgency of this intervention is underscored by the potential for rapid deterioration in viral encephalitis. Cases can progress to malignant edema requiring neurosurgical evaluation for decompressive craniectomy if medical management fails [1][3]. The nurse must recognize that head-of-bed elevation is a critical, independent nursing action that buys time by stabilizing ICP while preparing for potential escalation of care.References (research sources)

- [1]A Diagnostic Challenge: From Suspected Ischemic Stroke to Confirmed Herpetic Encephalitis.Research articleNeves MD, Pereira MG, Silveira N, Barbosa S, Sousa JMM, Pereira E, Monteiro E. (2026) · DOI: 10.1002/ccr3.72772

- [2]A prospective observational study of head-of-bed adjustment for patients following elective craniotomy based on cerebral autoregulation.Research articleLi Y, Huang Y, Mei M, Wang Y, Li J, Yao M, Ouyang B, Shi L, Wang L. (2025) · DOI: 10.3389/fmed.2025.1713881

- [3]Limited efficacy of adjunctive therapy in a case of severe herpes simplex virus encephalitis: A case report and literature review.Case reportZhong XL, Yang CL, Yu XL, Wang L. (2025) · DOI: 10.1016/j.idcr.2025.e02307

## 임상 시나리오

ICP Crisis: Head-of-Bed ElevationFirst-Line Positioning for Intracranial Hypertension
Elevating the head of the bed to 30 degrees is the immediate priority to reduce intracranial pressure (ICP). This position promotes jugular venous drainage, which lowers cerebral blood volume without invasive procedures.

Maintain strict head and neck alignment to avoid kinking the jugular veins. The head should be kept midline to prevent compression that can impede venous outflow and paradoxically increase ICP.

CautionAvoid hip flexion greater than 90 degrees as it can increase intra-abdominal and intrathoracic pressure, transmitting pressure to the cranial vault. Do not lower the head of the bed abruptly; a sustained elevation is required for therapeutic effect.

## 핵심 개념

- **Cerebral edema** — An accumulation of fluid in brain tissue that increases brain volume and intracranial pressure, commonly caused by inflammation in encephalitis.
- **Intracranial pressure (ICP)** — The pressure inside the skull exerted by brain tissue, blood, and cerebrospinal fluid; sustained elevation can lead to brain herniation.
- **Jugular venous drainage** — The outflow of deoxygenated blood from the brain via the jugular veins; optimizing this outflow helps reduce cerebral blood volume and ICP.
- **Cerebral perfusion pressure (CPP)** — The net pressure gradient driving blood flow to the brain, calculated as mean arterial pressure minus ICP; maintaining adequate CPP is critical.
- **Herniation** — A life-threatening shift of brain tissue from its normal compartment through rigid dural structures, caused by extreme pressure gradients.

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