After lumbar puncture procedure a patient complains of severe headache. As a staff nurse, in which position you will set the bed?

Question

Question

This question was previously asked in

KGMU Nursing Officer 2023 Memory-Based Previous Year Paper

Answer 1

Correct Answer: Raise Foot End

Rationale:

A lumbar puncture (LP), also known as a spinal tap, is a procedure in which a needle is inserted into the spinal canal to collect cerebrospinal fluid (CSF) for diagnostic or therapeutic purposes. One of the most common complications following this procedure is a post-lumbar puncture headache (PLPH), which occurs due to a leak of CSF from the puncture site.
The correct intervention to alleviate symptoms of post-lumbar puncture headache is to position the bed with the foot end raised (Trendelenburg position). This position helps by redistributing CSF and reducing the downward pull of gravity on the brain and meninges, thereby relieving the headache.
Encouraging the patient to stay well-hydrated and lie flat for a period after the procedure can also help reduce the risk of headache.

Explanation of Other Options:

Lithotomy Position

Rationale: The lithotomy position involves lying on the back with the legs flexed and elevated, typically used for gynecological, urological, and rectal procedures. This position is not relevant for managing headaches following a lumbar puncture.

Semi-Fowler Position

Rationale: In the Semi-Fowler position, the head of the bed is elevated to 30-45 degrees, commonly used for patients with respiratory distress or to facilitate digestion. However, this position may exacerbate post-lumbar puncture headaches by increasing the downward pull of gravity on the brain and meninges.

Raise Head End

Rationale: Raising the head end of the bed is contraindicated in cases of post-lumbar puncture headache. This position can worsen the headache by further reducing CSF pressure in the cranial cavity.

Additional Information:

Post-lumbar puncture headaches can be severe and are more common in younger patients, women, and those with a smaller body mass index. To minimize the risk of this complication, the use of a smaller-gauge needle and adequate hydration is recommended.
If conservative management (e.g., bed rest, hydration, caffeine) does not alleviate the headache, a blood patch procedure may be performed. This involves injecting a small amount of the patient’s blood into the epidural space to seal the CSF leak.

Conclusion:

Raising the foot end of the bed is the most appropriate intervention for managing post-lumbar puncture headache. This position helps alleviate symptoms by redistributing cerebrospinal fluid and relieving intracranial tension caused by CSF leakage.