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EBN Presentation

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    Far Eastern UniversityInstitute of Nursing

    Group 22BSN 406

    Alvarez, Ronel M.

    Celestial, Sharmaine Kaye B.Chua, Sheila May Sidney B.Crisostomo, Jessa Mae C.Cruz, Don Darryl G.De Guia, John Ronnel A.Del Mundo, Nina Renz Ivy C.

    Delgado, Arcel John A.Niu, Rachel T.

    EBN

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    Brief Background

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    IntroductionI. Clinical Question"What is the effect of Beach Chairpositioning in patients with increaseintracranial pressure and cerebralperfusion?"

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    II. CitationThe effect of Beach Chair positionon intracranial pressure andcerebral perfusion pressure inindividuals with brain injury;A Systematic Review

    Introduction

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    PATIENTS INCLUDED 178 Participants

    4-25 sample size with ages rangingfrom 7 to 83 years old, Patients withbrain injury (severe head injury,decreased GCS usually lower than 8)

    III. Study Characteristics

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    III. Study CharacteristicsINTERVENTION COMPAREDDifferent Back Chair positioning1) Elevated Head of Bed (30-60 degrees)2) Reverse Trendelenburg3) Flat on Bed

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    III. Study CharacteristicsOUTCOMES MONITOREDElevation of the head > Decrease in ICPFlat w/ no elevation > Maximum ICP

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    These studies are significant inimproving quality care for neurologicpatients. ICP and CPP are two of themost important vital signs inneurologic care. Proper positioningcontributes in the care of patients withconditions/diseases that effect thebrain.

    III. Study Characteristics

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    V. Methodology/DesignMethodology/Design/SettingDescriptive / Quasi Experimental Design &Experimental Design /United States & Germany

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    V. Methodology/DesignSubject Selection 3 Different Positions Cases of Brain injury, Hemorrhage,

    and Brain tumor Less than 18 months of age are excluded

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    V. Methodology/DesignThe study is not a replication, but basedon the different articles, participantseither experienced an improvementor a decrease in ICP & CPP.

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    V. Methodology/DesignThe intervention of positioning has its risks,head elevation may put the brain-injuredindividual at risk for secondary cerebralinjury because of impaired arterial bloodpressure and compromised CPP.There is a risk in harming the patientbecause of altered vitals signs andunexpected neurological accidents.

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    V. Results of the StudyOverall, the result of the study yields, adecrease in ICP for participants whoseheads were elevated 30 degrees

    30 degrees head elevation from the bed iswhat we call, Beach Chair Positionof 30-60 degrees

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    Beach Chair Position

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    VI. Authors Conclusion/ RecommendationsThe contribution of this study in the health

    status of future patients is that they can betreated effectively and decreasing the rateof mortality due to ICP. It can be a usefulalternative in reducing ICP by a noninvasivephysical intervention.

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    VI. Authors Conclusion/ RecommendationsIt contributes to general nursing

    knowledge, that proper positioningtreatment is a better alternativeintervention to treat and reduce thepressure of ICP patients and it maydecrease the amount of drugs thatmay be used for the treatment.

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    VII. ApplicabilityYes it is a direct enough answer to ourclinical question. Head elevation is aconventional nursing procedure for brain-injured individuals with intracranialhypertension; it is performed with theintent of reducing ICP by means of anon-invasive physical intervention.

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    VII. ApplicabilityYes, Beach chair positioning in patients withincreased intracranial pressure is veryfeasible to be carried out in real worldsettings.

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    VII. ApplicabilityTheoretically the head is above the level ofthe heart on the vertical axis, and as a

    result, CSF is redistributed from the cranialto the spinal subarachnoid space (Kenning,Toutant, & Saunders, 1981), and it

    facilitates cerebral venous return(Magnaes, 1976; Magnaes, 1978;Marmarou, Shulman, & LaMorgese, 1975;

    Potts & Deonarine 1973)

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