NCLEX-RNReduction of Risk PotentialHard
Two hours after a lumbar puncture, a client reports a severe headache that worsens when sitting up and improves when lying flat. Which nursing action is most appropriate?
- AEncourage ambulation to promote cerebrospinal fluid circulation
- BMaintain the client in a flat, supine position and encourage oral fluids
- CElevate the head of the bed to 45 degrees to reduce intracranial pressure
- DRestrict fluid intake to prevent cerebral edema
Show answer & explanationAnswer & explanation
Correct answer: B. Maintain the client in a flat, supine position and encourage oral fluids
A positional headache that worsens with sitting and improves when lying flat after lumbar puncture is characteristic of a post-lumbar puncture headache caused by CSF leakage at the puncture site. Management includes keeping the client flat, encouraging fluids (and caffeine) to promote CSF production, and monitoring; a persistent headache may require an epidural blood patch.
Why the other options are wrong
- A. Ambulation would aggravate the headache by increasing upright pressure changes.
- C. Elevating the head would worsen the positional headache caused by low CSF pressure.
- D. Fluid restriction would worsen the headache since increased fluids help replace CSF volume.
Post-Lumbar Puncture Headache
A positional headache caused by cerebrospinal fluid leakage at the puncture site, worse when upright and relieved when supine.
- Caused by low CSF pressure from leakage at puncture site
- Managed with flat positioning, hydration, and caffeine
- Persistent headache may require an epidural blood patch
Memory trick: Lie low to say no to LP headache