In the PACU, a client who has had a hypophysectomy for Cushing's disease requires which intervention to be most important in the plan of care?

• A. Keep head of bed at 30°
• B. Maintain strict bed rest
• C. Encourage coughing and deep breathing frequently
• D. Keep the patient flat to reduce CSF leakage

Answer: (A)

Elevating the head of the bed to about 30 degrees is the most important in the immediate postoperative period after a hypophysectomy because it lowers intracranial pressure and improves venous drainage. This position helps protect the surgical site from stress and reduces the risk of a CSF leak through the nasal/incisional route, which is a key concern after this procedure. Keeping the patient flat would raise intracranial pressure and increase the chance of CSF leakage, while repeatedly coughing and deep breathing can transiently raise ICP and put strain on the repair. Strict bed rest isn’t required once stable, and elevation assists healing without unnecessary restriction.