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Introduction:
In the past, the earliest evidence of craniotomy is most likely found in the
procedure called trephination, which is basically an antiquated medical
intervention in which a hole is drilled or scraped into the human skull, exposing
the dura mater in order to treat health problems concerning intracranial diseases.
Cave painitings also indicate that people believed such practice would cure
epileptic seizures, migraines, and mental disorders. It was also suggested that it
was a primitive, if not the oldest, emergency surgery for head wounds.
Today, as contemporary era comes in, it has evolved to craniotomy per se,
or considering the word’s etymology, the surgical cutting of the cranium. A
craniotomy is a surgical operation in which part of the skull, called a bone flap, is
removed in order to access the brain. Craniotomies are often a critical operation
performed on patients suffering from brain lesions or traumatic brain injury (TBI),
and can also allow doctors to surgically implant deep brain stimulators for the
treatment of Parkinson's disease, epilepsy and cerebellar tremor. The procedure
is also widely used in neuroscience for extracellular recording, brain imaging, and
for neurological manipulations such as electrical stimulation and chemical
titration.
primary brain cancers occur in adults, more commonly in males between 55 and
65 years of age. Tumors in children peak between the ages of three and 12.
Brain tumors are presently the most common cancer in children (four out of
100,000).
In a news article dated April 21, 2009, it was found out that a new type of
brain surgery actually allows patients to stay conscious so there will be foolproof
monitoring of speech and motor functions as doctors basically fiddle with a tumor
or two resting on principal tasks of their brain.
After months of her body being racked by seizures, she finally found a
doctor who could remove the tumor safely.
In May, while surgeons scraped her brain of cancerous cells, Mullins lay
on the operating table reciting the alphabet and wiggling her toes and
fingers.
The "Awake Craniotomy" allowed her to stay conscious during the surgery
so doctors could monitor her speech and other functions as they fiddled
with a tumor resting on key functions of her brain.
People can view the Awake Craniotomy performed on Mullins when Methodist University Hospital streams a
webcast of the procedure today.
Questions about the hourlong webcast will be answered live between 4 and 5 p.m.
The procedure has been in the spotlight recently since U.S. Sen. Ted Kennedy underwent an Awake
Craniotomy last year to remove a tumor.
Executing these awake surgeries for the last decade, Methodist is the only facility in the Mid-South qualified
to do the procedure.
The hope is that by educating the public that this procedure is painless and safer than brain surgery of the
past, Methodist hopes to expand its visibility to patients and referring doctors, hospital officials say.
"All of us fear the unknown, particularly when it comes to medical procedures," said Dr. Allen Sills, one of
two neurosurgeons featured in the webcast.
Very sick patients have refused brain surgery because they were too frightened, said the director of
Methodist Healthcare's Neuroscience Institute.
4|Craniotomy
Sills is also associate professor of neurosurgery for the University of Tennessee Health Science Center.
"Everyone wants to know if they're going to hurt or be uncomfortable," he said. "This helps the patient to
know exactly what to expect."
-- Lindsay Melvin: 529-2445
Staff Writer
9:33 AM CDT, April 8, 2009
More than half a million people will have brain surgery this year.
Large scars and lenghty recoveries typically go along with the surgery.
Now Doctors are using the eyes as the gateway to the brain to make surgery less invasive.
Swelling aside, you'd never guess Mike Hogan had life-saving brain surgery just a few weeks ago.
"The doctor ordered a CAT scan. When they did the CAT scan, the aneurysm showed up."
Doctors determined the aneurysm was in danger of ruptureing.
Hogan's surgeons used a new and unusual technique to treat it.
Neurosurgeon Dr. Khaled Aziz "when we do the standard procedure we make an incision behind the hairline
-- from here, all the way to here."
Instead, surgeons fixed the aneurysm through a tiny hole in his eyelid.
During the eyelid Craniotomy a Neuro-Opthamologist marks the eyelid crease then makes an incision and
removes a
small piece of bone from the patient's eye socket.
Next a Neurosurgeon reaches the front of the brain, clips the blood vessel that feeds the aneurysm and then
puts the bone back in place.
Doctors say a smaller incision means a shorter hospital stay, faster recovery and less pain.
"In the long run, I think this it's more helpful for the patient outcome rather than standard surgical
approaches."
Mike has no scar, little pain, and more importantly more time to watch his grandchildren grow up.
"It's amazing what they can do."
Doctor Aziz says the eyelid approach is not for every patient.
It only works for patients who need brain surgery toward the front of the skull
Neurosurgeons also use the eyelid surgery to operate on certain brain tumors.
Copyright © 2009, WQAD-TV
5|Craniotomy
impulses from one neuron to the next. The interaction of the different neurons
form neural circuits that regulate an organism’s perception of the world and what
is going on with its body, thus regulating its behavior. Nervous systems are found
in many multicellular animals but differ greatly in complexity between species
The central nervous system (CNS) is the largest part of the nervous
system, and includes the brain and spinal cord. The spinal cavity holds and
protects the spinal cord, while the head contains and protects the brain. The CNS
is covered by the meninges, a three layered protective coat. The brain is also
protected by the skull, and the spinal cord is also protected by the vertebrae.
Brain is a part of the Central Nervous System, it plays a central role in the
control of most bodily functions, including awareness, movements, sensations,
thoughts, speech, and memory. Some reflex movements can occur via spinal
cord pathways without the participation of brain structures.
The cerebrum is the largest part of the brain and controls voluntary
actions, speech, senses, thought, and memory.
The surface of the cerebral cortex has grooves or infoldings (called sulci), the
largest of which are termed fissures. Some fissures separate lobes.
• The frontal lobes are located in the front of the brain and are responsible
for voluntary movement and, via their connections with other lobes,
participate in the execution of sequential tasks; speech output;
organizational skills; and certain aspects of behavior, mood, and memory.
7|Craniotomy
• The parietal lobes are located behind the frontal lobes and in front of the
occipital lobes. They process sensory information such as temperature,
pain, taste, and touch. In addition, the processing includes information
about numbers, attentiveness to the position of one’s body parts, the
space around one’s body, and one's relationship to this space.
• The temporal lobes are located on each side of the brain. They process
memory and auditory (hearing) information and speech and language
functions.
• The occipital lobes are located at the back of the brain. They receive and
process visual information
• The Cardiovascular System
• The heart and circulatory system make up the cardiovascular system. The
heart works as a pump that pushes blood to the organs, tissues, and cells
of the body. Blood delivers oxygen and nutrients to every cell and removes
the carbon dioxide and waste products made by those cells. Blood is
carried from the heart to the rest of the body through a complex network of
arteries, arterioles, and capillaries. Blood is returned to the heart through
venules and veins.
• The one-way circulatory system carries blood to all parts of the body. This
process of blood flow within the body is called circulation. Arteries carry
oxygen-rich blood away from the heart, and veins carry oxygen-poor blood
back to the heart. In pulmonary circulation, though, the roles are switched.
It is the pulmonary artery that brings oxygen-poor blood into the lungs and
the pulmonary vein that brings oxygen-rich blood back to the heart.
• Twenty major arteries make a path through the tissues, where they branch
into smaller vessels called arterioles. Arterioles further branch into
capillaries, the true deliverers of oxygen and nutrients to the cells. Most
capillaries are thinner than a hair. In fact, many are so tiny, only one blood
cell can move through them at a time. Once the capillaries deliver oxygen
and nutrients and pick up carbon dioxide and other waste, they move the
8|Craniotomy
blood back through wider vessels called venules. Venules eventually join
to form veins, which deliver the blood back to the heart to pick up oxygen.
• Vasoconstriction or the spasm of smooth muscles around the blood
vessels causes and decrease in blood flow but an increase in pressure. In
vasodilation, the lumen of the blood vessel increase in diameter thereby
allowing increase in blood flow. There is no tension on the walls of the
vessels therefore, there is lower pressure.
• Various external factors also cause changes in blood pressure and pulse
rate. An elevation or decline may be detrimental to health. Changes may
also be caused or aggravated by other disease conditions existing in other
parts of the body.
• The blood is part of the circulatory system. Whole blood contains three
types of blood cells, including: red blood cells, white blood cells and
platelets.
• These three types of blood cells are mostly manufactured in the bone
marrow of the vertebrae, ribs, pelvis, skull, and sternum. These cells travel
through the circulatory system suspended in a yellowish fluid called
plasma. Plasma is 90% water and contains nutrients, proteins, hormones,
and waste products. Whole blood is a mixture of blood cells and plasma.
• Red blood cells (also called erythrocytes) are shaped like slightly
indented, flattened disks. Red blood cells contain an iron-rich protein
called hemoglobin. Blood gets its bright red color when hemoglobin in red
blood cells picks up oxygen in the lungs. As the blood travels through the
body, the hemoglobin releases oxygen to the tissues. The body contains
more red blood cells than any other type of cell, and each red blood cell
has a life span of about 4 months. Each day, the body produces new red
blood cells to replace those that die or are lost from the body.
• White blood cells (also called leukocytes) are a key part of the body's
system for defending itself against infection. They can move in and out of
the bloodstream to reach affected tissues. The blood contains far fewer
white blood cells than red cells, although the body can increase production
9|Craniotomy
of white blood cells to fight infection. There are several types of white
blood cells, and their life spans vary from a few days to months. New cells
are constantly being formed in the bone marrow.
• Several different parts of blood are involved in fighting infection. White
blood cells called granulocytes and lymphocytes travel along the walls of
blood vessels. They fight bacteria and viruses and may also attempt to
destroy cells that have become infected or have changed into cancer
cells.
• Certain types of white blood cells produce antibodies, special proteins that
recognize foreign materials and help the body destroy or neutralize them.
When a person has an infection, his or her white cell count often is higher
than when he or she is well because more white blood cells are being
produced or are entering the bloodstream to battle the infection. After the
body has been challenged by some infections, lymphocytes remember
how to make the specific antibodies that will quickly attack the same germ
if it enters the body again.
• Platelets (also called thrombocytes) are tiny oval-shaped cells made in the
bone marrow. They help in the clotting process. When a blood vessel
breaks, platelets gather in the area and help seal off the leak. Platelets
survive only about 9 days in the bloodstream and are constantly being
replaced by new cells.
• Blood also contains important proteins called clotting factors, which are
critical to the clotting process. Although platelets alone can plug small
blood vessel leaks and temporarily stop or slow bleeding, the action of
clotting factors is needed to produce a strong, stable clot.
• Platelets and clotting factors work together to form solid lumps to seal
leaks, wounds, cuts, and scratches and to prevent bleeding inside and on
the surfaces of our bodies. The process of clotting is like a puzzle with
interlocking parts. When the last part is in place, the clot is formed.
10 | C r a n i o t o m y
• When large blood vessels are cut the body may not be able to repair itself
through clotting alone. In these cases, dressings or stitches are used to
help control bleeding.
• In addition to the cells and clotting factors, blood contains other important
substances, such as nutrients from the food that has been processed by
the digestive system. Blood also carries hormones released by the
endocrine glands and carries them to the body parts that need them.
• Blood is essential for good health because the body depends on a steady
supply of fuel and oxygen to reach its billions of cells. Even the heart
couldn't survive without blood flowing through the vessels that bring
nourishment to its muscular walls. Blood also carries carbon dioxide and
other waste materials to the lungs, kidneys, and digestive system, from
where they are removed from the body.
11 | C r a n i o t o m y
12 | C r a n i o t o m y
↓
elasticity
of BV Sluggish
blood flow
↑ blood vessel
resistance Apneustic
Breathing
Mostly, patient having a CVA does not get any clue that they are having a
stroke, but there are some manifestations that one must be alerted if he is
experiencing the following manifestations below as this could be an
indication of a stroke.
In relation with Mr. Enfarcion’s case, his CVA was initially brought
about by a hemorrhagic type of CVA due to a leak of venous blood from
the subdural meninges of the brain brought about by an increased
pressure on the blood vessels due to an increased vascular resistance
due to hypertension and viscosity of the blood related to his diabetes
mellitus. This resulted to a decreased volume of the circulating blood due
to a decreased venous return, and a depression of the brain due to the
mass formation. This resulted to neurologic deficits manifested by severe
headache, hemiparesis, decreased LOC, and dizziness.
18 | C r a n i o t o m y
You will typically undergo tests (e.g., blood test, electrocardiogram, chest X-ray)
several days before surgery. In the doctors office you will sign consent forms and
complete paperwork to inform the surgeon about your medical history (i.e.,
allergies, medicines, anesthesia reactions, previous surgeries). You may wish to
donate blood several weeks before surgery. Discontinue all non-steroidal anti-
inflammatory medicines (Naproxin, Advil, etc.) and blood thinners (coumadin,
aspirin, etc.) 1 week before surgery. Additionally, stop smoking, chewing tobacco,
and drinking alcohol 1 week before and 2 weeks after surgery because these
activities can cause bleeding problems.
19 | C r a n i o t o m y
After the scalp is prepped with an antiseptic, a skin incision is made, usually
behind the hairline. The surgeon attempts to ensure a good cosmetic result after
surgery. Sometimes a hair sparing technique can be used that requires shaving
only a 1/4-inch wide area along the proposed incision. Sometimes the entire
incision area may be shaved.
20 | C r a n i o t o m y
Because the brain is tightly enclosed inside the bony skull, tissues cannot be
easily moved aside to access and repair problems. Neurosurgeons use a variety
of very small tools and instruments to work deep inside the brain. These include
long-handled scissors, dissectors and drills, lasers, ultrasonic aspirators (uses a
fine jet of water to break up tumors and suction up the pieces), and computer
21 | C r a n i o t o m y
Step 6. Closure
After surgery, you are taken to the recovery room where vital signs are monitored
as you awake from anesthesia. The breathing tube (ventilator) usually remains in
place until you fully recover from the anesthesia. Next, you are transferred to the
neuroscience intensive care unit (NSICU) for close observation and monitoring.
You are frequently asked to move your arms, fingers, toes, and legs.
22 | C r a n i o t o m y
INDICATIONS:
Craniotomy is of course, usually performed for problems with the brain and head
injuries. Indications for such procedure include:
• Brain tumors
o An abnormal growth of cells within the brain or inside the skull,
which can be cancerous or non-cancerous.
• Bleeding (hemorrhage)
o A loss of blood in the circulatory system
• Blood clots (hematomas)
o A collection of blood outside the blood vessels generally the result
of hemorrhage, or more specifically, internal bleeding. It is named
based on the site of injury. Examples of which is subdural
hematoma (between the dura mater and arachnoid mater) and
epidural hematoma (between the dura mater and the skull).
• Weaknesses in blood vessels (cerebral aneurysms)
o A localized, blood-filled dilation (balloon-like bulge) of a blood
vessel caused by disease or weakening of the vessel wall. As the
size of an aneurysm increases, there is an increased risk of
rupture, which can result in severe hemorrhage or other
complications including sudden death.
• Relief from increased intracranial pressure
• Damage to tissues covering the brain (dura)
• Pockets of infection in the brain (brain abscesses)
o Abscess caused by inflammation and collection of infected material
coming from local (ear infection, dental abscess, infection of
paranasal sinuses, infection of the mastoid air cells of the temporal
bone, epidural abscess) or remote (lung, heart, kidney etc.)
23 | C r a n i o t o m y
infectious sources within the brain tissue. The infection may also be
introduced through a skull fracture following a head trauma or
surgical procedures. Brain abscess is usually associated with
congenital heart disease in young children. It may occur at any age
but is most frequent in the third decade of life.
• Severe nerve or facial pain (such as trigeminal neuralgia or tic douloureux)
o A neuropathic disorder of the trigeminal nerve that causes episodes
of intense pain in the eyes, lips, nose, scalp, forehead, and jaw.
• Epilepsy
o A common chronic neurological disorder characterized by recurrent
unprovoked seizures
• Chiari malformations
o A malformation of the brain. It consists of a downward displacement
of the cerebellar tonsils and the medulla through the foramen
magnum, sometimes causing hydrocephalus as a result of
obstruction of cerebrospinal fluid (CSF) outflow. The cerebrospinal
fluid outflow being caused by phase difference in outflow and influx
of blood in the vasculature of the brain
All operations carry some risks. Brain surgery carries more than most. Any
operation can be complicated by heart trouble, chest infection, blood clots in the
leg (thrombosis) and wound infection. The chances of these complications are
greater in elderly or unhealthy patients and, in particular, those who smoke or
24 | C r a n i o t o m y
drink heavily. The major specific complications of brain surgery are damage to
the brain at the time of surgery and bleeding within the head after the operation.
Meningitis and epilepsy occasionally follow craniotomy. When bleeding is
suspected, you would have to return to operating room within a few hours of the
operation for a reopening of the wound. Sometimes deterioration is due to brain
swelling and the bone flap is left out, being stored frozen in antibiotic solution. It
may then be replaced at a later date when the swelling has settled down.
The actual risk in a particular case will depend on the complexity of the
operation.
Jansen Retractor
Weitlaner retractor
Scalpel
Echlin Rongeur
stille-Liston Rongeur
Operating Scissors
EQUIPMENTS
Suction
Electrosurgical unit
34 | C r a n i o t o m y
FACILITIES
Emergenc
y
Cart
Surgic ANESTHESIOLOGIST
`
al Surgic
light al
light
P
S A
U A S
`
R S
G T I
E S
O T
I A
N
N
E T
SCRUB T
SUTURE
SUCTION
TUBE
Electrosurgical
35 | C r a n i o t o m y
e. Clean the materials used properly and arrange them after drying
2. Perform any duties which will speed up the surgical procedure to follow in that
room.
CIRCULATING NURSE
Pre-operative Responsibilities
1. Care for the patient before surgery by:
a. Greeting patient and assist nurse with identification
b. Checking patient's chart, preparation, etc.
2. Prepare the room by:
a. Obtaining instruments, supplies, and equipment for the designated
operative procedure
b. Opening unsterile supplies
c. Assisting in gowning
d. Observing breaks in sterile technique
e. Assisting anesthesiologist as necessary
f. Assisting with skin preparation and positioning
g. Assisting with forming of the sterile field
3. Count the instruments, sharps and sponges before the procedure and confirm
with scrub nurse.
Intra-operative Responsibilities
1. During the Procedure:
a. Remain in room and dispense materials as necessary
b. Observe procedure as closely as possible
c. Begin establishing method of anticipating needs of surgical team
d. Care of specimen as indicated
e. Care of operative records as indicated
f. Assist with application of dressing
g. Monitor the instruments, sharps and sponges used and take note of
additional instruments.
37 | C r a n i o t o m y
2. Before the closing of the organ or peritoneum, count all instruments, sharps
and sponges and confirm with scrub nurse.
3. Inform the surgeon and assistant surgeon of a report of the instruments.
Post-operative Responsibilities
1. Properly document all the necessary information on the patient’s chart.
2. Assist in the cleaning of the Operation Room as necessary.
Prior to operation:
• A careful history and physical examination are performed
• Intravenous fluids are given to correct volume depletion and any electrolyte
imbalances are measured and corrected. Monitor and regulate IVFs
• The nurse instructs the patient about the need to avoid smoking to enhance
pulmonary recovery postoperatively and avoid respiratory complications. It is
also important to instruct the patient to avoid the use of aspirin and other
agents that can alter coagulation and other biochemical process
• On of the most important responsibility of the nurse is to let the patient sign
an informed consent regarding the surgery.
• The patient is given anaesthesia prior to surgery and the patient is under
NPO.
• Placing warm blankets on the patient to enhance comfort and preserve the
patient's body temperature
• Assessing the patient's vital signs, oxygen saturation level, level of
consciousness, circulation, pain, IV site, fluid rate, and hydration status, as
well as the status of the surgical site and dressing and all related monitoring
equipment
• The nurse helps in relieving the pain by instructing the patient regarding
proper positioning.
• The nurse helps in improving the respiratory status by instructing the patient
regarding deep breathing exercises.
• The nurse also provides skin care like cleaning the incision part and providing
clean dressing following a strict aseptic technique
• The nurse instructs the patient about the medications that are prescribed by
the physician
• Discussing recommended follow-up management with the physician and the
surgeon
Since there would be the elimination of the signs and symptoms such as
pain, there would be a better quality of life for the patient which could increase
productivity and minimize hospital or clinic visits, upon discharge clients may
be given information regarding:
Discomfort
1. After surgery, headache pain is managed with narcotic medication. Because
narcotic pain pills are addictive, they are used for a limited period (2 to 4 weeks).
Their regular use may also cause constipation, so drink lots of water and eat high
fiber foods. Laxatives (e.g., Dulcolax, Senokot, Milk of Magnesia) may be bought
without a prescription. Thereafter, pain is managed with acetaminophen (e.g.,
Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., aspirin;
ibuprofen, Advil, Motrin, Nuprin; naproxen sodium, Aleve).
2. A medicine (anticonvulsant) may be prescribed temporarily to prevent
seizures. Common anticonvulsants include Dilantin (phenytoin), Tegretol
(carbamazepine), and Neurontin (gabapentin). Some patients develop side
effects (e.g., drowsiness, balance problems, rashes) caused by these
anticonvulsants; in these cases, blood samples are taken to monitor the drug
levels and manage the side effects.
Restrictions
1. Do not drive after surgery until discussed with your surgeon and avoid sitting
for long periods of time.
2. Do not lift anything heavier than 5 pounds (e.g., 2-liter bottle of soda),
including children.
3. Housework and yardwork are not permitted until the first follow-up office visit.
This includes gardening, mowing, vacuuming, ironing, and loading/unloading the
dishwasher, washer, or dryer.
4. Do not drink alcoholic beverages.
Activity
5. Gradually return to your normal activities. Fatigue is common.
6. An early exercise program to gently stretch the neck and back may be
advised.
40 | C r a n i o t o m y
7. Walking is encouraged; start with short walks and gradually increase the
distance. Wait to participate in other forms of exercise until discussed with your
surgeon.
Bathing/Incision Care
8. You may shower and shampoo 3 to 4 days after surgery unless otherwise
directed by your surgeon.
9. Sutures or staples, which remain in place when you go home, will need to be
removed 7 to 14 days after surgery. Ask your surgeon or call the office to find out
when.
When to Call Your Doctor
10. If you experience any of the following:
• A temperature that exceeds 101º F
• An incision that shows signs of infection, such as redness, swelling, pain,
or drainage.
• If you are taking an anticonvulsant, and notice drowsiness, balance
problems, or rashes.
• Decreased alertness, increased drowsiness, weakness of arms or legs,
increased headaches, vomiting, or severe neck pain that prevents
lowering your chin toward the chest.
Recovery
The recovery time varies from 1 to 4 weeks depending on the underlying disease
being treated and your general health. Full recovery may take up to 8 weeks.
Walking is a good way to begin increasing your activity level. Start with short,
frequent walks within the house and gradually try walks outside. It’s important not
to overdo it, especially if you are continuing treatment with radiation or
chemotherapy. Ask your surgeon when you can expect to return to work.
What are the risks?
No surgery is without risks. General complications of any surgery include
bleeding, infection, blood clots, and reactions to anesthesia. Specific
complications related to a craniotomy may include:
• stroke
41 | C r a n i o t o m y
• seizures
• swelling of the brain, which may require a second craniotomy
• nerve damage, which may cause muscle paralysis or weakness
• CSF leak, which may require repair
• loss of mental functions
• permanent brain damage with associated disabilities
1.6 Medical Management (this is based form previous handled patient in the
medicine ward with a diagnosis of CVA)
a. IVF’s, BT, NGT Feedings, Nebulization, TPN, Oxygen Therapy.etc.
General
IV Fluids Indication(s)or Purposes
Description
PNSS Normal Saline It is used as a source of fluid and
Plane Normal solution is a electrolytes. Normal saline is most
Saline Solution solution of sodium commonly used as an intravenous (IV)
chloride, or salt, in infusion, administered through an IV
sterile water. drip to prevent dehydration in patients
Normal saline who cannot consume liquids and
solution is 0.9% nutrients by mouth.
sodium chloride. It
is isotonic. An
isotonic solution is
less irritating to
the body cell
Nursing Implication:
Before:
1. Check the physician’s order for IV solution and explain to the client the
procedure.
2. Check the potency of IV line and needle
3. Check the type of infusion, condition of the vein and medical condition of the
patient
During:
1. Maintenance of Aseptic Technique
2. Proper procedure and steps in infusing IV solution
3. Count drops per minute in drip chamber.
42 | C r a n i o t o m y
After:
1. Monitor IV infusion at least every 2 hour
2. Adjust IV clamp as needed and recount drop per minute.
3. Monitor client for fluid overflow
4. More frequent check maybe prn if a medication(s) are being infused.
5. More frequent check maybe prn if a medication(s) are being infused.
6. Inspect site for pain, swelling, coolness or pallor at the site of insertion, which
may indicate infiltration of IV
7. Inspect site for redness, swelling, heat and pain which may indicate phlebitis
b. Drugs
Route, Dosage &
Name of Drug Frequency of Indication(s) or Purposes
administration
Generic Name: Cefazolin is used for treating bacterial infections
Cefazolin or preventing bacterial infections before, during,
1gram IV q 8 ° or after certain surgeries. Cefazolin is a
Brand Name: cephalosporin antibiotic. It works by killing
Ancef sensitive bacteria.
Used in short-term treatment of active duodenal
Generic Name:
ulcer, duodenal ulcer associated with H.Pylori
Omeprazole
,short-term treatment of active benign gastric
40mg IV q 12 °
ulcer, long term treatment of hypersecretory
Brand Name:
conditions, treatment of heartburn and symptoms
Prilosec
associated with GERD
1gram IV q 12 °
Citicholine is used to treat cerebrovascular
Generic Name: 9/15/08
disorders, head injury, and Parkinson’s disease
Citicholine Shifted to oral:
500mg 1cap BID
Cefuroxime is a cephalosporin antibiotic. It works
Generic Name:
by fighting bacteria in your body. Cefuroxime is
Cefuroxime
used to treat many kinds of bacterial infections.
500mg BID
Surgical prophylaxis, prophylaxis against
Brand Name:
infection in cardiac, pulmonary, esophageal &
Ceftin
vascular surgery.
To boost metabolism, enhance the immune
Vitamin B system and nervous system, keep the skin and
1cap BID
Complex muscles healthy, encourage cell growth and
division.
Nursing Implication
Before:
1. Check and confirm the order (dosage, frequency and route) for the said drug
2. Check and recheck the drug indication and computation
3. Check the patient’s identity
4. Inform the patient, its purpose and action
5. Explain the importance of strict compliance to medical regimen.
43 | C r a n i o t o m y
During:
1. Maintenance of Aseptic Technique
2. Administer IV Meds slowly
After:
1. Maintain hydration
2. Monitor vital signs carefully monitor therapeutic response and the occurrence
of adverse reactions
3. Inform the patient to report adverse reactions without delay
Instruct patient to report discomfort at the IV site immediately
c. Diet
Type
Of General description indication
diet
The clear liquid diet helps to keep
Liquids that you can see through at you hydrated (body fluids, salts and
room temperature (about 78-72 minerals) and helps to get the body
Clear degrees Fahrenheit are considered used to food after long periods of
Liquid diet clear liquids. This includes clear time without food. The clear liquid
juices, broths, hard candy, ices and diet is easy to digest and does not
gelatin leave much residue in the stomach
and intestines.
Very similar to regular diet except To provide a transitional diet
Soft Diet that the textures of foods have between liquids and regular food for
been modified. patients who have undergone
surgery.
A full, well-balanced diet containing To attain optimal growth, tissue
Diet as all of the essential nutrients repair and normal functioning of the
Tolerated needed. It is a regular diet with no organs.
(DAT) food restrictions as tolerated by the For maintenance of nutrition & for
patient. promotion of wellness through food
intake via regular diet per orem.
Nursing Responsibilities for soft diet
d. Activity/ Exercise
Type General description indication
Of
exercise
High Back A type of activity or exercise To reduce oxygen demand and prevent
Rest wherein the patient is kept on bed fatigue. Rest decreases body metabolic
with the head of bed held at at least rate.
45° with limitations to other
activities.
May Sit on A type of activity wherein the client This is to prevent bed sores and promote
Bed is held on a sitting position for a strength gaining.
period of time to facilitate
circulation and prevent bed sores.
Nursing Responsibilities
● Assist patient if with such privilege in going to the bathroom.
● Change client’s position from time to time, to promote circulation and prevent bed sores.
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46 | C r a n i o t o m y
blood pressure membrane Mellitus and when to contact to note if there are when to contact
>altered secondary hypertension). health care improvements/ health care
mental status; to Diabetes Cigarette, which professional as changes in the professional as
Speech Mellitus contains evidence by patient’s condition evidenced by
abnormalities nicotine, and compliance with compliance with
>difficulty of alcohol intake the medication >Determine the >To note the the medication
swallowing cause and health duration of the severity of the and health
constriction of teachings being problem/frequency patient’s condition teachings being
= The patient the blood given. of recurrence, and to also assess given.
may manifest vessels which precipitating or for the
the following: impaired blood Long Term: aggravating factors interventions Long Term:
>Restlessness flow to the After 4 days of appropriate for the The patient
>Confusion different parts of Nursing patients condition shall have
>Lethargy the body Intervention, the >Determine demonstrated
>Seizure particularly in the patient will presence of visual, >To obtain reliable, lifestyle
activity brain. Also demonstrate sensory/motor objective way of modification as
>Pupillary because of his lifestyle changes, recording the evidenced by
changes lifestyle, he modification to headache, conscious state of cessation of
>Decreased developed improve circulation dizziness, altered a person smoking, dietary
reaction to hypertension as evidence by mental status changes and
light that has lead as cessation of (Glassgow Coma exercise.
well in increased smoking, dietary Scale)
intracranial changes and >Elevate head of >To promote
pressure. exercise. bead, and maintain circulation or
Another factor, head/neck in venous drainage
which is midline or neutral and decrease
Diabetes, position intracranial
causes viscosity pressure
of the blood.
Vasoconstriction >Administer >To improve the
and viscosity of medications as patient’s condition
the blood of the directed
patient have
impaired the >Administer oxygen >To saturate
51 | C r a n i o t o m y
Nursing Scientific
Assessment Objectives Interventions Rationale Evaluation
Diagnosis Explanation
S> Ø Risk for injury r/t One of the Short term: > Establish > To gain trust of the patient and
O> received to generalized complications After 4 hrs. of rapport patient/SO his SO shall
patient on bed weakness and that may arise nursing > Monitor and > To obtain have
conscious, limited ROM after a CVA is intervention the recoded vital baseline data participated in
coherent the numbness, patient and his signs prevention
> with intact paralysis, or SO will > Assess > To assess measures of
suture over the weakening of participate in patient’s causative/contribu possible
head either the half of prevention condition ting factors injuries
> appears weak the body or the measures of > Note changes > To assess
>Unable to whole body this possible injuries in color, texture extent of
move left depends on the & turgor involvement/injury
extremities brain that was Long Term: > Identify > To assess the patient
been damaged. After 4 days of underlying causative/contribu shall have
nursing condition/patholo ting factors displayed
intervention, the gy involved management
patient will > Note presence > To determine of simple ADL’s
display of impact of with the apt
management of uncompromised condition support of the
simple ADL’s with vision, hearing SO
the apt support of or speech
the SO > Provide wound > To assist client
care w/ correcting/
minimizing
condition & to
promote optimal
healing
> modify client’s > to prevent
activity fatigue
> Encourage > To promote
client to wellness
53 | C r a n i o t o m y
verbalize
feelings esp.
pain
> free clients > to minimize
bedside from chances of
articles that may acquiring injury
promote injury
> Instruct the SO > To involve
on how to assist patients family in
their patient in his care and to
doing his ADL’s maximize clients
willingness
>refer client to > for continuity of
rehab to regain care
strength
V. Conclusion
Craniotomy, as repeatedly being emphasized on this report, involves the
surgery that is performed through an opening in the skull. It is basically a type of
brain surgery. It may be performed to treat or remove cancer, to correct a brain
disorder, or to repair injuries. Because this is very specialized surgery with many
risks, craniotomy mortality rates may be high even at hospitals that rely on highly
experienced neurosurgical teams.
With this case report, the researchers realized that physical and
psychological implications involved in this procedure. Medically, the procedure
may be life-saving at its best. However, social stigma often pinned down the
person as terminally ill. This would definitely affect the person’s self concept and
hope over his disease condition. As aspiring nurses, they should always consider
better patient outcomes so as to provide efficient and effective care delivery.
57 | C r a n i o t o m y
INTERNET:
• http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Craniotomy?o
pen
• http://www.mayfieldclinic.com/PE-Craniotomy.htm
• http://www.gastromd.com/diets/clearliquid.html
58 | C r a n i o t o m y
“Craniotomy”
A Surgical Case Report
In partial fulfillment of the requirements in
Nursing Care Management – Related Learning Experience 103 (NCM
RLE 103)
Mabalacat District Hospital – OR, 2nd Rotation
April 27 – 30, 2009
Submitted By:
Ano, Carl Elexer
Cabrera, Kristina Edna
Calma, Ariane Camille
Palcis, Daniel
BSN III- 1
Submitted To:
Jerry Ligawen, R.N.