HANDOUTS

1. BRAIN SURGERY

Craniotomy - involves the opening of the skull surgically to gain access to intracranial sutures.
This is done to:
1. remove a tumor
2. relieve elevated ICP
3. evacuate a blood clot
4. control hemorrhage

Different Approaches in Intracranial surgery

1. SUPRATENTORIAL

Site of Surgery

Above the tentorium

Incision Location

Incision is made above the area to be operated on; is usually located behind the hairline.

Nursing Interventions:

-Maintain head of bed elevated 30 to 45 degrees, with neck in neural alignment.

-Position patient on either side or back. (Avoid positioning patient on operative side if a large
tumor has been removed.)

INFRATENTORIAL

Below the tentorium, brain stem Incision is made at the nape of the neck, around the occipital
lobe.

Nursing interventions:
-Maintain neck in straight alignment.
-Avoid flexion of the neck to prevent possible tearing of the suture line.
-Position the patient on either side.

TRANSPHENOIDAL

Sella turcica

Incision is made beneath the upper lip to gain access into the nasal cavity.

Nursing Inteventions:
-Maintain nasal packing in place and reinforce as needed.
-Instruct patient to avoid blowing the nose.
-Provide frequent oral care.
-Keep head of bed elevated to promote venous drainage and drainage from the surgical site.

PRE OPERATIVE CARE:

-CT scan
-Antisiezure medications (Phenytoin (Dilantin) – to reduce the risk of post operative seizures
-Dexamethasone to relieve cerebral edema
-Diuretics (Mannitol, Lasix)
 -Diazepam – to relieve anxiety
-Antibiotics – to prevent cerebral contamination

PRE OPERATIVE NURSING MANAGEMENT:

• Assess LOC
• Assess for dysfunctions
• Assess family’s understanding about procedure
• Shave the incision site at the operating room
• Urinary catheterization
• IV lines
• Assess and provide client’s needs

POST OPERATIVE NURSING MANAGEMENT:

• Reduce Cerebral edema
o Mannitol
o Dexamethasone
• Relieve pain and prevent seizure
o Morphine sulfate
o Antiseizure medications (Phenytoin, diazepam)
• Monitor ICP

NURSING PROCESS IN PATIENT UNDERGOING INTRACRANIAL SURGERY:

ASSESS:
• Respiratory function
• Hyperthermia
• ICP
• Neuro check
• LOC
• Dressing for drainage

NURSING DIAGNOSES:
• Ineffective cerebral tissue perfusion
• Potential for ineffective thermoregulation
• Potential for impaired gas exchange
• Disturbed sensory perception

INTERVENTIONS:
• Maintain cerebral tissue perfusion
• Regulate temperature
• Improve gas exchange
• Enhance self image
• Monitor and Manage potential complications

NURSING PROCESS POSTOPERATIVE INTERVENTIONS

• Risk for ineffective breathing pattern r/t postoperative cerebral edema
o Establish respiratory exchange
o Suction prn (but may increase ICP)
o Maintain client in controlled ventilation
o Elevate head 30.5 cm to promote venous drainage
o NPO until (+) swallowing reflex, to prevent aspiration
• Risk for imbalanced fluid volume r/t intracranial pressure or diauretics
o Monitor for polyuria
 o Monitor I and O, serum and electrolyte levels
o Evaluate client’s electrolyte levels
o Weigh patient daily
o Administer IVF cautiously
• Disturbed sensory perception r/t periorbital edema and head dressings
o Change position as indicated
o Administer analgesics
o Lubricate eyelids with petrolatum
o Apply light, cold compress to eyes
o ROM exercise
o Evaluate and support patient during episodes of restlessness
o Orient patient frequently to time, place and person

MANGE COMPLICATIONS:
A. Cerebral Edema
• Assess LOC
• GCS
• Corticosteroids and diuretics as ordered
• Monitor fluid intake, avoid overhydration
• Maintain a normal temperature
• Elevate HOB to facilitate respirations and reduce ICP
• Avoid excessive stimuli

B. Intracranial hemorrhage
• Post operative bleeding may be:
o Intraventricular
o Intracerebelar
o Subdural
o Extradural
• Assess LOC
• Prevent infections
• Prevent venous thrombosis
o Assess for homan’s sign
o Apply elastic compression stockings
o Administer anticoagulant therapy as ordered
• Assess for CSF leakage
o Assess for moderate elevation of temperature and mild neck rigidity
o Caution client to avoid blowing his nose