Craniotomy

CRANIOTOMY THE TERM CRANIOTOMY MEANS TO SURGICALLY CREATE AN OPENING INTO THE SKULL FOR VARIOUS TYPES OF SURGICAL PROCEDURES ON THE BRAIN. NURSING MANAGEMENT OF THE PATIENT AFTER A CRANIOTOMY. 1. RISK FOR INEFFECTIVE TISSUE PERFUSION, CEREBRL RELATED TO CEREBRAL EDEMA OR BEEDING AFTER CRANIOTOMY.  ASSESS THE NEUROLOGIC STATUS AND VITAL SIGNS FREQUENTLY.  ELAVATE HEAD END OF THE BED TO 30 DEGREES.  MAINTAIN HAED AND NECK IN NEUTRAL ALIGNMENT.  CHANGE THE POSITION SLOWLY WOTH PROPER SUPPORT TO THE HEAD     

AND NECK. MANAGE BP EFFECTIVELY. MONITOR INTAKE & OUTPUT CHART. MONITOR PULSE OXIMETRY AND ARTERIAL BLOOD GAS. SUCTION AIRWAY AS NEEDED. CONTINUOUS ASSESSMENT WITH GLASGOW COMA SCALE IS ALSO

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ESSENTIAL. ADMINISTER CORTICOSTEROIDS AS PER ORDER. ADMINISTER ANTI EPILEPTIC DRUGS AS ORDERED. ADMINITER IV MANNITOL TO REDUCE INTRACRANIAL PRESSURE. PROVIDE STOOL SOFTNERS TO AVOID STRAINING OF THE BOWEL.

2. PAIN RELATED TO SURGICAL INCISION.  PROVIDE PAIN MEDICATIONS AS PER ORDER OF THE PHYSICIAN.  TREAT FOR CEREBRAL EDEMA AS MENTIONED ABOVE.  PROMOTE SLEEP AND PROPER BED REST. 3. IMPAIRED PHYSICAL MOBILITY RELATED TO IMMOBILIZATION AFTER A SURGERY.  CHANGE POSITIONS FREQUENTLY BUT SUPPORT THE HEAD AND NECK    

WHILE DOING SO. PROVIDE FOR PASSIVE ROM EXERCISES. INSPECT THE SKIN FOR ANY REDNESS. GIVE A BED BATH AND A BACK MASSAGE TO THE CLIENT. PROVIDE A COMFORTABLE BED WITH WRINKLE FREE LINEN.

4. INEFFECTIVE COPING RELATED TO FEAR OF CHANGES IN BODY IMAGE AND LIFE EXPECTANCY.  PROVIDE OPPORTUNITIES FOR EXPRESSION OF FEELINGS.

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ENCOURAGE FAMILY MEMBERS TO ASSIST IN MEETING CLIENT’S NEEDS. ENCOURAGE THE CLIENT WHEN HE COOPERATES. ESTABLISH TRUST RELATIONSHIPS. REDUCE ENVIRONMENTAL STRESS AND STIMULI.

5. ANXIETY RELATED TO UNCERTAIN FUTURE AND PROGNOSIS.  PROVIDE PROPER KNOWLEDGE AND INFORMATION TO THE CLIENT 

ABOUT HIS CONDITION. ENCOURAGE OPEN COMMUNICATION BETWEEN THE CLIENT, FAMILY MEMBERS AND HEALTH CARE TEAM PROFESSIONALS.

6. RISK FOR DISTURBED THOUGHT PROCESS RELATED TO NEUROLOGICAL CHANGES FROM EDEMA OR SURGICAL EXICISIONS OF AREAS OF BRAIN.  INFORM FAMILY ABOUT THE REASONS FOR CHANGES IN BEHAVIOUR.  MAINTAIN A NON JUDGEMENTAL BEHAVIOUR  HAVE A CALM APPROACH TOWARDS THE CLIENT.  ALLOW THE CLIENT TO VERBALIZE CONCERNS.

Medications Take prescribed medications as directed. You may be sent home with prescriptions for the medications you have been taking in the hospital and these medications may include the following 

Pain relief: (Panadol with codeine) these medications are used to reduce the amount of headache and wound pain that may be present after surgery

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Antiswelling: (Steroids; Decadron, Dexamethasone, Hydrocortisone) this medication is used to decrease the amount of post-operative brain swelling that might occur following the surgery. It should be gradually tapered (lowering of dose) over time. Your doctors will discuss the dosages of these medications

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Antacid: (Pepcid, Axid, Zantac, Prilosec) this medication is used to decrease the amount of excess stomach acid which may be caused by steroids (see above) or from the stress of surgery

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Anti-seizure: (Dilantin, Phenobarb, Tegretol, Gabapentin, Epilem) this medication is given to almost all patients before, during and after a brain operation in order to help reduce the risk of seizure. There still is a seizure risk despite these medications and your doctor may need to adjust the dose of medication by using periodic blood tests

Post operative care  o o o o o    

To reduce the risk of brain pressure build-up: You may receive steroids and other medicines to keep your body fluid level low. The head of your bed will be raised. Fluids given to you may be limited. You may be given medicines to prevent vomiting. Do not strain or hold your breath unless your healthcare staff says it is okay. Your mental status will be checked often. You may receive medicine to prevent seizures. You may receive antibiotics to prevent infection. Your dressing will be removed 24-48 hours after surgery and be replaced with lighter dressing.

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You may have a drain inserted after surgery. In most cases, it will be removed in the hospital.

warn the client not to cough, sneeze, or blow nose. You may be asked to get out of bed and walk around to prevent complications like blood clots or pneumonia .

Perform frequent oral hygiene with soft swabs to cleanse the teeth and mouth rinses; no toothbrushing.