1. CRANIOTOMY

2. DESCRIPTION
 Craniotomy is a surgical procedure that involves an incision through the
cranium to remove accumulated blood or a tumor
 Complications of the procedure include increased ICP from cerebral edema
, hemorrhage or obstruction of the normal flow of CSF
 Additional complications include hematomas, hypovolemic shock ,
hydrocephalus , respiratory and neurogenic complications, pulmonary
edema, and wound infections
 Complications related to fluid and electrolyte imbalances include diabetes
insipidus and inappropriate secretion of antidiuretic hormone

3. PREOPERATIVE INTERVENTIONS
 Explain the procedure to the client and family
 Ensure that an informed consent has been obtained
 Prepare to shave the client’s head as prescribed and
cover the head with appropriate covering
 Stabilize the client before surgery

4. POSTOPERATIVE INTERVENTION
 Monitor vital signs and neurological status every 30 minutes to 1 hour
 Monitor for increased intracranial pressure
 Monitor for decreased level of consciousness , motor weakness or paralysis ,
aphasia , visual changes, and personality changes
 Maintain mechanical ventilation and slight hyperventilation for the first 24 to
48 hours as prescribed to prevent increased intracranial pressure
 Assess the physician ‘s orders regarding client positioning
 Avoid extreme hip or neck flexion , and maintain the head in a midline neutral
position
 Provide a quiet environment
 Monitor the head dressing frequently for signs of drainage

5.  Mark the area of drainage at least once each nursing shift for baseline
comparison
 Monitor the Hemovac or Jackson –Pratt drain , which may be in place for 24
hours
 Maintain suction on the Hemovac or Jackson –Pratt drain
 Maintain drainage from the Hemovac or Jackson –Pratt drain every 8 hours,
and record the amount and color
 Notify the physician if drainage is greater than the normal of 30 to 50 ml per
shift
 Notify the physician immediately of excessive amounts of drainage or a
saturated head dressing
 Record strict measurement of hourly intake and output
 Maintain fluid restriction at 1500 ml/day as prescribed

6.  Monitor electrolyte values
 Monitor for dysrhythmias , which may occur as a result of fluid and electrolyte
imbalance
 Apply ice packs or cool compresses as prescribed for periorbital edema and
ecchymosis of one or both eyes, which is not an unusual occurrence
 Provide range of motion exercises every 8 hours
 Place antiembolism stockings on the client as prescribed
 Administer anticonvulsants, antacids , corticosteroids, and antibiotics as
prescribed
 Administer analgesics such as codeine sulfate and acetaminophen as
prescribed for pain