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Saturday, 9 July 2011

Nursing care for a patient with 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 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.
·         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.


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