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Care of Neurosurgical Clients

Posted on November 6, 2009 | 1 Comment

Post-operative care for neurological clients having supratentorial and infratentorial procedures

Positioning
a.  Supratentorial: Semi-Fowler’s position is used because lwoering the head can cause venous congestion and bleeding.  Position flat only when client is in shock.  No Trendelenburg position, which would increase intracranial pressure.

b.  Commonalities: Keep off operative site; turn every 2hours; keep head on small pillow; mouth in dependent situation to drain secretions.

c.  Infratentorial: Position flat on eaerither side; keep off back because of impaired swallowing and gag reflexes; head may be gradually elevated on the third post-operative day.

Vital Signs
a.  Commonalities: Minor vital signs; monitor neurological signs; observe for shock and increased intracranial pressure

b.  Infratentorial: Observe for respiratory difficulty

Food and Fluids
a.  Supratentorial: Limit to 1,500 ml during first 24 hours to control edema; food diets as tolerated after return of swallowing and gag reflexes.

b.  Commonalities: Record intake and output

c.  Infratentorial: No oral fluids or solids for 24hours; begin oral fluids and diet on second post-operative day after ascertaining presence of swallowing and gag relexes.

Other Measures
a.  Check dressing for clear drainage and excessive bleeding and reinforce as necessary.  Restrain client if necessary to prevent distrubance of dressing.

b.  Suction as necessary to clear mouth or airway, being careful not to stimulate the cough reflex, since this facilitiates increasing intracranial pressure

c.  Encourage deep breathing, coughing should be discouraged.

d.  Apply ice bag to head as necessary for headache.

e.  Monitor bowel and bladder elimination.  Catheterize if necessary.  Avoid enemas, since they may increase the intracranial pressure

f.  Give analgesics, anticonvulsants, stimulants or steroids as ordered

g.  Follow eye-care regimen if corneal reflex is absent

h.  Facilitate advance activities as indicated.

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Comments:1

  1. 10/02/04

    @Markus I get your drift on where you were going there. I often think of my past and use it as a means to analyze where I am and where I want to get to. Where I struggel is balancing it all out. How do you guys balance things out?

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