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8/2/2019 Head Injuries, Etc 2012
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Neurological
Lewis Chapter 57 pg. 1439
Head Injury any trauma to the scalp, skull, or brain
o HEAD TRAUMA- craniocerebral trauma altered
consciousness- most common cause of death from trauma in
United States
o Est. 1.1 million persons are treated and released for traumatic
brain injury- 235,000 hospitalized and 22% of these die
decreased number of fatalities
Males are more likely- almost twice as likely; ages 15-21 more common
Causes- falls, motor vehicle collisions, fire-arms, sports-related
injuries, recreational injuries Prevention is key- steps to prevent falls, coaches- educate, headgear;
obey traffic laws (DUIs), caution against riding in the back of trucks,
wearing helmets
High potential for poor outcome-look for: presence of intracranial
hemorrhage, increasing age of patient, abnormal motor responses,
impaired or absent eye movements or pupillary light reflexes, early
sustained hypotension, hypoxemia or hypercapnia, ICP levels higher
than 20 mm Hg. (normal 0-15) Any bleeding in brain will cause ICP to
increase-may cause actual displacement of braino Most deaths occur within a few hours after the head injury
IT IS CRITICAL TO RECOGNIZE CHANGES IN NEURO
STATUS AND RAPIDLY INTERVENE
Primary Injury- initial damage to brain resulting from traumatic event
Secondary Injury- evolves- unchecked cerebral edema; ischemia
1. Scalp lacerations-
External- abrasion, contusion, laceration, hematoma
Profuse bleeding (very vascular)
Major complications: blood loss and infection- avulsion (tearingaway)
Irrigate wound before suturing (remove organisms)
2. skull fractures- break in continuity of skull caused by functional
trauma
head trauma
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type depends on velocity, momentum, direction of injuring
agent, and site of impact
descriptions- Table 57-6 pg. 1481
o simple- linear (break in continuity of bone without
alteration of relationship of parts) or depressed(inward indentation of skull-fragments get embedded
into brain, possibly)
o simple (linear or depressed skull fracture without
fragmentation or communicating lacerations),
comminuted- splintered (multiple linear fractures with
fragmentation of bone into many pieces), or compound
(depressed skull fracture and scalp laceration with
communicating pathway to intracranial cavity)
o
closed or open- depends on presence of scalp lacerationor extension of fracture into air sinuses or dura;open
increases risk of infection
symptoms will depend on location of fracture- Table 57-7 pg.
1439- must know: RHINORRHEA( CSF leakage from the nose),
OTORRHEA (CSF leakage from ear), BATTLES SIGN
(postauricular ecchymosis), and PERIORBITAL ECCHYMOSIS
(raccoon eyes)
o frontal fracture- exposure of brain to contaminants
through frontal air sinus, possible association with air in
forehead tissue, CSF rhinorrhea, or pneumocranium
o orbital fracture-periorbital ecchymosis (raccoon eyes),
optic nerve injury
o temporal fracture- boggy temporal muscle because of
extravasation of blood, oval-shaped bruise behind ear in
mastoid region (Battles sign), CSF otorrhea, middle
meningeal artery disruption, epidural hematoma
o parietal fracture- deafness, CSF or brain otorrhea,
bulging of tympanic membrane caused by blood or CSF,
facial paralysis, loss of taste, Battles sign
o posterior fossa fracture- occipital bruising resulting in
cortical blindness, visual field defects, rare appearance
of ataxia or other cerebellar signs
o basilar skull fracture (base of skull)- CSF or brain
otorrhea, bulging of tympanic membrane caused by
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blood or CSF, Battles sign, tinnitus or hearing
difficulty, rhinorrhea, facial paralysis, conjugate
deviation of gaze, vertico
Testing of fluid to determine if CSF: test fluid with Dextrostix or Tes-Tape strip-
looking for glucose- if positive, CSF
if present in blood, glucose will be unreliable- look
for HALO OR RING test- allow fluid to drip on
4x4- blood coalesces to center- will see yellowish
ring around blood if CSF is present
presence of CSF indicates the potential of a
meningeal infection
bloody CSF indicates brain laceration or contusionNote color, appearance, and amount
Major complications of skull fractures: intracranial infections and
hematomas meningeal and brain tissue damage esp. with basilar fracture
(tend to be open; increases chance of meningeal infection)
Treatment of skull fractures- usually conservative- may need craniotomy if
there are loose bone fragments- craniectomy for large amounts- replaced by
cranioplasty- if significant cerebral edema repair may be delayed 3-6
months; administer IV antibiotics
3. minor head trauma- brain injury (injury to brain that is severe enough
to interfere with normal functioning)
concussion- sudden transient mechanical head injury with
disruption of neural activity and a change in the LOC- may or
may not lose consciousness (or may have temporary loss)
o signs: brief disruption in LOC, amnesia regarding the
event, headache; bizarre behavior (frontal lobe)
o seeing stars; dizziness
generally of short duration
o treatment depends on length of LOC-may keep in
hospital for observation; may be discharged with
instructions to notify HCP if behavioral changes occur
(changes in mental status- speech, confusion, lethargy,
vomiting, irritation, anxiety)
o observation- management of ICP if occurs
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o have patient resume normal behavior slowly
postconcussion syndrome- seen anywhere from 2 weeks to 2
months after injury
o symptoms- persistent headache, lethargy, personality
and behavioral changes, shortened attention span,decreased short term memory, changes in intellectual
ability
may be problematic if patient has had more than one concussion
or head injury- residual effects- behavior changes, attention
deficits, memory loss
4. major head trauma
Contusion- bruising of brain tissue within a focal area usually a
CLOSED HEAD INJURY (head accelerates and then rapidly
decelerates or collides with another object and brain tissue indamaged)
o May contain areas of hemorrhage, infection, necrosis,
and edema and frequently occurs at a fracture site
o Coup-contrecoup- brain moves inside skull due to high-
impact have two areas of injury- both at the site of
the direct impact and also at the opposite side
o Patient prognosis depends on amount of bleeding
o May continue to bleed- appear to blossom on CT scans
Hemorrhage is worsened by anticoagulant therapy-
also have higher mortality
Will see signs/symptoms of shock- decreased HR,
BP, temp
o Neurologic assessment- focal (symptoms related to
function of damaged area) and generalized findings-
may have seizures
o Management of ICP is treatment
o May have cerebral irritability- be conscious but easily
disturbed by stimulation
o Residual headache, vertigo
o May have seizures
Lacerations- actual tearing of brain tissue- often occur with
DEPRESSED and OPEN fractures and penetrating injuries (open
brain injuries- object penetrates skull and damages soft brain
tissue or severe blunt trauma)
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o Severe tissue damage
o Focal and generalized signs will be seen when bleeding is
deep in brain parenchyma
o Intracerebal hemorrhage- space-occupying lesion
accompanied by unconsciousness, hemiplegia oncontralateral side, and dilated pupil on ipsilateral side
Delayed responses will be seen secondary to major head
trauma- hemorrhage, hematoma formation, seizures, and
cerebral edema
Diffuse axonal injury- widespread axonal damage (cerebral
hemispheres) accruing after TBI- occurs primarily around axons
in subcortical white matter of cerebral hemispheres, basal
ganglia, thalamus, and brain stem- trauma is thought to be
caused from axon swelling and disconnection- usually takes 12-24 hours decreased LOC, increased ICP, decortication or
decerebration, global cerebral edema
o Dx- clinical symptoms and CT/MRI
Complications- Note: signs and symptoms will be determined by
size- prognosis is poorer with those that develop more rapidly
(unable to compensate for increased ICP)
o Epidural hematoma- bleeding between dura and inner
surface of skull- neurologic emergency- associated with
linear fracture crossing an artery venous hematomas
occur more slowly signs/symptoms: initial period of
unconsciousness- lucid then decreased LOC- headache,
nausea and vomiting, focal findings; will see rapid
deterioration; TX- evacuate hemorrhage (burr holes
to decrease ICP)- remove clot and place drain
o Subdural hematoma- bleeding between dura mater and
arachnoid layer of meninges- usually results from injury
to brain substance and parenchymal vessels- slower to
develop- generally venous- may be secondary to rupture
of aneurysm
Acute- signs within 48 hours of injury-similar to
those associated with brain tissue compression in
increased ICP- decreased LOC and headache- may
be drowsy and confused or unconscious- pupillary
symptoms and hemiparesis; if ICP is elevated,
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ipsilateral pupil dilates and becomes fixed- brain
injury may occur- may be fatal (coma, increased
BP, decreased HR- need immediate treatment)
Subacute subdural hematoma- 2-14 days of injury-
may appear to enlarge over time Chronic subdural hematoma- weeks or months
after minor head injury- actual injury may be
forgotten
a. 50-60 years of age- may have brain atrophy
b. Focal symptoms
c. Chronic alcoholics
d. Delay in elderly- dementia, vascular disease,
somnolence, confusion, lethargy and memory
loss may be attributed to medical conditione. Treatment is surgical evacuation of clot;
supportive care; control of ICP
o Intracerebral hematoma- bleeding within parenchyma-
usually in frontal and occipital lobes; symptoms HTN,
aneurysm, bleeding disorders (complication of
anticoagulants)
o Hematoma Treatment-surgical evacuation of blood-
craniotomy Burr-hole openings in emergency drain
Diagnosis of Head Trauma/Injury
CT scan- can note abnormalities in skull, edema, contusion
(intracerebral or extracerebral hemorrhage)
MRI, PET, evoked potential studies- may be used in differentiation
of head injuries- patient must be stable
o MRI more specific than CT- can pick up small DAI (diffuse
axonal injury)
Transcranial Doppler study
Cervical spine x-ray- cervical collar, backboard
X-ray for skull fracture
Cerebral angiography- hematomas and contusions
GCS- mild (13-15), moderate (9-12), or severe (3-8)
Timely diagnosis is key! Surgery if necessary interventions should
be rapid
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Treatment for Head Injury- Table 57-9 pg. 1442
-determine etiology- blunt vs. penetrating trauma
-assess- look at surface findings (what you can see bruising, bleeding, cuts,
raccoon eyes); look at resp. status (may be compromised with head injury-
Cheyne-Stokes, decreased O2); look at CNS (pupils, facial movements,speech, LOC, combativeness, seizure, bowel/bladder, posturing, CSF leakage,
GCS score)
Prevent secondary brain injury; stabilize cardiovascular and respiratory
function
-Emergency:
Airway- Keep HOB up 30 degrees but maintain head in neutral
midline position
Stabilize C-spine
Administer oxygen- non-rebreather IV access- large bore- NS or LR
Control external bleeding
Assess for CSF leakage or wounds
Patients clothing-
Maintain warmth
Monitor vital signs- GCS- O2 sat- LOC- Pupils
Anticipate need for intubation- gag reflex?
Assume neck injury- so protect
Administer fluids cautiously when maintaining because of
chance of ICP
Vent support
Seizure precautions
Fluid and electrolyte and nutritional support
Pain/anxiety
Nursing Management
Remember that with a head injury there is a great likelihood that
the patient will have ICP- leads to higher mortality rates and
poorer functional outcomes-
o Assess, assess, and assess- GCS , neuro status, CSF leakage
When did injury happen? What caused the injury?
Direction and force of blow? LOC- how long?
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*remember GCS- eye opening; verbal response; motor
response (15-3)
o Nursing diagnoses???
Ineffective tissue perfusion (cerebral)
Complications- decreased cerebral perfusionpressure- treat by decreasing cerebral edema-
may give fluids with caution to treat low BP
Hyperthermia- metabolism, infection, and regulatory
status
Acute pain
Risk for pain
Ineffective airway clearance
Impaired gas exchange- treat with ET and mech vent
Impaired physical mobility Anxiety
Risk for injury- seizures; assess for development of
seizure activity; administer anti-seizure meds
Nutrition- tube feedings
Risk for infection- pneumonia, UTI, wound infection,
brain abscess
Increased ICP
o Planning- Goals are:
Maintain adequate cerebral oxygenation and perfusion
Remain normothermic
Achieve control of pain and discomfort
Be free from infection
Attain maximum function
o Nursing Implementation
Health Promotion- PREVENTION IS KEY!!!! Educate on
ways to prevent car and motorcycle collisions- HELMETS-
driver ed classes- be active in discouraging DUIs
Acute Intervention- quick action- see Table 57-9 pg.
1442
Maintain oxygen and perfusion prevent secondary
cerebral ischemia- brain is sensitive to hypoxia;
Monitor ABGs and administer oxygen
Monitor for changes in neurologic status
Treat other life-threatening injuries
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Talk to family and patient- let them know what to
expect and also what to look for (behavioral
changes, combativeness)- See Table 57-11 pg.
1444- what to notify HCP about (increased
drowsiness, N/V, worsening heachache/stiff neck,seizures, vision changes, behavioral changes, motor
problems, slow heart rate, sensory problems have
someone stay with patient abstain from alcohol
check with HCP about meds avoid operating heavy
machinery, driving, etc.
Assess, assess, assess- GCS, LOC, V/S
Assess motor function- spontaneous movement;
response to painful stimuli if no spontaneous
movement Other problems-
o Eye problems include loss of corneal reflex,
periorbital ecchymosis and edema, and
diplopia may need eyedrops or tape eye
shut cold compresses initially then warm
eye patch
o Hyperthermia- damage to hypothalamus;
cerebral irritation from hemorrhage,
infection- Administer Tylenol, cooling
blankets. Use caution- do not induce
shivering (increased ICP)
o Sleep pattern disturbance- must be
awakened every hour- check level of
consciousness- group nursing activities and
decrease environmental noise
o Notify HCP immediately if CSF leakage is
suspected- raise head of bed- place loose
collection pad caution patient not to sneeze
or blow nose (increased ICP) no NG tube
o Immobilized patient- elimination needs,
protection of skin integrity (turn and
reposition, keep clean and dry)
o Antiemetic meds
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o Treat pain- acetaminophen or small doses of
codeine
o Benzos for agitation (dont affect ICP)
o Antiseizure meds
o
Calm, restful environmento Pain meds- avoid opioids
o corticosteroids
Ambulatory/Home Care
Rehab- may be chronic problems with motor,
sensory, communication, memory, intellectual
functioning
Seizure disorders may be seen- most vulnerable
time is within first week of head injury- Dilantin
Personality change- may be hard for patient andfamily to cope with- loss of concentration, memory
processing, euphoria, mood swing, lack of social
restraint, tact, emotional control may be noted
Support family- financial, personal needs,
communication help them with their expectations
and let them know how patient is doing--- dont give
false hope
Specific post hospitalization rules- no drinking,
driving, firearms, work with hazardous materials,
unsupervised smoking
Counseling- cognitive rehab activities- sensory
stimulation, behavior modification, video games,
reality orientation
Head Injuries and Ethics- Brain death- pg. 1443
Death by neurologic criteria- cerebral cortex stops functioning or is
irreversibly destroyed
Controversy- technology
Criteria- coma or unresponsiveness, absence of brainstem reflexes,
and apnea- physician
Do not address patient in permanent vegetative state- brainstem
activity enough to sustain heart and lung function
EEG- to check cerebral blood flow
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Brain Tumors- 1445 Annual rate- 18,500 with 12, 760 deaths
Frequent site of metastasis from other sites
Higher incidence in males
More common in middle-aged persons Types-
o Primary- arising from brain- rarely mets. Outside; cause
unknown- ionizing radiation is known risk factor
o Secondary- metastasis- most common type- lung, breast, kidney
Also classified according to tissue- Review Table 57-12 pg. 1446
o Gliomas (within brain tissue); most common type
Astrocytoma- supportive tissue, glial cells, and astocytes-
low to moderate grade malignancy
Glioblastoma multiforme- primitive stem cell (glioblast)-highlty malignant and invasive- one of most devastating
Oligodendroglimoma- oligodendrocytes- may be beningn
(majority) but may also be highly malignant-
Medulloblastoma- primitive neuroectodermal cell- highly
malignant and invasive metastasize to spinal cord
o Meningioma- meninges- can be benign (most) or malignant- slow-
growing; middle-aged women- symptoms result of compression;
treatment is surgery to remove
o
Acoustic neuroma- cells that form myelin sheath around nerves-commonly affects cranial nerve VIII( vestibulocochlear)-
usually benign or low grade- slow-growing; causes facial
problems- hearing loss, vertigo, headache, visual disturbances
o Pituitary adenoma- pituitary gland- usually benign- sleep;
appetite; amenorrhea (females); acromegaly; Cushings(obesity
in face, abdomen; HTN, osteoporosis, elevated glucose)
o Hemangioblastoma- blood vessels of brain- rare and benign
o Primary central nervous system lymphoma- lympocytes-
increased incidence in transplant and AIDS patientso Metastatic tumors- from lungs, breast, kidney, thyroid,
prostate-malignant
o Brain angiomas- masses composed largely of abnormal blood
vessels- usually in cerebellum; increased risk for hemorrhagic
stroke
If not treated, will be fatal because of ICP
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Clinical Manifestations
o Depends mainly on location and size of tumor- look at Figure 57-
18 pg. 1447
o Wide range of symptoms
o
Headache- worsen at night or early morning- dull and constant;deep and unrelenting; location may depend on location of tumor
o Seizures- gliomas and brain metastases
o Nausea and vomiting (projectile) - ICP
o Cognitive dysfunction- memory problem, mood and personality
changes
o Muscle weakness, sensory losses, aphasia, vision/spatial
disturbances
o Papilledema (edema of optic disk)
o
ICP, cerebral edema, obstruction of CNS pathwayso Review Table 57-13 pg. 1447
Cerebral hemisphere
Frontal lobe- unilateral- unilateral hemiplegia,
seizures, memory deficit, personality and judgment
changes, visual disturbances
Frontal lobe- bilateral- symptoms associated with
unilateral frontal lobe tumor and ataxic gait
Parietal lobe- speech disturbances may have
inability to write, spatial disorders, unilateral
neglect
Occipital lobe- vision disturbances and seizures
Temporal lobe- few symptoms- seizures, dysphagia
Localized symptoms- hemiparesis, seizures, mental
status changes
Progression of signs/symptoms is important-
indicates tumor growth and expansion
Subcortical- hemiplegia; other symptoms depend on area
of infiltration
Meningeal tumors- compression of brain and dependant on
area of tumor
Metastatic tumor- headache, nausea, vomiting.. increased
ICP depend on tumor location
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Thalamus and sellar tumors- headache, nausea, vision
disturbances, papilledema, nystagmus (ICP), diabetes
insipidus
Fourth ventricle and cerebellar tumor- headache, nausea,
papilledema, ataxic gait, changes in coordination Cerebellopontine tumors- tinnitus and vertigo, deafness
Brainstem tumors- headache on awakening, drowsiness,
vomiting, ataxic gait, facial muscle weakness, hearing
loss, dysphagia, dysarthria, crossed eyes or visual
changes, hemiparesis
Assess activities of daily living
Complications
o Hydrocephalus- occurs if ventricles or outlet is occluded
surgical treatment is necessary ventriculoatrial orventriculoperitoneal shunt rapid decompression of ICP may
cause prostration and headache keep patient in upright
position patient should avoid contact sports
Shunt malfunction- signs of ICP- decreasing LOC,
restlessness, headache, blurred vision, vomiting
Infection- high fever, persistent headache, stiff neck
Diagnostic Studies for Brain Tumor
Extensive history and workup- comprehensive neuro exam
New-onset seizures may be initial sign
MRI, PET, CT scan with contrast
EEG may be performed- abnormal brain waves in area of tumors
Angiography- blood flow to tumor
Endocrine studies
Rule out other primary sites
Obtain tissue for histology usually at time of surgery- may do a
smear in OR to help neurosurgeon know what to do further
Check for CSF
Nursing Diagnoses
Impaired tissue perfusion
Acute pain
Self-care deficits
Anxiety
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Planning
Goals:
1. maintain normal ICP
2. maximize neurologic functioning3. achieve control of pain and discomfort
4. be aware of long-term implications with respect to prognosis and
cognitive and physical functioning
Nursing Interventions
Collaborative Care
o Goals are aimed at identifying tumor type and location,
removing or decreasing tumor mass, and preventing or
managing increased ICP Surgical Therapy- preferred treatment
o Stereotactic techniques- biopsy and remove small
brain tumors- uses CT scan- localizes site- may use
gamma knife
o Outcome depends on type, size, and location of tumor
o Ultrasound, functional MRI, cortical mapping are used
to localize tumor
o Complete removal isnt always possible may reduce
tumor mass which will decrease ICP and provide some
relief of symptoms- malignant gliomas- often cant
remove all of tumor
Radiation Therapy and Radiosurgery- may be a follow-up
after surgery- often used when tumors are unable to be
completely removed
o Radiation seeds may be implanted- brachytherapy-
allows for high doses directly at site
o Complication- increased ICP and cerebral edema- high
doses of corticosteroids
o Stereotactic radiosurgery- high concentration of
radiation at a precise location within brain- may be
used when conventional surgery has failed or isnt an
option
Chemotherapy- may not cross blood-brain barrier so may not
be effective- nitrosources- wafers may be implanted during
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surgery- methotrexate and procarbazine- intrathecal
administration
o Temodar- crosses blood-brain barrier
o Corticosteroids- decrease cerebral edema
Nurse will assess, assess, assess determine limitations andhow long patient has had these
Medical history, intellectual abilities and educational level,
history of nervous system infections and trauma presence of
symptoms such as seizures, headache, N/V, pain, syncope
Assist family with coping esp. with behavioral changes
limitations
Safety- patient may become aggressive and even harmful to
self- environment- calm
Risk for aspiration- assess gag reflex and ability to swallow;reassess preop and postop
Minimize stimulation and have a routine
Antiseizure meds and seizure precautions
ADLs- assist with these but promote maintenance of self-
function self-image
Communication
Nutrition- assess status, encourage them to eat, tube
Evaluation- will reach goals set in planning stage
Cranial Surgery- 1449; Table 57-14 May be indicated for brain tumor, CNS infection, vascular
abnormalities, craniocerebral trauma, seizure disorder, or intractable
pain
Types- Table 57-15 pg. 1449
o Stereotactic surgery- precision apparatus- often computer
guided- precisely target area of brain- frame or frameless
system based on 3-dimensional coordinates
May be used to obtain tissue samples for histologic
examination
CT scan and MRI image targeted tissue
Used for removal of small brain tumors and abscesses,
drainage of hemotomas, ablative procedures for
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extrapyramidial diseases, and repair of arteriovenous
malformations
Radiosurgery- procedure that involves closed-skull
destruction of an intracranial target using ionizing
radiation focused with the assistance of an intracranialguiding device- gamma knife- may treat tumors over
several weeks
Can be used in combo with surgical lasers
Reduction in damage to surrounding tissue
o Burr hole- opening into the cranium with a drill- used to remove
localized fluid and blood beneath the dura- may be used to determine
presence of swelling and to evacuate hematoma/abscess
o Craniotomy- opening into the cranium with removal of a bone flap and
opening the dura to remove a lesion, repair a damaged area, drainblood, or relieve increased ICP- depends on location of pathologic
condition where this will be performed- incision into skull- burrholes are drilled and saw is used to connect the holes to remove flap
afterward it is wired or sutured. Drains will be placed- used for
meningioma, acoustic neuromas
o Supratentorial- above the tentorium; below tentorium into
intratentorial (posterior fossa)
o Transphenoidal approach- mouth and nasal sinuses- often for pituitary
Preop for both- CT scan, MRI, Doppler flow studies; antiseizure meds,Decadron (decreased cerebral edema and restrict fluids); Mannitol
and Lasix IV may also be given afterward; may see transient diabetes
insipidious after- vasopressin; Pre-op- endocrine tests; rhinologic
evaluation; most serious effect of pituitary tumor is localized
pressure on optic nerve/chiasm; culture nasopharyngeal secretions-
contraindicated in sinus infection; corticosteroids before and after-
no source of ACTH- may have antibiotics; Post-op- assess visual
field/visual acuity; keep HOB up to keep pressure down at least 2
weeks after surgery- keep from blowing nose; measure I & O; check
nasal packing for blood and CSF- remove 3-4 days; frequent oral care;
incision above teeth- no brushing teeth until healed; room humidifier
o Craniectomy- excision into cranium to cut away a bone flap
o Cranioplasty- repair of a cranial defect resulting from trauma,
malformation, or previous surgical procedure artificial material is
used to replace damaged or lost bone
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o Shunt procedures- alternate pathway to redirect CSF from one area
to another using a tube or implanted device- ventriculoperitoneal
shunt
Nursing Management Assessment- similar to patient with increased ICP- neuro
assessment
Diagnoses- tissue perfusion, infection, disuse syndrome
Planning- Goals are to return to normal consciousness, achieve
control of pain and discomfort, maximize neuromuscular
function, be rehabilitated to maximum ability
Nursing Interventions
Assess- compare pre and post op- level of consciousness,
neuro status ,personality, bowel and bladder; motorfunction
Acute
Compassionate nursing care- patient and family will
have coping issues because of severity of surgery
Preop teaching- general info about type of
procedure- hair will be shaved- ICU or special care
unit
Prevention of ICP is primary goal- frequent
assessment- neuro, fluid and lytes, serum
osmalarity, turning and positioning depends on type
of procedure
o Posterior fossa- flat or at slight elevation
(10-15 degrees)
o Avoid flexion of neck
o Surgical dressing- 3-5 days- if bone flap
removed- do not position on operative side
o Head dressing after surgery may have
limited hearing/vision
o Notify immediately HCP if dressing has
excessive bleeding or clear drainage
o Check drains for placement and assess area
o Antiseptic soap
Tubes- communication may be difficult
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Art lines/central venous pressure- monitor
cerebral edema, relieving pressure, prevention of
seizures, monitor ICP
HOB up 30 degrees
Avoid lying on operative side Ambulatory and Home Care
o Rehab potential depends on reason for surgery, general health,
and postop course
o Foster independence
o Careful positioning, meticulous skin and mouth care, elimination,
ROM, adequate nutrition until cerebral edema/ICP are resolved
o Referrals- ST, PT
o Deficits both cognitively and emotionally may be hard on family-
copingo Client safety- headache treatment; Decadron, Dilantin,
antiemetics
o May have SIADH, diabetes insipidus, and increased ICP post-op