Chăm sóc Điều Dưỡng Phẫu thuật sọ não (bản tiếng Anh) ppsx

Indications for Cranial Surgery Intracranial infection abscess - usually staphylococci or streptococci.. Cranial surgery performed to open and drain abscess  Epilepsy - Cranial surger

Care of the Client with Cranial Surgery

Kathleen Ohman, RN, CCRN, EdD

Developed in cooperation with Kim Scott, RN, MS

Indications for Cranial Surgery

 Intracranial infection (abscess) - usually

staphylococci or streptococci Cranial surgery

performed to open and drain abscess

 Epilepsy - Cranial surgery to remove the epileptic

focus for patients whose epilepsy cannot be

controlled by drug therapy

 Skull fractures - for depressed fracture or fracture

with loose fragments Cranial surgery necessary to elevate depressed bone and/or remove fragments

Indications for Cranial Surgery

Brain Tumors (cont.)

 Primary tumors - arise from tissues in the brain

 Secondary tumors - result from metatastisis from malignant

neoplasm elsewhere in body

 Gliomas account for 65% of primary tumors (malignant)

 Astrocytoma- most common glioma

 Oligodendroglioma-often localized frontally

 Glioblastoma multiforme highly malignant and invasive

 Meningioma and Pituitary tumors

 Benign

 Tend to recur

 Unless treated, all tumors cause death from increased tumor

volume leading to increased ICP

MRI showing a meningioma crossing the tentorium on left

Indications for Cranial Surgery

Intracranial bleeding

Indications for Cranial Surgery

Hydrocephalus

 Overproduction, malabsorption, or accumulation

of CSF Shunting procedure performed to drain CSF.

Hydrocephalus (cont.)

AVM (Arteriovenous

malformation)

Aneurysm Repair

A clip is placed across the neck of the aneurysm which originates from the carotid artery

 Preoperative teaching to patient and family

• Explain preop labs, tests, procedures

• Explain anesthesia, estimated length of procedure, how long in recovery and where will go after

recovery (ICU)

• Explain how pt will look after surgery

• Explain what to expect postoperatively re: dressings, catheter, ET tube, Foley, IV’s, IS, pain management

Preoperative nursing

management

Preoperative nursing management (cont.)

 Nearest relative may need to sign consent

 Scalp prep - hair shaved (save hair) to reduce risk of infection and provide better exposure

 Baseline neuro assessment

 Family anxious re: potential physical and

emotional deficits related to surgery -

compassionate preoperative nursing care

Types of Cranial Surgery :

Burr Hole

-to remove blood/fluid or in preparation for a craniotomy

Types of Cranial Surgery:

Craniotomy

Craniotomy (cont.)

After the dura has been stitched closed, the piece of bone is replaced and sutured into place An ICP monitoring device may then be implanted

Craniotomy (cont.)

Types of Cranial Surgery: Craniectomy

Shunt Procedures (cont.)

A small catheter is passed into a ventricle of the brain A pump is attached

to the catheter to keep the fluid away from the brain Another catheter is attached to the pump and tunneled under the skin, behind the ear,

down the neck and chest, and into the peritoneal cavity (abdominal cavity)

The CSF is absorbed in the peritoneal cavity

Minimally Invasive Cranial Surgery

 A preoperative cerebral arteriogram (A) shows a basilar tip

aneurysm A postoperative arteriogram, after aneurysm clipping via a superolateral orbital craniotomy, confirms successful

clipping (B) A patient with a healed superolateral orbital

craniotomy incision line (C) (arrows)

Nursing Management after

 Allows for intraventricular drug administration

 Measures pressure within vessels

Monitor ICP and CPP Pressure

Waves

A waves (plateau waves)

- associated with ICP>20

- indicates exhausted intracranial spatial

compensation

- associated with increased cerebral volume and decreased cerebral blood flow, cerebral ischemia and brain damage

B waves in raised ICP

- associated with normal

changes in systemic art

pressure

Nursing management after

cranial surgery (cont.)

 Frequent assessment of neurological status (every 30 minutes, then hourly) for the first 24-48 hours

 Frequent vital signs

 Limit care activities that increase ICP

 DO NOT cluster cares!

Nursing management: Positioning

 Elevate HOB ( 30 to 45 degrees for supratentorial surgery

 Keep patient flat or slightly elevated if incision

in posterior fossa (infratentorial)

Nursing management after

cranial surgery (cont.)

 Assess for pain and provide pain relief

measures-narcotics mask LOC

 Check drains for placement, patency - strict sterile

technique

 Check dressing for drainage, CSF leak - strict sterile technique

 Suction—limit to < 15 seconds; preoxygenate

 Turn q 2 hrs (slow, gentle movements)

 ROM exercises

Nursing management after

cranial surgery (cont.)

 Assess effect of ill family member on family

 Teach family to provide care to ill family member

 Facilitate family communication and planning

 Provide accurate information to family regarding patient’s condition

 Initiate referrals as needed, i.e speech therapy, physical therapy

 Neuro care complex

 Encompasses science and art of nursing

 Requires technical expertise

 Requires collaboration, communication, compassion