Craniotomy pt care

[CorcorVN]

Hi! I'm a LVN in a SNF. I just got a new admit and they have a craniotomy I also have another craniotomy pt coming in next week. I'm trying to find out specifics on nursing interventions I should be aware of this is my first time dealing with a pt with a craniotomy

[Here.I.Stand, BSN, RN]

We clean our crani incisions just w/ sterile cotton swabs and NS.

They're probably pretty stable since they're well enough to discharge to SNF, but you'll want to be on the lookout for neuro changes. Changes in mental status--decreased LOC, confusion--are generally the first sign that something is amiss.

Also watch for surgical site and systemic signs of infection.

Collaborate with PT/OT for management of falls risk, any neuro deficits if they have come out of surgery w/ any, and for deconditioning.

[amoLucia]

Be aware that if there are permanent deficits (cognitive, speech, ADLs, etc) you may be dealing with emotional & coping problems of the pt AND family. Even short-term alterations can cause adjustment problems, incl the pt's ability to participate in rehab (esp depression, despair, refuasal to participate, etc).

Haven't seen a crani in a while, but if they've been shaved, changes to self-image may influence your care also.

[Here.I.Stand, BSN, RN]

Be aware that if there are permanent deficits (cognitive, speech, ADLs, etc) you may be dealing with emotional & coping problems of the pt AND family. Even short-term alterations can cause adjustment problems, incl the pt's ability to participate in rehab (esp depression, despair, refuasal to participate, etc).

Very good point. When you meet the pts (or if you are able to review the chart prior to admission), find out what area of the brain was operated on and look up the possible deficits associated w/ that part of the brain.

[CorcorVN]

We'll the pt LOC decreased couldn't even fallow simple commands! Pt just kept staring off huge difference from yesterday so I got the order and sent him out! I get another craniotomy next week though I read online there head should never be down. To monitor glascow coma scale regularly yesterday it was 11 today I would say 15 so big decrease!!

[Sun0408, ASN, RN]

I'm not sure what you mean by the pt scoring an 11 yesterday and doing well but scoring 15 and doing pour today. A GCS of 15 is normal with no deficits. Am I missing something?

[CorcorVN]

I'm not sure what you mean by the pt scoring an 11 yesterday and doing well but scoring 15 and doing pour today. A GCS of 15 is normal with no deficits. Am I missing something?

No your correct I'm sorry I meant 11 yesterday 7 today

[Sun0408, ASN, RN]

Thanks for the clarification. You were right to get an order to send them out. Sounds like a head CT was needed.

[Here.I.Stand, BSN, RN]

Oh wow, 7 isn't good. It is scary how fast they can turn and you were absolutely right to get the order to send out. Good work!

I hope he's ok

[CorcorVN]

Well he's not back today so I guess they are keeping him there are 5 new admits tonight and one is another craniotomy I'm excited to work with the pt!!!