Pre - Operative management of a patient undergoing Cranial Surgery. Medical Management_- ¢ CT Scan / MRI (for more enhanced contrast imaging of tissues) to demonstrate the lesion & to see the degree of surrounding cerebral edema, ventricular size & brain tissue displacement. ¢ Cerebral Angiography for checking the tumor's blood supply & also for obtaining information about the underlying cerebral vasculature. ¢ Transcranial doppler flow studies are done to evaluate blood flow within the intracranial blood vessels. e Medications that are to be given preoperatively includes - 1. Phenytoin/-levera for controlling post op. Seizures. 2. If the patient is having any tumor then Dexamethasone can be given pre operatively to reduce cerebral edema. 3. Mannitol (hyperOsmotic agent) & lasix can be given if the patient tends to retain fluids (these can be given before and even during the Surgeries as well). 4. Antibiotics as prophylaxis can be given according to age of the patient. 5. Benzodiazepines such as diazepam & lorazepam can be given to reduce theanxiety of the patient and make him relaxed. e An indwelling catheter is inserted to drain the bladder as diuretics are administered. Central & Arterial lines are to be inserted for administration of medications, fluids during the surgery & for measuring the blood pressure more accurately. Nursing Management - Tell the patient to take a bath before the surgery and wash the hairs with a medicated cleansing solution. Check LOC & GCS. Identify for any neurological defectbefore the surgery such as visual & auditory changes, paralysis, bowel & bladder dysfunction, personality or speech disorders, etc. Check for proper motor function of both upper & lower extremities. As there can be chances of motor defects so trochanter rolls are to be applied to the extremities & feet are to be positioned against a foot board and ankles are to be supported in a neutral position by orthotic boots. Educate the patient and family members regarding the surgery, its procedure, its need and what can be the post op complications & effects.Post - Operative management of a patient undergoing Cranial Surgery. (1) preserving adequate cerebral perfusion -positiong (head elevated) (2) keep the incision dry and clean (3)watch incision for singns of infection or complication (An incision that becomes red or warm to touch may be infected) (4)vital sings and neurogical status monitored (5) pharmacological agent's may be prescribed to control increasing ICP. (6) Respiratory status is assessed depth and pattern of Respiration.A patent airway is maintained (7) Turn side to side every 2 hours.(Craniotomy pt. Should not be turned on the side of cranial defect) (8) signs of infection are monitored by checking craniotomy site. (9)Pt . Is encouraged to move while on bed to prevent pressure sores. (10)sequential compression device my be applied to legs to prevent blood clots. Patient Education Fatigue: It may take 6 weeks or more for your energy level to return to normal. You will probably feel very fatigued for the first 2 weeks then notice a gradual increase in energy thereafter. Nausea: Post-operative nausea may be related to your pain medications. Ifpossible, take the medication with food. Eat small, frequent meals and avoid spicy or fried food. Constipation: This is a common problem after surgery due to anesthesia, inactivity, and prescription pain medications. It is helpful to increase water, fresh fruits and vegetables, fiber and bran in your diet. Also, take over-the-counter docusate sodium tablets, 100 mg 1 to 2 times per day to keep your stools soft. You may decrease the amount taken if your stools become too soft. If constipation is not relieved with these measures, you may take Milk.of. Magnesia,.1 to 2 tablespoons every 12 hours. If this doesn’t work, it is recommended that you use an enema orrectal suppository to assist withevacuation of the rectum. This is preferred over heavy straining. If an enema or rectal suppository is not successful, please notify us. Side effects of steroid medications: You may be discharged from the hospital on a steroidmedication (dexamethasone) to decrease brain swelling. Some of the possible side effects of steroid medications include: dizziness, appetite changes, emotional changes, heartburn, constipation, insomnia, and fluid retention. Steroids help ease the aches and pains that you feel on a day to day basis so when you are tapering off of the steroids, you might feel these symptoms return. You may also feel tired and emotionally down for a few days. Just restand know that you will feel better in time.