The nurse is caring for a client who just returned from a supratentorial craniotomy, during which a large tumor was removed. Which of the following interventions by the nurse are appropriate for this client?
monitor for signs of increased intracranial pressure
apply antiembolism stockings to the client once he is alert
turn the client every 2 hours from the operative side to the nonoperative side
Numbers 1 and 4 are correct.
Rationale: The head of the bed should be elevated 30 degrees to promote venous drainage and prevent hemorrhage caused by excessive blood flow to the brain. The client should be monitored for signs of increased intracranial pressure such as increased blood pressure with widening pulse pressure and altered level of consciousness. Elevating the head of the bed 90 degrees is incorrect as increased hip flexion should be avoided. Neurological status should be monitored more frequently in the client immediately post-op, often every 15 minutes during the first hour, then every 30 minutes for the second hour, or according to health care provider orders. Antiembolism stockings should be in place either when the client returns to the room or immediately upon arrival. The client should not be positioned on the operative side due to the risk of brain shift.
