Resource Unit (Craniotomy) - Platolon, Honey Bee

Republic of the Philippines
Mindanao State University

COLLEGE OF HEALTH SCIENCES
Marawi City
Name: Honey Bee S. Platolon Subject: NSG 124 Pain and Surgery
Clinical Instructor: Prof. Jamal Tango P. Alawiya, LPT, RN Date: June 17, 2021
Topic: Craniotomy
General Objective: The students are expected to learn about Craniotomy, the purpose why this surgery is needed, its procedure including it risk and complications, instruments
used, perioperative nursing care, and how it is done. The students will understand and apply their knowledge in the actual setting and be gladly competitive.
LEARNING OUTCOMES TIME TEACHING REFERENCES EVALUATION

OUTCOMES FRAME STRATEGIES
What is  A craniotomy is type of brain surgery. It involves removing part of the skull, 30 secs. Content is discussed CRANIOTOMY (2018, The students able to
Craniotomy? or cranium, to access the brain. The bone is replaced when the surgery is done. through the Feb.20) Retrieved from know and understand
prerecorded video. https://www.healthpages. what is Craniotomy.
org/surgicalcare/craniotomy/
What is the The purpose of Craniotomy is to: 1-2 min. Content is discussed CRANIOTOMY (2018, The students able to
purpose of through the Feb.20) Retrieved from know and understand
Craniotomy?  Diagnosing, removing, or treating brain tumors prerecorded video. https://www.healthpages. the purpose of
 Clipping or repairing of an aneurysm org/surgicalcare/craniotomy/ Craniotomy.
 Removing blood or blood clots from a leaking blood vessel
 Removing an arteriovenous malformation (AVM) or addressing an
arteriovenous fistula (AVF)
 Draining a brain abscess, which is an infected pus-filled pocket
 Repairing skull fractures
 Repairing a tear in the membrane lining the brain (dura mater)
 Relieving pressure within the brain (intracranial pressure) by removing
damaged or swollen areas of the brain that may be caused by traumatic injury
or stroke
 Treating epilepsy
How is the  PREPARATION 3-4 min. Content is discussed CRANIOTOMY (2018, The students able to
procedure done? • Tests are ordered by the doctor several days before the procedure. These tests through the Feb.20) Retrieved from know and understand
include blood tests, chest x-ray, electrocardiogram as well as a brain scan by prerecorded video. https://www.healthpages. how the procedure
MRI, CT, or PET. org/surgicalcare/craniotomy/ done.
• The patient should not take anti-inflammatory medicines or blood thinners,
for at least one week before the procedure. The doctor may prescribe
medications to take prior to surgery to remove anxiety and/or prevent
procedure swelling, infection or seizures after surgery.
• The patient should stop smoking, chewing tobacco, and drinking alcohol for
12 weeks before the surgery since these are known to cause complications
during and after surgery and thereby slowing down the healing process.
• The patient should not eat or drink anything for at least 8 – 12 hours before
the procedure.
• Just before the procedure, the patient’s head is shaved over the area where the
craniotomy will be done. The scalp is usually shaved in the shape of a small
horse-shoe.
 ANESTHESIA
Two broad categories of anesthesia are used for a craniotomy: local and general.
Most craniotomies involve both methods of anesthesia; local anesthetic is injected
into the incision site for superficial hemostasis and postoperative pain control, while
general endotracheal anesthesia (GETA) is administered for the duration of the
operation.
 DURING THE SURGERY:

• Once anesthesia takes effect and the patient is asleep, the head is help in a fixed
position using a 3-pin skull fixation device. Next, a drain is placed in the lower
back to drain off the cerebrospinal fluid secreted in the brain and passed
through the spinal column. Removing the spinal fluid helps relieve pressure
from the
brain during surgery. The scalp is then prepped with an antiseptic and an
incision made on the skin. The incision may be made either around the occipital
bone at the nape of the neck or a curved incision above the ear and eye. Care is
taken to avoid the hairline; however, if the surgeon thinks it is needed he may
shave a part of the head and cut there.
• Once the incision is made, the skin, muscles and tissues of the scalp are then
folded back and the skull is exposed. Next, small holes are drilled in the skull
using a high-speed drill and a bone saw to cut out a flap through the holes. This
bone flap is then removed to expose the brain tissues at the area the surgeon
will do surgery or examination.
• Then, the bone flap is put back in place and held with soft wires, plates and
screws. The surgeon may choose to place a drain under the skin to remove blood
and fluid from the site of the surgery. The drain may stay in place for 1-2 days.
The skin and muscles are then sewn together. Finally, a bandage or dressing is
put over the incision.
 AFTER THE SURGERY

• After the surgery, the patient is taken to the recovery room and watched closely.
The vital signs (that is, temperature, blood pressure, heart rate, and breathing)
are monitored. The breathing tubes and catheters are usually left in place and a
drip may be put into a vein to give fluids. After the patient wakes up, the patient
is then transferred to the ICU (intensive care unit) for further neurological
observation. The patient is asked to do simple commands like move their hands,
legs, fingers, toes to check for complications from surgery.
• Nausea and headaches are common after a craniotomy. Medicines can be given
to control these along with seizures and swelling in the brain following surgery.
• If everything is going as expected, the patient is transferred to a regular hospital
room, where the patient may stay for 3-14 days depending on the type of brain
surgery and if there are any complications.
• The patient is discharged with instructions to follow at home and to make an
appointment to see the doctor in 7-10 days to have stitches or staple removed.
What are the • JANSEN RETRACTOR 2-3 min Content is discussed CRANIOTOMY (2018, The students able to
instruments - used for retraction during mastoid surgical procedures through the Feb.20) Retrieved from know and understand
used? • WEITLANER RETRACTOR prerecorded video. https://www.healthpages. the instruments used
- used to deviate and hold tissues. org/surgicalcare/craniotomy/ and its function.
• SCALPEL HANDLE
- intended to be use with surgical blades for tissue separation and other
procedure that require a sharp surgical blade to puncture or cut.
• SOLID BAR HANDLE FOR GIGLI SAW
- used for sawing bones, commonly amputations, but may also be used in
neurosurgery for cutting cranial flaps.
• ADSON FORCEPS
- used for handling dense tissue, such as in skin closures, holds objects, or
provide hemostasis.
• BACKHAUS TOWEL CLAMP
- used for grasping tissue, securing towels or drapes, and holding or
reducing small bone fractures.
• CUSHING BRAIN FORCEPS
- used on delicate tissue
• RUSKIN RONGEUR
- used for clearing space or scooping out in bone to increase access to the
surgical area or bone remodeling.
• FOERSTER SPONGE FORCEPS
- Firmly clasp gauze squares that will hold abundant fluids and blood from
the opera table region or surgical hemostasis.
• HALSTED MOSQUITO FORCEPS
- clamping vessels and controlling blow flow and other clamping tasks in
general surgical procedures.
• STILLE-LISTON BONE FORCEPS
- used for cutting through hard bony texture to get better access to the
surgical site.
MAYO HEGAR Nh
•
- used to hold a suturing needle during surgical procedures.
• GIGLI SAW WIRE
- used for cutting through the skull in brain surgery.
• METZENBAUM DISSECTING SCISSOR
- Used for cutting delicate tissue and blunt dissection.
What are the Complications from craniotomy are usually of 3 types: 1 min Content is discussed CRANIOTOMY (2018, The students able to
possible risks through the Feb.20) Retrieved from know and understand
and  Those normally associated with any kind of surgery. prerecorded video. https://www.healthpages. the possible risk and
complications  Those related to the craniotomy procedure org/surgicalcare/craniotomy/ complications after the
that may arise  Those related to the surgery done on brain and nerves after the procedure.
after the craniotomy
procedure?
The common risks associated with any types of these surgery include bleeding;
infections; blood clots; risks related to anesthesia like light-headedness, low
blood pressure, etc.
What is the PREOPERATIVE 3-4 min Content is discussed CRANIOTOMY (2018, The students able to
perioperative • Protection of the CNS is the major priority of care for the patient awaiting a through the Feb.20) Retrieved from know and understand
nursing care in craniotomy. prerecorded video. https://www.healthpages. the perioperative
the procedure? • Detailed assessment and documentation of the patient’s preoperative org/surgicalcare/craniotomy/ nursing care which
neurological status are imperative for accurate post-operative evaluation. includes the before,
• In pituitary patient, evaluation of endocrine function is necessary to prevent INTRAOPERATIVE during, and after the
intraoperative and postoperative complication. PHASE (2014, Jan. 23) procedure.
• Routine preoperative screening should be performed (CBC, BUN, FBS, chest Retrieved from
x-ray, ECG, cross match). https://nurseslabs.com/int
• Preoperative teaching is important to both patient and family about raoperative-phase/
postoperative period, which include the following issues
• Patient should know that all or part of his/her head’s hair will be shaved to do
the operation; facial edema, suspected complications such as infection,
hemorrhage, anesthesia problems, and also suspected neurological deficit.
INTRAOPERATIVE
• Prepares the surgical set-up
• Maintains surgical asepsis while draping and handling instruments
• Assists the surgeon by passing instruments, sutures, and supplies.
• Respond to request from the surgeon, anesthesiologist or anesthetist
• Obtain supplies, deliver supplies to the sterile field, and carry out the nursing
care plan.
POSTOPERATIVE
• Preserving adequate cerebral perfusion

• Promoting arterial oxygenation
• Providing comfort and emotional support
• Maintain surveillance for complications
• Educate the patient on deep-breathing exercises to help re-expand the lungs
and prevent pneumonia.
• Frequent neurological checks will be done by to test the brain for function
and to make sure body systems are functioning properly after your surgery.
• Initiating early rehabilitation

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Republic of the Philippines

Mindanao State University

LEARNING OUTCOMES TIME TEACHING REFERENCES EVALUATION

 DURING THE SURGERY:

 AFTER THE SURGERY

• Preserving adequate cerebral perfusion

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