- Fluid and electrolyte disturbances
- Infection
- Seizures
Planning
- Major goals may include:
- Improved tissue perfusion
- Adequate thermoregulation
- Normal ventilation and gas exchange
- Ability to cope with sensory deprivation
- Adaptation to changes in body image
- Absence of complications
Maintaining Cerebral Perfusion
- Monitor respiratory status; even slight hypoxia or hypercapnia can effect cerebral
perfusion - Assess VS and neurologic status every 15 minutes to every hour
- Strategies to reduce cerebral edema; cerebral edema peaks 24–36 hours
- Strategies to control factors that increase ICP
- Avoid extreme head rotation
- Head of bed may be flat or elevated 30° according to needs related to the surgery and
surgeon preference
Interventions
- Regulating temperature
- Cover patient appropriately.
- Treat high temperature elevations vigorously; apply ice bags, use hypothermia
blanket, administer prescribed acetaminophen.
- Improving gas exchange
- Turn and reposition every 2 hours.
- Encourage deep breathing and incentive spirometry.