A 35-year-old patient with an infratentorial craniotomy for a brain tumor was newly admitted to the ICU. Which of the following should the nurse include in the care plan?

Keep the head of bed flat.
Place a small pillow under the neck.

Explanation

• A craniotomy is a surgical opening into the skull to gain access to the intracranial structures to remove a tumor, evacuate blood clot, control hemorrhage or relieve increased ICP. An infrantentorial craniotomy has the incision made at the nape of the neck; the site of surgery is below the tentorium into the infratentorial compartment

• The correct position for an infratentorial approach is to keep the head of bed flat and place a small pillow under the nape of the patient's neck to promote venous return and reduce ICP

• Elevating the head of bed at 30-45˚ is for the supratentorial approach

• Post-craniotomy patients must be monitored for neurovital signs every 30 minutes

• Flexing the neck of this particular patient could disrupt the suture line

• Post-craniotomy patients are at risk for cerebral edema and increased ICP. Fluids at 175 ml/hr could lead to fluid overload

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