GROUP 1

CRANIOTOMY Opening the skull to gain access to intra cranial structures. Performed to remove a tumor, relieve elevated ICP, evaluate a blood clot and and control hemorrhage.

3 APPROACHES: 1. SUPRATENTORIAL CRANIOTOMY 2. POSTERIOR FOSSA 3. TRANSPHENOIDAL

BURR HOLES circular opening made in the skull by either a hand drill or an automatic craniotome to determine the presence or cerebral swelling or injury. CRANIECTOMY- excision of a portion of a skull CRANIOPLASTY- repair of cranial defect using plastic or metal plate

PRE-OPERATIVE MANAEMENT: CT scan MRI Cerebral angiography Transcranial Doppler flow Anti-seizure medications Corticosteroids Fluid restriction Diazepam

PRE-OPERATIVE NURSING MANAGEMENT: Evaluate LOC Assess patients and familys understanding and reaction to surgical procedure Assess emotional status Encourage ambulation Shave surgical site Insert indwelling urinary catheter

POST-OPERATIVE MANAGEMENT: o o o o o Arterial line and CVP line Supplemental oxygen Reduce cerebral edema Relieve pain and prevent seizures Monitor ICP

THORACOTOMY PRE-OPERATIVE MANAGEMENT: a) b) c) d) e) f) g) Assess breath sounds Assess retained secretions Bronchoscopic examination Chest x-ray ECG BUN and creatinine Glucose tolerance

PRE-OPERATIVE NURSING MANAGEMENT: I. II. III. Improve airway clearance Relieving anxiety Teaching the patient

POST-OPERATIVE MANAGEMENT: Check vital signs Administer oxygen Careful repositioning Medication for pain

CHEST TUBE THORACOSTOMY -is a surgical opening in the chest wall and inserting. A thoracostomy tube (chest catheter) is inserted into the chest wall above the area of the second or third rib. A local anesthetic (xylocaine 1% or 2%) is administered and an incision is then made into the pleural space of the chest wall. The tube is inserted, positioned, and clamped, and silk sutures are use to secure the chest tube in place. TYPES OF CHEST DRAINAGE 1. CLOSED-CHEST DRAINAGE -known as the water seal drainage. -use to restore the negative pressure that has been lost inside the pleural space owing to pneumothorax, and to prevent additional air and fluid from entering the pleural cavity. A Simple One - bottle systemIt provides water-seal gravity drainage. The gravity system allows the flow of air or water into the bottle when the pressure in the pleural space is sufficient to displace the water in the glass rod. Two bottle water seal drainage system-It involves the addition of a suction source and a suction-control bottle. These are added if gravity is not sufficient to clear the air or fluid from the chest. The suction-control bottle allows the entrance of air which bubbles through the column of water in the glass rod, reducing the amount of negative pressure from the suction source. This is sometimes called a suction-breaking bottle. A three-bottle system- It involves the addition of a separate collection bottle so that the drainage may be separate collection bottle so that drainage may be measured and inspected as it comes from the chest. Pleur-evac-It is a commercially available product incorporating all the features all ready discussed. It is a single light weight unit which indicates the amount of air bubbling through the suction chamber from the atmosphere. It calibrates the exact amount of negative pressure in the pleural space and has a client leak air flow meter to indicate the amount of air coming from the individual.

P O S E : Remove excess air, blood, or fluid from the pleural cavity, Reduce the size of the pleural space, and restore negative intrapleural pressure to promote lung expansion. Remove tumors of the lung, bronchus or chest wall Repair or reverse structures contained in the thorax such as open heart surgery or repair of a thoracic aneurysm Repair trauma to the chest or chest wall, such as penetrating chest wounds or crushing chest injuries. Sample a lesion for biopsy