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Difficulty: HardBasic Care and Comfort

A client who underwent a supratentorial craniotomy two days ago requires morning hygiene care and a complete bed linen change. The client is alert, reports a mild headache, and has stable vital signs. Which approach must the practical nurse use when delivering this basic care?

  1. Keep the head of the bed elevated at 30 degrees during the procedure and ensure the client's neck remains in a neutral, midline alignment.Answer
  2. B
    Lower the bed to a flat, supine position temporarily to ensure proper body mechanics while log-rolling the client to change the sheets.
  3. C
    Administer a prescribed PRN opioid analgesic for the headache before the bath, prioritizing immediate pain relief over strict positional precautions.
  4. D
    Instruct the client to assist with the turn by tightly gripping the side rails and pulling their chin toward their chest.

Answer

The practical nurse must maintain the head of the bed at a 30-degree elevation and keep the client's neck in a neutral, midline position throughout the hygiene care and linen change.
Following a craniotomy, preventing increased intracranial pressure (ICP) is a critical nursing priority. Maintaining the head of the bed at 30 degrees and keeping the neck in a neutral, midline alignment promotes optimal venous return from the brain via the jugular veins. Even during basic care activities such as bathing or linen changes, these strict positional precautions must be maintained to ensure physiological integrity.

Step-by-Step Solution

1
Identify the client's postoperative status and specific physiological risks.
The client had a supratentorial craniotomy two days ago, placing them at high risk for increased intracranial pressure (ICP).
Understanding the surgical history dictates which routine care modifications are strictly necessary.
2
Evaluate standard hygiene procedures against postoperative constraints.
Standard bed baths and linen changes often involve lowering the head of the bed; however, this standard practice is contraindicated for this specific client.
A flat position decreases cerebral venous drainage, which can dangerously elevate ICP.
3
Select the intervention that provides necessary basic care while maintaining physiological safety.
The nurse modifies the care delivery by keeping the head of the bed elevated and preventing any neck flexion during turning.
A 30-degree elevation with neutral neck alignment optimizes venous return from the brain, preventing ICP spikes during routine movement.

Key Concept

Post-craniotomy physiological positioning during basic care
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Topics

Basic Care and Comfort

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