Page 2046 - Saunders Comprehensive Review For NCLEX-RN

▪ To protect the operative site from pressure and minimize tension on the suture
line, position the client on the side, with a pillow under the head for support,
and not on the back.

Infratentorial Surgery

▪ Infratentorial surgery involves surgery below the tentorium of the brain.
▪ The PHCP may prescribe a flat position without head elevation or may prescribe
that the head of the bed be elevated at 30 to 45 degrees.
▪ Do not elevate the head of the bed in the acute phase of care following surgery
without an PHCP’s prescription.

Supratentorial Surgery

▪ Supratentorial surgery involves surgery above the tentorium of the brain.
▪ The PHCP may prescribe that the head of the bed be elevated at 30 degrees to
promote venous outflow through the jugular veins.
▪ Do not lower the head of the bed in the acute phase of care following surgery
without a PHCP’s prescription.

Box 58-12

Aneurysm Precautions

▪ Maintain the client on bed rest in a semi-Fowler’s or a side-lying position.

▪ Maintain a darkened room (subdued lighting and avoid direct, bright, artificial
lights) without stimulation (a private room is optimal).
▪ Provide a quiet environment (avoid activities or startling noises); a telephone in
the room is not usually allowed.
▪ Reading, watching television, and listening to music are permitted, provided
that they do not overstimulate the client.
▪ Limit visitors.
▪ Maintain fluid restrictions.
▪ Provide diet as prescribed; avoid stimulants in the diet.

▪ Prevent any activities that initiate the Valsalva maneuver (straining at stool,
coughing); provide stool softeners to prevent straining.
▪ Administer care gently (such as the bath, back rub, range of motion).

▪ Limit invasive procedures.
▪ Maintain normothermia.
▪ Prevent hypertension.
▪ Provide sedation.
▪ Provide pain control.

2046