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may also be done in the surgical suite.
5. Prepare the child as much as possible; tell the child
that he or she will wake up with a large head
dressing.

D. Postoperative interventions

1. Assess neurological and motor function and level of
consciousness.
2. Monitor temperature closely, which may be elevated
because of hypothalamus or brainstem involvement
during surgery; maintain a cooling blanket by the
bedside.
3. Monitor for signs of respiratory infection.
4. Monitor for signs of meningitis (opisthotonos,
Kernig’s and Brudzinski’s signs).
5. Monitor for signs of increased ICP (see Box 31-1; see
also Chapter 38).
6. Monitor for hemorrhage, checking the back of the
head dressing for posterior pooling of blood; mark
drainage edges with marker, reinforce dressing if
needed, and do not change dressing without a specific
prescription.
7. Assess pupillary response; sluggish, dilated, or
unequal pupils are reported immediately because
they may indicate increased ICP and potential
brainstem herniation.
8. Monitor for colorless drainage on the dressing or from
the ears or nose, which indicates cerebrospinal fluid
and should be reported immediately; assess for the
presence of glucose in the drainage (dipstick).
9. Assess the surgeon’s prescription for positioning,
including the degree of neck flexion (Box 31-4).
10. Monitor intravenous fluids closely.
11. Promote measures that prevent vomiting (vomiting
increases ICP and the risk for incisional rupture).
12. Provide a quiet environment.
13. Administer analgesics as prescribed.
14. Provide emotional support to the child and parents,
and promote optimal growth and development.

Box 31-1

Manifestations of Increased Intracranial Pressure
in Infants and Children

Infants

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