A nurse is caring for a client who has returned to recovery unit following a craniotomy. The nurse can safely place client in which position?

Correct Answer: C. Semi-Fowler’s position with the head in a midline position.

Post-craniotomy clients should be placed in a semi-Fowler’s position and the head is in a midline position to facilitate venous drainage from the head. For nearly all types of craniotomy, the patient is observed for at least the first 24 hours in a neurological intensive care unit (NICU) or general surgical ICU. Basic laboratory tests are sent (complete blood cell count and basic metabolic panel). Neurological examinations are performed by the nursing staff every 1-2 hours and any changes in neurologic status.

• Option A: Placing the client in a Trendelenburg position may increase the swelling of the brain. Frequent neurological checks will be done by the nursing and medical staff to test the brain function and to make sure the body systems are functioning properly after the surgery. The client will be asked to follow a variety of basic commands, such as moving the arms and legs, to assess brain function.
• Option B: The client’s head must be placed in a midline position to facilitate venous drainage from the head and reduce the swelling. The recovery process will vary depending upon the type of procedure done and the type of anesthesia given. Once the client’s blood pressure, pulse, and breathing are stable and he is alert, he may be taken to the ICU or the hospital room.
• Option D: The head of the bed may be elevated to prevent swelling of the face and head. Some swelling is normal. The client will be encouraged to move around as tolerated while in bed and to get out of bed and walk around, with assistance at first, as his strength improves. A physical therapist (PT) may be asked to evaluate the client’s strength, balance, and mobility, and give him suggestions for exercises to do both in the hospital and at home.