A nurse is caring for a client who has just undergone a craniotomy to the left side of the head. In which position does the nurse expect that the healthcare provider will prescribe the client to be placed?
A. Supine
B. Semi-Fowler
C. Prone
D. High Fowler with the head turned to the left side
The correct answer and explanation is:
Correct Answer: B. Semi-Fowler
After a craniotomy, positioning the client properly is essential to promote optimal recovery and prevent complications. The appropriate position is usually Semi-Fowler unless otherwise ordered. Semi-Fowler means the head of the bed is elevated about 30 to 45 degrees. This position helps to reduce intracranial pressure (ICP) by promoting venous drainage from the brain while preventing excessive flexion of the neck that could obstruct cerebral venous outflow.
Placing the client supine is generally avoided because lying flat can increase ICP and reduce venous drainage from the surgical site. If the head were flat, blood or cerebrospinal fluid might accumulate around the surgical area, increasing swelling or pressure. Prone is rarely used after any type of cranial surgery because it can cause facial swelling, airway obstruction, and increased pressure on the surgical site. High Fowler is also not appropriate because sitting the client up too high could lower cerebral perfusion pressure excessively, potentially decreasing blood flow to the brain. Turning the head toward the surgical side, in this case the left side, is not recommended either because it can compress the surgical area and impede venous outflow.
After a left-sided craniotomy, the head is often positioned midline and slightly elevated to maintain proper alignment. The head should be turned away from the side of the surgery to avoid direct pressure on the operative site and to encourage drainage away from the area. Semi-Fowler with the head midline allows for the best balance between promoting drainage and maintaining perfusion.
Nurses must also monitor for signs of increased ICP such as headache, changes in level of consciousness, or changes in pupil size and response. They should adjust positioning if ordered by the provider based on how the client is responding postoperatively.