Sara Gardiner is the perioperative nurse in the circulating role in OR 2,and is planning for her three neurosurgical procedures for the day.She is explaining the basic processes of the three procedures to the scrub person and double-scrubbed surgical technology student:(1)a VP shunt insertion(2)a reconstructive craniosynostosis for an infant with severe deformity,and (3)exploration of a severe head injury with increased intracranial pressure (ICP)to evacuate a hematoma and possible brain tissue.To give the brain room to swell in the third procedure,the bone flap may need to be sterile-wrapped and stored,for later replacement.Sara asks the student to name the appropriate surgical approach to the brain for each of the procedures.She expects the correct sequence to be:

Question

Quizplus · Accepted Answer

A burr hole is the minimum exposure made to gain access to the brain.Burr holes are necessary for many neurosurgical procedures and can be used to access the intracerebral ventricles for the placement of a ventricular catheter (VP shunt)to drain obstructed CSF.Craniectomy is the permanent removal of a section of the cranium using burrs and rongeurs to enlarge one or more burr holes.Craniectomy is indicated as treatment for craniosynostosis in infants and young children.A craniotomy may be performed to evacuate intracranial hematomas,tumors,or vascular lesions not accessible through a burr hole.The bone plate may be separated from the soft tissues,removed from the skull,and set aside for replacement at the end of the procedure.If intracranial swelling at the end of the procedure is a major concern,the bone plate may be frozen and stored in a sterile container according to hospital protocol to be replaced on the patient at a future date when the reduced ICP and swelling permits.

Sara Gardiner Is the Perioperative Nurse in the Circulating Role