AANN Core Curriculum, 7th Edition, Ch. 28 Perioperative Considerations: Digital Version-Chapter 28

Chapter 28

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This chapter outlines nursing care across the preoperative, intraoperative, postoperative, and postdischarge phases of neurosurgery, covering spine, cranial, trauma, cerebrovascular, and functional procedures.<br /><br />Preoperative care establishes the patient’s neurological baseline, identifies comorbidities and learning or communication needs, and clarifies goals and expectations. Nurses coordinate individualized education for patients and families on the procedure, anesthesia, postoperative monitoring, pain and nausea management, mobility and positioning restrictions, devices and drains, and possible complications. Diagnostic testing and preparation vary by procedure and may include laboratory tests, imaging, vascular studies, and neurological assessments. On the day of surgery, nurses verify the correct patient, site, and procedure, communicate risks and needs, and coordinate required resources.<br /><br />Intraoperative nursing focuses on patient advocacy, safety, positioning, equipment readiness, and collaboration with the surgical and anesthesia teams. Requirements differ by procedure and may include fluoroscopy or navigation, specialized instruments and implants, blood-loss management, and neurological monitoring. Accurate counts, specimen handling, and documentation are essential. Emergency trauma readiness includes consistent equipment and checklist preparation; after craniectomy, the exposed brain must be protected from pressure or further injury.<br /><br />Postoperative care prioritizes airway and cardiovascular stability, pain control, fluid balance, and prompt neurological assessment against the preoperative baseline. Nurses monitor for changes in consciousness, neurological deficits, seizures, bleeding, elevated intracranial pressure, respiratory complications, and other procedure-specific risks. Blood pressure control, prevention of nausea and coughing, safe drain management, and early mobility are important when indicated. Effective handoff between care settings supports continuity.<br /><br />Before discharge, patients and families need clear medication and wound-care instructions, guidance on activity, mobility aids or orthotics, and warning signs that require attention. Follow-up appointments, rehabilitation and home-care referrals, and community resources should be arranged as appropriate. Overall, coordinated, procedure-specific nursing care aims to reduce complications and support safe recovery and functional outcomes.

Keywords

neurosurgery nursing

preoperative care

intraoperative safety

postoperative monitoring

neurological baseline

patient education

spine surgery

cranial procedures

trauma care

discharge planning