Skull radiographs and a CT scan indicate a depressed skull fracture with a subdural hematoma. In planning care, the nurse anticipates that the patient will:

• A. Receive life-support measures until stable.
• B. Receive immediate burr holes for rapid decompression.
• C. Be treated conservatively with close neurologic monitoring.
• D. Undergo craniotomy for evacuation of blood and decompression.

Answer: (D)

The main concept here is that a depressed skull fracture with a subdural hematoma creates a mass effect that must be surgically relieved to prevent brain injury. When bone fragments are driven inward and a subdural clot compresses brain tissue, definitive relief of intracranial pressure requires removing the hematoma and addressing the fractured bone.

A craniotomy allows the surgeon to elevate depressed bone fragments, evacuate the subdural blood, control any bleeding, and provide decompression so the brain can recover. This approach directly treats the space-occupying lesion and its pressure effects, which conservative monitoring cannot correct and which immediate burr holes may not adequately accomplish in the setting of a depressed fracture. Life-support measures can support the patient, but they don’t remove the mass effect. Therefore, the planned care is craniotomy for evacuation of blood and decompression.