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Chapter 9

Unit 2: Nursing care of clients with neurosensory disorders

Brain tumors (Pg. 91) How classified? To the cell or tissue of origin
Supratentorial tumors occur where? In the cerebral hemispheres above the tentorium cerebella
Infratentorial tumors occur where? Below the tentorium cerebella -Brainstem and cerebellum
What do brain tumors do? Apply pressure to surrounding brain tissue; resulting in decreased outflow of CSF -Increased intracranial pressure -Cerebral edema -Neuro deficits
Tumors involving the pituitary gland can cause? Endocrine dysfunctions
Primary malignant brain tumors originate where? From neuro tissue; rarely metastasize outside the brain
Secondary malignant brain tumors originate where? From somewhere else in the body and spread to the brain
Where do benign brain tumors develop from? Meninges or cranial nerves; do not metastasize
Are there any routine screening procedures to detect brain tumors? No
Risks to developing brain tumors? Genetics, env't, ionizing radiation, electromagnetic fields, previous head injury
S/S of a brain tumor: (Pg. 92) Dysarthria , dysphagia, positive Romberg and positive babinski's -Vertigo, hemiparesis, loss of gag or blink (cranial nerves) Etc.
Lab tests for brain tumors? CBC & differential rule out anemia Blood alcohol & toxicology to rule out TB/HIV if social conditions warrant
Dx procedures for brain tumors X-ray, CT, MRI, PET, cerebral angiography
Cerebral biopsy: Dx procedure for brain tumors -Cellular pathology -Possible image guiding (MRI/CT) -What is seen to be abnormal is obtained then sent to pathology
Benefits to biopsy: Minimally disruptive to other brain areas -Decreased recovery time & less risks than open craniotomy
Negative to biopsy: Does not remove/debulk tumor -Could be inconclusive -Misdx can occur
Preprocedure nursing actions for a biopsy: -AED, aspirin -If on AED, con't to avoid seizures -Discontinue aspirin 72hrs prior to the procedure
Postprocedure for a biopsy: -Normal activities after recovery from general anesthesia -Clean/dry incision -If sutures; remove 1-7 days after -Avoid driving, etc. until dx known/follow up apt.
What kind of pain meds are used to tx headaches associated w brain tumors? Nonopioids; to avoid decreasing the client's LOC
What med is used to reduce cerebral edema? Corticosteroids
What med is used to control/prevent seizures? Anticonvulsant drugs (AEDs)
What reduces the risk of stress ulcers? H2 antagonists; decrease acid content of the stomach -High stress levels
What meds are used for nausea/vomiting? Antiemetics -D/t intracranial pressure or tx required
Surgical interventions for a brain tumor: Craniotomy
What is a craniotomy? Complete or partial resection of brain tumor through surgical opening in the skull
Preoperative nursing actions for a craniotomy: -Support/education, aspirin, other meds, what should be completed? -Have significant other or family member be present to hear questions/answers about surgery education -Discontinue aspirin 72hrs before -Doctor needs to know about other meds -Living will & DPOA should be completed
Postoperative nursing actions for a craniotomy: VS, pain, HOB, straining VS & neuro closely monitor; glasgow scale -Tx pain -HOB ^ 30 & in a neutral position to prevent increased intracranial pressure -Straining (BM, moving up in bed) avoided to prevent ^ ICP
Greatest risks to a craniotomy? Postop bleeding & seizures
Complications to brain tumors: SIADH & DI
SIADH as a complication to a brain tumor Fluid retained d/t overproduction of vasopressin (ADH) by the posterior pituitary gland -Hypothalamus damaged
How do you tx SIADH? Fluid restriction, oral demeclocycline (Declomycin) -Tx hyponatremia
S/s of SIADH commonly seen: Headache, vomit, disoriented
DI as a complication to a brain tumor Large amounts of urine are excreted d/t a deficiency of ADH from the PP -Hypothalamus damaged
Tx of DI? Massive fluid replacement, lab values, replace nutrients
Created by: mary.scott260!