tumors and neuro
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| Two-thirds childhood brain tumors are | infratentorial;The infratentorial region contains the cerebellum, while the supratentorial region contains the cerebrum. The infratentorial dura is innervated by nerves from C1-C3.
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| Occur all ages, peaks of incidence in | early childhood, 5-7
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| What are the BRAIN TUMORS Classification | Primary or Secondary
Location
Benign or Malignant
Cellular Differentiation
Tissue Type – Histological
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| _______astrocytoma or glioblastoma mutiformea is a type of tumor that starts in the brain or spine. It is called a glioma because it arises from glial cells. The most common site is the brain | Gliomas;A brain glioma=headaches, n/v, seizures.cranial nerve d/o as a result of ICP.optic nerve=visual loss. Spinal cord gliomas= pain, weakness, or numbness in the extremities. Gliomas do not mets by the bloodstream, but can spread via the csf
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| are a diverse set of tumors arising from the meninges,are the most common primary brain tumor,usually benign, | Meningiomas;
Changes in vision, such as seeing double or blurriness
Headaches that worsen with time
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| is a slow-growing tumor of the nerve that connects the ear to the brain. This nerve is called the vestibular cochlear nerve.is not cancerous (benign), | acoustic neuroma;
Abnormal feeling of movement (vertigo)
Hearing loss in the affected ear that makes it hard to hear conversations
Ringing (tinnitus) in the affected ear
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| are noncancerous (benign),cause excessive production of hormones or produce lower levels of hormones,noncancerous growths (adenomas) | Pituitary tumors;
Headache
Vision loss, particularly loss of peripheral vision
Nausea and vomiting
Symptoms of pituitary hormone deficiency
Fatigue
Weakness
Cold intolerance
Constipation
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| Papilledema Headaches Vomiting Change in mental status Seizures IICP Focal symptoms | SIGNS AND SYMPTOMS BRAIN TUMORS
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| Name some treatment for tumors | Surgery
Radiation
Gamma Knife Radiation
Chemotherapy
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| temozolomide (Temodar) – first oral agent nitrosoureas (BCNU) Gliadel wafers Bebacizumab (Avastin) – targeted therapy Intrathecal administration with Ommaya reservoir | Chemotherapy
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| Noninvasive form of radiation treatment Intersection of 201 beams of cobalt-60 Treats brain tumors & AVM’s Stereotactic frame to skull | GAMMA KNIFE
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| POTENTIAL COMPLICATIONS | IICP
Hemorrhage
Respiratory
Neurogenic Pulmonary Edema
Seizures
Infection
Alteration in ADH regulation*
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| A & P REVIEW OF ADH | Regulates body’s water balance
Hormone regulated by hypothalamus
Stored in post. pituitary
Released into circulation & acts on kidney’s distal tubules & collecting ducts
Increases permeability to water
More water reabsorbed
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| caused by a lack of ADH | Diabetes insipidus (DI)
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| excessive release of ADH from the posterior pituitary gland.The result is hyponatremia & sometimes fluid overload.usually found in pt's diag with pneumonia,brain tumors,head trauma,strokes,meningitis,encephalitis,or small-cell carcinoma of the lung. | SIADH
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| UO: 200 mL/hr* SG: 1.005 or < Serum Na+: 145 or > | DI or decrease ADH
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| <30 mL/hr for 2 hr >1.025 Decreased; S/S if Na+ <125* | SIADH or increased ADH
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| Plasma osmolality increased (Plasma osmolarity measures the body's electrolyte-water balance)Treat with: often transient problem, replace fluid vasopressin if needed | DI or decrease ADH
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| Decreased osmolality (Plasma osmolarity measures the body's electrolyte-water balance) Treat with: fluid restriction, Na+ replacement, assess for fluid overload | SIADH or increased ADH
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| Primary hyponatremia Decreased fluid volume and decreased sodium Treated by fluid and sodium replacement | Cerebral Salt Wasting (CSW)
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| Selected Nursing Diagnoses | Decreased intracranial adaptive capacity R/T postoperative edema, hemorrhage
Ineffective tissue perfusion: cerebral R/T cerebral edema, decreased cerebral perfusion, IICP
Acute pain R/T the surgical procedure
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| POST OPERATIVE NEUROLOGIC MANAGEMENT FOCUSES ON | Cerebral edema management
Cerebral perfusion promotion
Fluid balance
Neurologic monitoring
Respiratory status: gas exchange
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| Temodar used to treat glioma causes | myelosuppression;Before giving a dose, the absolute neutrophil count should be at least 1500/μL, and the platelet count should be at least 100,000/μL.
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| the most common type of brain tumors | Metastatic brain tumors from a malignant neoplasm elsewhere in the body
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| signs and symptoms include memory deficits, visual disturbances, weakness of right upper and lower extremities, and personality changes. You recognize this as a | a cranial tumor;A frontal lobe tumor may result in hemiplegia, seizures, memory deficit, personality and judgment changes, and visual disturbances.
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| The primary goal of care after cranial surgery is prevention of increased intracranial pressure (ICP), which includes keeping the body | in alignment
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| Fever, severe headache, vomiting, and nuchal rigidity (neck stiffness) are key clinical manifestations of | meningitis; the bacterial form can cause dementia, seizures, deafness, hemiplegia, and hydrocephalus. The viral has full recovery
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| Persons who have close contact with anyone who has bacterial meningitis should | be given prophylactic antibiotic
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| A side effect of Dilantin is.... | gingival hyperplasia (Phenytoin is used to control certain type of seizures, and to treat and prevent seizures that may begin during or after surgery to the brain or nervous system. )
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| A positive sign of ______in an adult can indicate disease of the brain or spinal cord | Babinski sign (toes curl downward, plantar reflex)
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| Rabies usually is fatal. Management efforts are directed at | preventing the transmission and onset of the disease, and postexposure prophylaxis is administered
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| This usually develops in the first week following a brain insult. Its duration is usually brief (spontaneously resolves in 2-4 wk), although it can last for several months. | Cerebral salt-wasting syndrome
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| Urine specific gravity greater than 1.025 indicate __________, whereas those of less than 1.010 indicate _________. | concentrated urine;dilute urine
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