Unit 2: Nursing care of clients with neurosensory disorders
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| Brain tumors (Pg. 91) How classified? | To the cell or tissue of origin
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| Supratentorial tumors occur where? | In the cerebral hemispheres above the tentorium cerebella
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| Infratentorial tumors occur where? | Below the tentorium cerebella
-Brainstem and cerebellum
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| What do brain tumors do? | Apply pressure to surrounding brain tissue; resulting in decreased outflow of CSF
-Increased intracranial pressure
-Cerebral edema
-Neuro deficits
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| Tumors involving the pituitary gland can cause? | Endocrine dysfunctions
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| Primary malignant brain tumors originate where? | From neuro tissue; rarely metastasize outside the brain
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| Secondary malignant brain tumors originate where? | From somewhere else in the body and spread to the brain
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| Where do benign brain tumors develop from? | Meninges or cranial nerves; do not metastasize
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| Are there any routine screening procedures to detect brain tumors? | No
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| Risks to developing brain tumors? | Genetics, env't, ionizing radiation, electromagnetic fields, previous head injury
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| 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.
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| Lab tests for brain tumors? | CBC & differential rule out anemia
Blood alcohol & toxicology to rule out
TB/HIV if social conditions warrant
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| Dx procedures for brain tumors | X-ray, CT, MRI, PET, cerebral angiography
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| 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
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| Benefits to biopsy: | Minimally disruptive to other brain areas
-Decreased recovery time & less risks than open craniotomy
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| Negative to biopsy: | Does not remove/debulk tumor
-Could be inconclusive
-Misdx can occur
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| Preprocedure nursing actions for a biopsy: -AED, aspirin | -If on AED, con't to avoid seizures
-Discontinue aspirin 72hrs prior to the procedure
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| 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.
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| What kind of pain meds are used to tx headaches associated w brain tumors? | Nonopioids; to avoid decreasing the client's LOC
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| What med is used to reduce cerebral edema? | Corticosteroids
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| What med is used to control/prevent seizures? | Anticonvulsant drugs (AEDs)
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| What reduces the risk of stress ulcers? | H2 antagonists; decrease acid content of the stomach
-High stress levels
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| What meds are used for nausea/vomiting? | Antiemetics
-D/t intracranial pressure or tx required
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| Surgical interventions for a brain tumor: | Craniotomy
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| What is a craniotomy? | Complete or partial resection of brain tumor through surgical opening in the skull
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| 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
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| 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
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| Greatest risks to a craniotomy? | Postop bleeding & seizures
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| Complications to brain tumors: | SIADH & DI
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| SIADH as a complication to a brain tumor | Fluid retained d/t overproduction of vasopressin (ADH) by the posterior pituitary gland
-Hypothalamus damaged
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| How do you tx SIADH? | Fluid restriction, oral demeclocycline (Declomycin)
-Tx hyponatremia
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| S/s of SIADH commonly seen: | Headache, vomit, disoriented
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| 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
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| Tx of DI? | Massive fluid replacement, lab values, replace nutrients
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