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Nursing Semester 3 > Beth - Week 4 - Exam 2 > Flashcards

Beth - Week 4 - Exam 2 Flashcards

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1
Q

what is a brain tumor?

A

an abnormal growth of tissue in the brain or central spine

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2
Q

tumors are referred based on what?

A
  • where tumor cells originated

- cancerous (malignant or non-meaning benign)

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3
Q

what are the characteristics of a benign tumor?

A
  • least aggressive
  • Originate from cells within or surrounding the brain
  • Do not contain cancer cells
  • Grow slowly, and typically have clear borders that
    do not spread into other tissue
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4
Q

what is a malignant tumor?

A

tumors contain cancer cells and often do

not have clear borders

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5
Q

what are the characteristics of a malignant tumor?

A
  • Life threatening because
  • Grow rapidly
  • Invade surrounding brain tissue
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6
Q

what is primary tumor?

A

starts in the brain

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7
Q

what is a metastatic tumor?

A

secondary brain tumors

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8
Q

which cancers metastasize to the brain?

A

breast cancer and lung cancer

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9
Q

what are the 6 different types of brain tumors?

A 
gliomas 
primary CNS lymphomas
meningioma
acoustic neuroma 
pituitary adenoma
hemangioblastoma
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10
Q

where do gliomas occur?

A

they infiltrate the brain (glioblasts)

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11
Q

where do primary CNS lymphomas occur?

A

lymphocytes

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12
Q

where do meningiomas occur?

A

they cover the brain tissue (meninges)

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13
Q

where do acoustic neuromas occur?

A

covering of any C.N.

- hard to find

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14
Q

where do the pituitary adenomas occur?

A

neoplasm of a gland

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15
Q

where do hemangioblastomas occur?

A

blood vessels

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16
Q

what are the grading scale for brain tumors?

A 
grade I - well differentiated
grade II - moderately differentiated (better outcome)
grade III - poorly differentiated 
grade IV - unable to differentiate 
** III and IV - 3 - 6 mo to live
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17
Q

what do gliomas affect?

A

affects the tissue that forms the cells and fibers of brain

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18
Q

gliomas: what grades are considered malignant and benign?

A

grade 1/2: benign

grade 3/4: malignant

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19
Q

what is a specific type of glioma?

A

astrocytoma

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20
Q

TEST: what are the characteristics of astrocytomas?

A

common/aggressive/malignant

- fast growing “fingers” or “star”

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21
Q

what glioma is the WORST?

A

glioblastoma multiforme

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22
Q

meningiomas are common in what group?

A

middle age, female, adults

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23
Q

how to meningiomas present?

A

encapsulated; compression rather than invasion

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24
Q

where do meningiomas present?

A

any part of brain from deep ventricles to the skull base

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25
Q

T/F: meningiomas are usually malignant

A

FALSE - they are usually benign

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26
Q

what are clinical manifestations of meningiomas?

A
  • INCREASED ICP *
  • severe HA
  • change in vision
  • hemiparesis
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27
Q

what C.N does acoustic neuromas affect?

A

C.N VIII (acoustic)

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28
Q

what are the two characteristics of acoustic neuromas?

A
  • slow growing

- benign

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29
Q

what population should we be aware of when it comes to acoustic neuromas?

A

> 50 y/o males

  • can’t hear well
  • should check out everything
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30
Q

what are the clinical manifestations of acoustic neuromas?

A
  • hearing loss
  • tinnitus
  • vertigo
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31
Q

who is at risk for a hemagioblastoma?

A

persons < 40 y/o w/ hemorrhage

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32
Q

those with a hemagioblastoma are at risk for what?

A

risk for CVA

33
Q

what are the characteristics of pituitary adenomas?

A
  • usually benign, small, encapsulated, and slow growing
34
Q

what population are pituitary adenomas at a higher risk for?

A

higher risk in women of child bearing ye`ars

35
Q

the symptoms of pituitary adenoma are _________?

A

symptoms of pituitary hormonal dysfunction

- tell tale signs: change in ability to smell

36
Q

primary CNS lymphomas are higher with what types of patients?

A
  • *higher with transplant recipients**
  • immunodeficiency syndrome
  • AIDS patients
37
Q

what are characteristics of primary CNS lymphomas?

A
  • Symptoms of lump or mass within the brain
  • It is nearly always due to diffuse large B-cell lymphoma (DLBCL), a type of high-grade nonHodgkin
    lymphoma
38
Q

what are the main assessment finding for someone with a brain tumor?

A
  • Personality changes
  • Confusion
  • Vision changes
  • HEADACHE (severity/pathway/different than normal ones; same tx doesn’t work)
  • SEIZURES
  • VOMITING/NAUSEA
39
Q

what are other assessment findings for someone with a brain tumor?

A
  • CSF obstruction – hydrocephalus (IICP)
  • Papilledema
  • Altered Sensorium
  • Motor abnormalities - weakness; paralysis
  • Sensory Abnormalities - depends on where the tumor is located
40
Q

T/F assessment can be specific to the lobe of the tumor location

A

TRUE

41
Q

where are the most obvious location findings?

A 
FRONTAL (behavior)
TEMPORAL (aphasia)
PARIETAL (loss of memory)
CEREBELLUM (balance)
OCCIPITAL (vision)
42
Q

`what are the least obvious location findings?

A 
Subcortical
Meningeal
Metastatic
Thalamus
Sellar (pituitary)
Fourth Ventricle
Cerebellopontine
Brain stem
43
Q

what does the frontal lobe control?

A

judgement, foresight, voluntary movement

44
Q

what does the motor cortex control?

A

movement

45
Q

what does broca’s area control?

A

speech

46
Q

what does temporal lobe control?

A

intellectual and emotional functions

47
Q

what does brainstem control?

A

swallowing, breathing, heartbeat, wakefulness center, and other involuntary functions

48
Q

what does cerebellum control?

A

coordination

49
Q

what does wernicke’s area control?

A

speech comprehension

50
Q

what does occipital control?

A

visual

51
Q

what does the temporal lobe control?

A

hearing

52
Q

what does the parietal lobe control?

A

comprehension of language

53
Q

what does the sensory cortex control?

A

pain, heath, and other sensations.

54
Q

what are the diagnostics of a brain tumor?

A 
CT - rapid 
MRI (MRA &amp; MRV) - gold standard 
PET
Stereotactic craniotomy - very precise; don't destroy good tissue 
Biopsy
LP-CSF
EEG (seizures → tx) 
Blood tests (HIV)
Bone Marrow
55
Q

what is the medical management for brain tumors ?

A
  • radiation (stereotactic - aimed at tumor)
  • chemotherapy (IV and the BBB; Intrathetcal; Intraventricular - ommaya reservoir)
  • steroids
  • combination
  • IV autologous bone marrow
56
Q

what are the surgical management for brain tumors?

A

removal of all
removal of part
shunts

57
Q

what surgeries are used for management of brain tumors?

A 
Craniotomy (any opening)
Craniectomy (Bone flap)
Cranioplasty
Burr Holes (For Subdural Hematoma)
Radio-isotope Implants
Stereotactic
Transphenoidal Hypophesectomy
58
Q

what are the NIs for a patient who had a craniotomy?

A
  • Assess for changes in LOC
  • HOB 30 degrees
  • Keep dressing in place to reduce edema and swelling
  • Treat headache/nausea
  • Assess drainage, bleeding and odor
59
Q

what is the post op assessment, care and

concerns following Crani Surgery?

A 
- NEURO STATUS
´Baseline
´When can they take fluids?
- HEMORRHAGE and SWELLING
´Steroids (usually w/ tumor resection)
60
Q

what are the characteristics of Diabetes Insipidus?

A
  • No secretion of ADH
  • U/O HIGH (>300-400cc/hr)
  • sp. gr. < 1.005
  • dehydrated
61
Q

what are the priorities with DI?

A

Assess electrolyte imbalance

Intake verse output

62
Q

what are the nursing interventions for DI?

A
  • fluid replacement Drink to Thirst
  • DDAVP (desmopressin acetate)
  • Assess for SIADH
  • WATER INTOXICATION
63
Q

what are the characteristics of Syndrome of Inappropriate Anti-Diuretic Hormone?

A
  • Intake verses output
  • too much ADH
  • water retention
  • U/O < 20 cc/hr
  • sp. gr. > 1.025
64
Q

what are the priorities for SIADH?

A

assess electrolyte imbalance (Na+)

65
Q

what are the NI for SIADH?

A
  • fluid restriction
  • diuretics
  • frequently assess lytes
  • assess s/sx dehydration or overload
  • specific gravity = #1 test
66
Q

what is the post-op care for meningitis following crani surgery?

A
  • Prophylactic antibiotics (have to cross BBB)

- Drain and incision sites—assess

67
Q

what is the post-op care for respiratory problems following crani surgery?

A
  • Emergency equipment? (have suction)
  • Suction when necessary
  • Don’t encourage coughing
  • DO encourage deep breathing and use I.S.
68
Q

what is the post op care for seizures following crani surgery?

A
  • Anticonvulsants (maybe)
  • sometimes prophylactically
  • protect airway, call MD, have them ask what we saw/decide
69
Q

what is the post op care for CSF leak following a crani surgery?

A
  • Call MD (where is the leak?) - call if wet dressing (clear)
  • Glucose present?
  • Assess drsg and wound if drsg removed
70
Q

what is the post op care for IICP following a crani surgery?

A
  • Proper positioning
  • What if there is a drain? → right side? looks like IVPB bag by shoulder dependent
  • What if surgery in posterior fossa?
  • Don”t restrain—get an order if needed → don’t pull out drain
  • Don”t give enemas → ↑ ICP
71
Q

what is the post op care for N+V following crani surgery?

A

antiemetics

72
Q

what is the post op care for pain/HA following crani surgery?

A

analgesics - codeine

73
Q

what is the post op care for psychosocial impact following crani surgery?

A

shaved head
peri-orbital edema (HOB at 30; ice in gloves)
ecchymosis of the face
will the pt die or ever be the same? be honest - i really don’t know → sounds like you have some ?s for the MD, I’ll make sure he comes in

74
Q

what are the assessments and post op care for a trans sphenoidal approach after surgery?

A

Nasal congestion
Nausea
Headache

75
Q

what are the assessments and post op care for a trans sphenoidal approach day after surgery?

A

hormone-replacement medications may be given

**MRI of the brain obtained 1 to 2 days

76
Q

what ispost op care for a trans sphenoidal approach?

A

´ Peri-orbital ecchymosis/ Facial edema
´ HOB elevated
´ Visual field loss or deterioration @ assess → call MD risk for damage to CN 3; know baseline vision
´ Urine Output? Assess for DI

77
Q

TEST: what are the nursing care considerations for surgery?

A
  • pain control
  • frequent assessment (report change in LOC; ALWAYS think about ABCs → pts headed toward coma can’t support their airway
  • family at bedside
  • ROM passive q 2-3 hrs
  • HOB 30
  • I + O
  • emotional support (possible referral to LCSW)
78
Q

TEST: what are the trans-sphenoidal patient education post-op?

A
  • Avoid blowing your nose, coughing, sneezing
  • Avoid drinking with a straw
  • Avoid bending over/straining onthe toilet for 4 weeks (stool softener)
  • Do not drive for 2 weeks after surgery unless instructed otherwise
79
Q

During the assessment of a patient who has a tumor of the left frontal lobe, the nurse would expect to find:

A

personality and judgement changes

Nursing Semester 3 (29 decks)

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