Brain Tumors Flashcards
tumors located within cerebral hemispheres
supratentorial tumors
tumors located beneath fold of dura mater
infratentorial tumors
2 types of cells within nervous system
neurons and neuroglial cells
responsibility of neurons
nerve impulse conduction
responsibility of neuroglial cells
support, nourishment, protection of neurons
4 types of neuroglial cells
astrocytes, oligodendroglia, ependymal, microglia
most common benign tumor
meningiomas
benign tumor, young middle aged adults, loss of hair, visual disturbances, hypopituitary signs, DI, infertility, visual field defects, headaches
pituitary tumors
tumor from sheath of Schwann cell in cranial nerve VIII, also called cerebellar pontine angle tumors – hearing loss, tinnitus, dizziness, vertigo — hard to remove
acoustic neuromas
grade – tissue is benign, cells look nearly like normal brain cells, grow slowly
grade I
grade – tissue is malignant, look less like normal cells
grade II
malignant tissue has cells looking very different than normal brain cells, actively growing (anaplastic)
grade III
has malignant cells looking most abnormal grow quickly
grade IV
acoustic neuroma, choroid plexus papilloma, meningioma, pituitary adenoma, astrocytoma grade I, chondroma, craniopharyngioma, hemoangioblastoma
benign tumors
astrocytoma grade IV, oligodendroglioma, ependymoma, medulloblastoma, glioma, lymphoma
malignant tumors
cerebral edema, brain tissue inflammation, increased ICP, neuro deficits, hydrocephalus, pituitary dysfunction
complications of cerebral tumors
cause of brain tumors
unknown
headache more severe on awakening, N+V, visual sx, seizures or convulsions, facial numbness tingling, balance loss or dizziness, weakness or paralysis, difficulty thinking speaking articulating, change in mentation or personality, papilledema
sx of brain tumor
tumor that results in paralysis, seizures, memory loss, cognitive impairment, language impairment, or vision problems
supratentorial tumors
tumor result in ataxia, ANS dysfunction, vomiting, drooling, hearing loss, vision impairment
infratentorial tumors
common brain tumors
cerebral and brainstem
scans used to dx brain tumor
CT, MRI, skull films
monitored by CT and MRI periodically
small benign tumors
managed by chemotherapy, radiation, and or surgery
malignant tumors
interstitial chemotherapy
disk-shaped drug wafer – carmustine
given for headache and fever
codeine, acetaminophen
given to control cerebral edema
dexamethasone
given to prevent seizure activity
phenytoin
given to decrease gastric secretion – prevent stress ulcers
PPI
types of stereotactic radiosurgery
modified linear accelerator, particle accelerator, isotope seeds implanted (brachytherapy)
using accelerated x-rays
modified linear accelerator
particle accelerator using beams of protons
cyclotron
isotope seed implanted in tumor
brachytherapy
SRS procedure using single high dose of ionized radiation to focus multiple beams of gamma to destroy intracranial lesions selectively
gamma knife
incision cranium to remove tumor, improve symptoms related to lesion, or debulk tumor size
craniotomy
concerns of patient going to have craniotomy
increased neuro deficits and self-image (shaved head)
pt should not have pre-op craniotomy at least 5 days before
alcohol, tobacco, ACs, NSAIDs
pt should be at least 8 hours before craniotomy
NPO
minimally invasive surgery
removes small tumors (trans-nasal approach with endoscopy for pituitary tumors)
uses burr holes and local anesthetic for easily reached tumors
stereotactic surgery
focus for post-op craniotomy care
monitor changes in status and prevent or minimize complications – increased ICP
how often to assess neuro and vital signs after craniotomy
every 15-30 mins for first 4-6 hours, then every hour
what to immediately document after craniotomy
new neuro deficits, decreased LOC, motor weakness, paralysis, change in speech, decreased sensation, reduced pupil reaction to light, personality changes
managing periorybital edema and ecchymosis of one of both eyes – craniotomy
cold compresses reduces swelling, irrigate eye with warm saline or artificial tears
fluid restriction amount for first 24 hours post craniotomy
1500 mL if pituitary involvement
prevention of VTE post craniotomy
repositioning and deep breathing every 2 hours
management of supratentorial surgery
elevated HOB 30 degrees for venous drainage from head
position for infratentorial craniotomy
flat and side-lying, alternating sides every 2 hours for 24-48 hours – prevents pressure on neck area incision site and internal tumor excision site form higher cerebral structures
infratentorial needs NPO for 24 hours post craniotomy bc…
edema around medulla and lower cranial nerves can cause vomiting and aspiration
how often to check dressing for signs of drainage post craniotomy
1-2 hours – mark areas of drainage once per shift for baseline comparison – 50 mL/8hr – watch for hypovolemic shock
how often to measure drainage post craniotomy
every 8 hours – record amount and color – 30-50 mL normal amount
why hyponatremia post craniotomy?
fld volume overload, SIADH, steroid admin
symptoms of hyponatremia?
weakness, change in LOC, confusion
causes of hypernatremia?
meningitis, dehydration, DI
signs of hypernatremia?
muscle weakness, restlessness, extreme thirst, dry mouth, decreased urinary output, thick lung secretions, hypotension (dehydration assoc.) – late is seizures
what is considered if voiding large amounts of dilute urine with increasing serum osmolarity and lyte concentration?
DI
what to do before, during, and after suctioning patient on vent after craniotomy
hyperoxygenate
major complications of supratentorial surgery
increased ICP from cerebral edema, hydrocephalus, hemorrhage
symptoms of increasing ICP
severe headache, deteriorating LOC, restlessness, irritability, dilated or pinpoint pupils slow reaction or nonreactive to light
caused by obstruction of normal CSF pathway from edema, expanding lesion (hematoma), or blood in subarachnoid space
hydrocephalus
sx of slowly progressing hydrocephalus
headache, decreased LOC, irritability, blurred vision, urinary incontinence
major complication of shunting procedure
subdural hematoma from tearing of bridging veins
sx of subdural and intracranial hemorrhage
severe headache, rapid decrease in LOC, progressive neuro deficits, herniation syndromes (tissue shift down)
what is used to treat intracranial hemorrhage
osmotic diuretics, ICP monitoring, CPP management
respiratory complications of craniotomy
atelectasis, pneumonia, neurogenic pulmonary edema
how to prevent atelectasis and pneumonia post-op
turn patient frequently and encourage frequent deep breaths hourly, humidified air, incentive spirometry
life-threatening complication of traumatic brain injury, tumors, and brain surgery, sx same of acute pulmonary edema – non cardiac related – terrible survival rate
neurogenic pulmonary edema
results from surgery, wound infection, CSF leak, contamination during surgery
meningitis
