brain tumors + CVA

Question 1

3 main parts of brain

Answer 1

cerebrum
cerebellum
brain stem

Question 2

brain stem

Answer 2

HR
breathing
BP
swallowing
digestion

Question 3

cerebrum

Answer 3

4 lobes
intelligence, learning, judgment
speech, memory
sense of hearing, vision, taste and smell
skeletal muscle movements

Question 4

cerebellum

Answer 4

balance and coordination

posture

Question 5

gliomas

Answer 5

30% of all brain tumors

80% of malignant tumors

Question 6

meningiomas

Answer 6

most common type of brain tumor

benign

Question 7

primary brain tumor

Answer 7

originates from cells within the brain
classified by type of cell from which they develop
may be benign or malignant

Question 8

secondary brain tumor

Answer 8

occur when cancer cells from other parts of the body invade brain tissue

Question 9

brain tumor patho

Answer 9

invasion of parenchyma
compression of brain tissue
development of cerebral edema
obstruction of flow of CSF
can cause brain herniation

Question 10

brain tumor generalized sx

Answer 10

headache
n/v
visual problems
drowsiness
seizures
mental/personality changes

Question 11

brain tumor focal sx

Answer 11

decreased muscle control
weakness/paralysis
difficulty with walking or speech
decreased sensation
balance issues
double vision

Question 12

brain tumor medical mgmt

Answer 12

glucocorticoids to decrease edema
chemo
radiation

Question 13

CVA

Answer 13

AKA stroke, brain attack

decrease in blood flow/O2 to brain cells with subsequent loss of neuro functioning

Question 14

causes of CVA

Answer 14

ischemic

hemorrhagic

Question 15

ischemic stroke

Answer 15

disruption of blood flow to part of the brain due to a thrombus or embolus
account for 80% of strokes

Question 16

hemorrhagic stroke

Answer 16

loss of blood flow due to rupture of cerebral vessels

account for 20% of strokes

Question 17

CVA risk factors

Answer 17

HTN
age
A-fib
hyperlipidemia, low HDL
alcohol/drug abuse

Question 18

CVA patho

Answer 18

brain cell damage impairs bodily function

paralysis, speech/sensory issues, memory deficits, coma, death

Question 19

thrombotic stroke

Answer 19

pathologic process promotes thrombus formation in a cerebral artery
causes infarction and stroke 2/2 decreased bloodflow
atherosclerosis is the most common cause of occlusion

Question 20

embolic stroke

Answer 20

caused by particles that arise from another part of the body
result in blockage of arterial blood flow to a particular area of the brain
onset of symptoms is abrupt and maximal

Question 21

causes of hemorrhagic strokes

Answer 21

intracerebral hemorrhage

subdural hematoma

Question 22

systemic hypoperfusion

Answer 22

general circulatory problem that can occur in the brain, other organs
2/2: cardiac arrest, arrhythmia, PE, pericardial effusion, bleeding

Question 23

stroke s/s

Answer 23

sudden!
confusion
difficulty understanding/speaking
loss of vision from one eye
severe headache
weakness of face, arm or leg especially on one side of body

Question 24

stroke hx/assessment

Answer 24

time is of the essence
TIME PT WAS LAST SEEN WELL
stroke scale

Question 25

stroke dx

Answer 25

CT/MRI
serum glucose
PT, PTT
ECG
CBC
cardiac enzymes, tpn
O2 sats

Question 26

CVA pt priorities

Answer 26

minimize brain injury

preventing medical complications

Question 27

thrombolytic therapy

Answer 27

rt-PA
may treat ischemic stroke
must be administered within 1 hour from pt’s presentation to ED

Question 28

ischemic stroke tx

Answer 28

revascularization is priority
thrombolysis (alteplase)
embolectomy
angioplasty
carotid stenting

Question 29

CVA nursing actions

Answer 29

airway/breathing mgmt
cardiac monitoring for arrhythmias
monitor for hyperthermia
BP mgmt
ongoing neuro assessment

Question 30

dysphagia

Answer 30

major risk factor for developing aspiration pneumonia

can occur especially when there is damage to the brain

Question 31

prior to swallow screening

Answer 31

evaluate lung sounds
obtain recent vitals
evaluate ability of pt to follow directions

Question 32

cease swallowing evaluation if

Answer 32

coughing before/during/after swallowing
gurgly/wet vocal quality
need to swallow 2+ times to clear
excessive length of time to swallow
excessive secretions

Question 33

if pt fails swallow eval

Answer 33

keep NPO

ask MD for speech therapy consult

Question 34

CVA nursing care

Answer 34

enhancing comfort (pain mgmt, continence)
provide nutrition
monitor glucose labs

Question 35

hyperglycemia and CVA

Answer 35

may intensify brain injury by increasing tissue acidosis and increasing blood-brain barrier permeability

Question 36

CVA complications

Answer 36

PE
UTI
aspiration pneumonia
decubitus ulcers
falls

Question 37

intracerebral hemorrhage (ICH)

Answer 37

~40% of hemorrhagic strokes

usually derived from bleeding of small arteries directly into the brain forming localized hematoma

Question 38

ICH causes

Answer 38

HTN
drug use
vascular malformations

Question 39

ICH complications

Answer 39

cerebral hypoxia
decreased cerebral blood flow
risk of further bleeding
IICP
hydrocephalus

Question 40

subarachnoid hemorrhage (SAH)

Answer 40

most commonly rupture of an aneurysm
blood spreads rapidly within CSF, immediately increasing ICP
sudden severe headache
coma or death may result from continued bleeding

Question 41

SAH tx

Answer 41

craniotomy + clipping of aneurysm

endovascular embolization with coils of platinum wire

Question 42

vasospasm

Answer 42

most feared complication of hemorrhagic stroke
can lead to delayed ischemia
triple H therapy (hypertension, hypervolemia, hemodilution)

Question 43

hydrocephalus

Answer 43

develops when blood in the subarachnoid space obliterates the arachnoidal villi
prevents absorption of CSF or blood blocks foramen of Monro preventing CSF drainage
treated with VP shunt