brain tumors + CVA Flashcards
3 main parts of brain
cerebrum
cerebellum
brain stem
brain stem
HR breathing BP swallowing digestion
cerebrum
4 lobes intelligence, learning, judgment speech, memory sense of hearing, vision, taste and smell skeletal muscle movements
cerebellum
balance and coordination
posture
gliomas
30% of all brain tumors
80% of malignant tumors
meningiomas
most common type of brain tumor
benign
primary brain tumor
originates from cells within the brain
classified by type of cell from which they develop
may be benign or malignant
secondary brain tumor
occur when cancer cells from other parts of the body invade brain tissue
brain tumor patho
invasion of parenchyma compression of brain tissue development of cerebral edema obstruction of flow of CSF can cause brain herniation
brain tumor generalized sx
headache n/v visual problems drowsiness seizures mental/personality changes
brain tumor focal sx
decreased muscle control weakness/paralysis difficulty with walking or speech decreased sensation balance issues double vision
brain tumor medical mgmt
glucocorticoids to decrease edema
chemo
radiation
CVA
AKA stroke, brain attack
decrease in blood flow/O2 to brain cells with subsequent loss of neuro functioning
causes of CVA
ischemic
hemorrhagic
ischemic stroke
disruption of blood flow to part of the brain due to a thrombus or embolus
account for 80% of strokes
hemorrhagic stroke
loss of blood flow due to rupture of cerebral vessels
account for 20% of strokes
CVA risk factors
HTN age A-fib hyperlipidemia, low HDL alcohol/drug abuse
CVA patho
brain cell damage impairs bodily function
paralysis, speech/sensory issues, memory deficits, coma, death
thrombotic stroke
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
embolic stroke
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
causes of hemorrhagic strokes
intracerebral hemorrhage
subdural hematoma
systemic hypoperfusion
general circulatory problem that can occur in the brain, other organs
2/2: cardiac arrest, arrhythmia, PE, pericardial effusion, bleeding
stroke s/s
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
stroke hx/assessment
time is of the essence
TIME PT WAS LAST SEEN WELL
stroke scale
stroke dx
CT/MRI serum glucose PT, PTT ECG CBC cardiac enzymes, tpn O2 sats
CVA pt priorities
minimize brain injury
preventing medical complications
thrombolytic therapy
rt-PA
may treat ischemic stroke
must be administered within 1 hour from pt’s presentation to ED
ischemic stroke tx
revascularization is priority thrombolysis (alteplase) embolectomy angioplasty carotid stenting
CVA nursing actions
airway/breathing mgmt cardiac monitoring for arrhythmias monitor for hyperthermia BP mgmt ongoing neuro assessment
dysphagia
major risk factor for developing aspiration pneumonia
can occur especially when there is damage to the brain
prior to swallow screening
evaluate lung sounds
obtain recent vitals
evaluate ability of pt to follow directions
cease swallowing evaluation if
coughing before/during/after swallowing gurgly/wet vocal quality need to swallow 2+ times to clear excessive length of time to swallow excessive secretions
if pt fails swallow eval
keep NPO
ask MD for speech therapy consult
CVA nursing care
enhancing comfort (pain mgmt, continence)
provide nutrition
monitor glucose labs
hyperglycemia and CVA
may intensify brain injury by increasing tissue acidosis and increasing blood-brain barrier permeability
CVA complications
PE UTI aspiration pneumonia decubitus ulcers falls
intracerebral hemorrhage (ICH)
~40% of hemorrhagic strokes
usually derived from bleeding of small arteries directly into the brain forming localized hematoma
ICH causes
HTN
drug use
vascular malformations
ICH complications
cerebral hypoxia decreased cerebral blood flow risk of further bleeding IICP hydrocephalus
subarachnoid hemorrhage (SAH)
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
SAH tx
craniotomy + clipping of aneurysm
endovascular embolization with coils of platinum wire
vasospasm
most feared complication of hemorrhagic stroke
can lead to delayed ischemia
triple H therapy (hypertension, hypervolemia, hemodilution)
hydrocephalus
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
