Brain Tumors, TPH, SAH Flashcards
Primary brain tumors originate within the ___
CNS
Secondary tumors from ___ in other parts of the body
Metastasis ( the spread of a cancer or other disease from one organ or part of the body to another not directly connected with it)
Classification of brain tumors
Benign (It does not invade nearby tissue or spread to other parts of the body the way cancer can) or malignant (cancerous and are made up of cells that grow out of control)
Classification (location) of brain tumors
Supratentorial- located within the cerebral hemispheres.
Infratentorial- the area composed of the cerebellum and brainstem.
Classification (cellular origin) of brain tumors
Astrocytes, oligodendroglia, ependymal, microglia (neuroglial cells that provide nourishment, support and protections for neurons.
Classification (anatomic location) of brain tumors)
Meningioma , Acoustic neuroma
Most common benign tumors that arise from the covering of the brain (meninges)
Meningioma (visual disturbances, loss of body hair, diabetes insipidus, infertility, visual fields defects and headaches)
Arise from the sheath of Schwann cells in peripheral portion of cranial nerve VIII (cerebellar pontine angle tumors)
Acoustic neuroma (hearling loss, tinnitus, dizziness or vertigo)
Nonsurgical management of brain tumors
Radiation therapy Chemotherapy (Orally, IV, intra-arterially or intrathecally Direct drug delivery post-surgically) Analgesics Dexamethasone Phenytoin Pantoprazole (protonix) Stereotactic radiosurgery (Gamma knife, CyperKnife) (Real Child Are Devine People Plus Saints)
Stereotactic radiosurgery procedure that uses a single high dose of ionized radiation to focus multiple beams of gamma radiation to destroy intracranial lesions selectively without damaging healthy tissues
Gamma knife treatment
Surgical removal of a section of bone (bone flap) from the skull for the purpose of operating on the underlying tissues, usually the brain.
Craniotomy
Nursing intervention post craniotomy (fluid balance)
Observe for DI- A disorder of salt and water metabolism marked by intense thirst and heavy urination or SIADH-A condition in which high levels of a hormone cause the body to retain water.
Nursing intervention post craniotomy (incision)
Assess site
Observe presence or absence of bone flap
Observe for CSF leak
Nursing intervention post craniotomy (ICP/ decrease ICP)
Ventriculostomy -neurosurgical procedure that involves creating a hole (“ostomy”) within a cerebral ventricle for drainage. It is done by surgically penetrating the skull, dura mater, and brain such that the ventricle of the brain is accessed.
Nursing intervention post craniotomy (avoid activities that increase ICP)
Stool softeners to avoid valsalva
Antiemetics for N/V
Antipyretics/cooling blanket for fever
Proper positioning: (Avoid extreme neck or hip flexion and maintain the head in a neutral midline position)
Nursing intervention post craniotomy (others)
DVT prophylaxis
Stress ulcers: (Cushing Stress Ulcer)
Pneumonia: (High risk aspiration altered LOC)
Nursing intervention post craniotomy (eye care)
periorbitial edema, treated with cold compressions to decrease swelling, irrigate effected eye with warm saline or artificial tears to improve discomfort
Commonly used surgical approach for pituitary region masses
Transsphenoidal hypophysectomy (TPH)
Transsphenoidal hypophysectomy (TPH) uses a ___ ___ approach
Nasal cavity
Transsphenoidal hypophysectomy (TPH) abtains a ___ tissue graft
Adipose
Transsphenoidal hypophysectomy (TPH) nursing interventions for nasal packing
no nose blowing, breathe through mouth, check nose for CSF leak ( can cause meningitis)
Transsphenoidal hypophysectomy (TPH) complications include
air embolism
CSF leak (meningitis)
Diabetes Insipidus
Visual disturbances
Transsphenoidal hypophysectomy (TPH) post operative care include
HOB increase to 35-40° Hourly UOP (0.5-1 mL/kg/hr) Monitor electrolytes Avoid any straining (Antiemetics for nausea Do NOT blow your nose) Monitor for visual disturbances
Types of cerebral aneurysms
Berry- on the anterior communicating artery of the brain, outpouching affecting only a distinct portion of the artery
Fusiform- diffuse dilation affecting the entire circumference of the artery
Assessment findings of a Subarachnoid Hemorrhage from cerebral aneurysm
Severe, sudden HA
Brief loss of consciousness
N/V
Kernig’s Sign, Brudzinski’s Sign, Photophobia
Diagnostics of a Subarachnoid Hemorrhage from cerebral aneurysm
CT
Lumbar Puncture
Cerebral angiogram
Pre operative management goals of a Subarachnoid Hemorrhage from cerebral aneurysm
Medical Emergency
Direct effects of initial hemorrhage
Craniotomy with aneurysm clipping within 48 hours post bleed
Flush out blood basal cistern (reservoir of CSF around cistern and base of brain and circle of Willis, prevent vasospasms)
Pre operative precautions of a Subarachnoid Hemorrhage from cerebral aneurysm
BP control, keep low (To prevent rebleeding) Bedrest Dark, quiet environment Stool softeners, no straining No restraints, keep calm HOB ↑ 35- 45° degrees at all times DVT precautions Educate family to keep calm environment
Post operative management of a Subarachnoid Hemorrhage from cerebral aneurysm
Complications can lead to death
Cerebral vasospasm
Treatment post op of a Subarachnoid Hemorrhage from cerebral aneurysm
HHH after clipping
HHH stands for
Hypertensive (increase BP and CO with vasoactive drugs)
Hypervolemic- volume expanders (albumin)
Hemodilution- Fluid
SAH complications
Hyponatremia (Isotonic fluids= NS or LR) Rebleeding (Sudden onset HA, N&V, Increased BP Respiratory changes) Hydrocephalus (Ventriculostomy – temporary measure Shunt – permanent measure) Seizures (Prophylactic anticonvulsant medication)
Purulent infection of brain
Frontal and temporal most common
Brain abscess
Findings of a brain abscess by be ___ at presentation
atypical
Treatment of a brain abscess
Antibiotics and surgical intervention (drain)
Symptoms of a brain abscess
Headache, fever, pain, motor deficits, ataxia, aphasia, sensory impairments, seizure activity, visual field changes
