brain tumour

Question 1

what are the types of brain tumor?

Answer 1

• infratentorial
• supratentorial

Question 2

what are the general clinical manifestations?

Answer 2

• headache: worse upon wakening + intensified by lowering head or straining
• vomiting WITHOUT nausea: progressively projectile (relieved w moving around and change in position)
• neuromuscular changes: lack of coordination/balance/fine motor control, weakness, hypo or hyperreflexia, (+) Babinski sign, spasticity/paralysis, bad school perf
• behavioural changes: irritability, personality changes, decreased appetite, fatigue, lethargy, coma, lies flat, avoids light, not wanting to play
• Cranial nerve neuropathy: head tilt, visual disturbances(associated with brain stem involvement)
• cushings triad : widening pulse pressure, decreased +irregular HR&RR, increased BP
  (d.t increasee ICP)

Question 3

what are infant specific clinicial manifestations?

Answer 3

• no detectable symptoms till CSF obstruction causes ICP (increased HC + sunset eyes

Question 4

what are the diagnostic tests?

Answer 4

• physical exam : neuro+cranial nerve testing
• MRI = gold standard
• CT
• EEG
• Biopsy
  -LP (dangerous if ICP present

Question 5

treatment options?

Answer 5

• sx (resect as much as they can - debulking)
• radio
• chemo:
  in kid less than 3 years (brain still developing) w malignant tumors -> high dose followed by autologus peripheral SCT has replaced RT

Question 6

pre op?

Answer 6

inetrventions:
- HC
- pulse
- hx of symptoms : headaches PQRST
- gait balance posture
- degree of physical inacapcity

teaching:
- who will be there
- suture bandages
- NPO
- possible side effects: blindness and ataxia
- lines and drains

Question 7

post op care?

Answer 7

• vs q 15-30min till stable
• temp (hyperthermia -> cooling blanket !!hypothermia)
• monitor s and s of increased IC
  - HC
  - cushings triad
  - dilated/unequal pupils = increased ICP =
  report!!)
  - regression or lethargy
• neuro checks : PERRLA, LOS, cranial nerves, reflexes, sleep pattern
• soiled dressing not removed but reinforced (observe and document drainage)
  
  • colorless = CSF = report
  • odor = infection = culture
• NPO 24 h
  
  • longer if no gag reflex or swallowing reflex
  • supa smtg -> clear fluid after alert - if
    vomits = stopped

Question 8

positioning pt?

Answer 8

• 2 nurses
• pillow below back
• dont put on op side