Brain Tumours and Surgical Intervention

Question 1

Brain Tumours - Secondary

Answer 1

Resulting from a malignant neoplasm located somewhere else in the body. These are the most common kind

Question 2

Brain Tumours - Primary

Answer 2

Arising from tissues in the brain

Question 3

How are brain tumours classified?

Answer 3

Classified from the tissue they arise from
ex. meningiomas
- over half of all brain tumours are malignant

Question 4

How do brain tumours lead to death?

Answer 4

Unless treated all will eventually cause death by tumour volume leading to increased ICP

Question 5

Clinical manifestations (4)

Answer 5

Depend on location, rate of growth and size
Headache: common symptom (tend to be worse at night and awaken the patient. a dull constant pain that is occasionally throbbing)
Seizures especially in gliomas and brain metastases
Nausea and vomiting from increased ICP
Cognitive and motor dysfunctions and sensory deficits depending on location of the tumour

Question 6

Interprofessional Care: TX aimed at (3)

Answer 6

1. Identifying the tumour
2. Removing or decreasing tumour mass
3. Preventing or managing increased ICP

Question 7

Medication

Answer 7

steroids - prednisone, methylprednisone, dexamethasone

Question 8

Surgery

Answer 8

preferred method. tricky because it can damage brain function if the tumour is taken out

Question 9

Ventricular Shunts

Answer 9

hydrocephaly. can drain the fluid out of the ventricles. risk for infection, misplaced shunt

Question 10

Radiation

Answer 10

radiation seeds implanted in the brain

Question 11

Chemotherapy and Targeted Therapy

Answer 11

Difficult because of the blood brain barrier
Chemotherapy is a systemic treatment. Only certain medications get past blood brain barrier

Question 12

Reasons for Neurosurgery (2)

Answer 12

The removal or repair of brain tissue to prevent more harm
To give palliative relief of distressing symptoms when the cause cannot be removed

Question 13

Surgery for:
1. trama
2. infection
3. vascular disorders
4. spinal disorders

Answer 13

1. fractured skull, traumatic brain injury
2. Cerebral and spinal abscesses
3. cerebral aneurysm and arteriovenous malformation
4. tumours of the spine

Question 14

Surgery for:
1. Congenital abnormalities
2. cerebral & spinal tumors
3. Degenerative disorders

Answer 14

1. hydrocephalus
2. glioma
3. arthritic changes in the spine

Question 15

Surgical Approaches: Burr Holes

Answer 15

Holes drilled into the skull and is used for
- insertion of brain needles to remove tissue for biopsy or subdural hematoma
- to insert Gigli’s saw to create a bone flap in a craniotomy

Question 16

Craniotomy

Answer 16

• the bone flap is surgically removed and later returned to the skull after surgery
• often performed so the brain can be accessed for further surgery

Question 17

Craniectomy

Answer 17

• the bone flap is surgically removed but IS NOT returned to the skull after surgery
• often performed to relieve pressure on the brain

Question 18

Post craniotomy nursing care: principles (4)

Answer 18

• safe recovery from anesthesia
• monitoring for signs of increased ICP & its clinical management
• provide nursing care based on pts degree of dependency
• promote rehabilitation

Question 19

Management of increased ICP (6)

Answer 19

• HOURLY NEUROLOGICAL OBSERVATIONS (glasgow coma scale)
• VS per protocol (q1h)
• full neurological assessment
• report any change in pts condition immediately
• admin ordere meds to decrease ICP
• all abnormal motor responses indicate damage to the opposite side of the brain except pupils

Question 20

Additional Intervention for management of increased ICP (7)

Answer 20

Likely caused by hemorrhage into wound site, cerebral edema, or hydrocephalus
- HOB elevated to 30-40 degrees
- chin and sternum should be aligned
- pace nursing activities to decrease frequency of stimulation
- prevent constipation
- pain control
- require good oxygen supply and sufficient CO2 to stimulate respiration
- If cerebral edema is causing deterioration of neurological status - may need to administer Mannitol (diuretic)

Question 21

Wound Care (5)

Answer 21

• inspect incision to ensure edges remain well approximated and staples/sutures intact
• monitor for redness, discharge, signs of infection
• incision usually left open to air
• removal of sutures, usually in 2 weeks
• cover incision when going outside

Question 22

Safety Considerations (3)

Answer 22

Support positioning with towels and pillows to prevent pressure on surgical site
Sign at bedside (no right bone flap)
Keep bed at lowest level - high risk of falling

Question 23

Bacterial Meningitis

Answer 23

• Acute inflammation of meningeal tissues surrounding brain & spinal cord
• medical emergency
• if untreated, mortality rate near 100%
• leading causal agents (streptococcus pneumoniae and neisseria meningitidis)

Question 24

Clinical manifestations and complications of bacterial meningitis

Answer 24

Clinical manifestations:
- fever, severe headache
- N/V
- Nuchal rigidity (resistance to flexion of the neck)
- + Kernig sign (pain when hip fexed to 90 degree and extension of the knee
Complication:
- increased ICP (major cause of altered mental status)

Question 25

Encephalitis

Answer 25

Acute inflammation of brain
Usually caused by virus

Question 26

Clinical manifestations of Encephalitis

Answer 26

• onset is typically nonspecific
• fever, headache, N/V
• signs appear on day 2 or 3
• may vary from minimal to coma
• Hemiparesis, seizures, tremores, cranial nerve palsies, personality changes, memory impairment, amnesia