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neuro eval ii > Neuro-Oncology II > Flashcards

Neuro-Oncology II Flashcards

1
Q

What is rehabilitation guided by?

A

findings of initial examination

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2
Q

Cerebral tumors symptoms

A
  • Headaches
  • Seizures
  • Mental Change and Behavior
  • Hemiparesis/Weakness
  • Midline shift- Impact on presenting symptoms
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3
Q

Frontal Lobe Common Findings

A
  • Ataxia
  • Hemiparesis
  • Gait disturbances
  • Impaired sensation
  • Urinary incontinence
  • Impaired judgement
  • Personality changes
  • Short term memory loss
  • Impaired judgement
  • Personality changes
  • Communication problems
  • Behavioral changes
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4
Q

Occipital lobe common findings

A
  • visual disturbances
  • homonymous hemianopsia
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5
Q

parietal lobe common findings

A
  • Sensation loss
  • Tactile localization
  • Sterognosia – recognizing form of object without visual/auditory information
  • Autopagnosia (body scheme) * Anosognosia (lack of awareness of disability)
  • Aphasia
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6
Q

Temporal lobe common findings

A
  • Difficulty with recognizing sounds
  • Memory impairments
  • Vision impairment
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7
Q

Basal Ganglion Common Findings

A
  • Contralateral choreoathetosis- combination of chorea (irregular migrating contractions) and athetosis (twisting and writhing)
  • Contralateral dystonia
  • Movement disorders
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8
Q

Corpus Callosum Commons findings

A
  • apraxia
  • Agraphia
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9
Q

Cerebellum common findings

A
  • ataxia
  • dysmetria
  • nystagmus
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10
Q

Brainstem common findings

A
  • Cranial nerve dysfunction
  • Ataxia
  • Papillary abnormalities
  • Nystagmus
  • Hemiparesis
  • Autonomic Dysfunction
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11
Q

Intradural- Extramedullar tumors presenting signs and symptoms by type

A
  • Local neck or back pain
  • Radicular pain is common
  • Weakness or sensory
    symptoms below level of tumor (typically recognized first on side tumor is present)
  • Spinal Cord Compression-
    paraplegia, loss of bowel or
    bladder control
  • Nerve Root Compression-
    focal muscle wasting
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12
Q

Intradural- Intramedullary Tumors Presenting signs and symptoms

A
  • Constant back and neck pain * Pain and midline tenderness at the level of the tumor and at night (pain worse in recumbent position)
  • Weakness
  • Spasticity
  • Poor coordination
  • Paresthesias
  • Stiffening of gait
  • Clonus
  • Scoliosis or Torticolis
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13
Q

look at spinal tumor interventions if you want

A

im not gonna

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14
Q

Contraindications/Precuations for spinal tumors

A
  • Ultrasound
  • Diathermy
  • Laser
  • Hot/Cold or topical agents at location of skin undergoing radiation
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15
Q

Barriers to Rehabilitation

A
  • Patients, Families, Medical Providers knowledge of the benefits of rehabilitation and accessibility to rehabilitation
  • Overwhelmed by diagnosis, complexity, cost, resources
  • Limited Workforce of rehabilitation personnel with expertise and experience
  • Lack of coordinated care
  • Lack of standardized rehabilitation clinical protocols and outcome measures
  • Limited coverage
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16
Q

Goals of Rehabilitation

A
  • Minimize negative effects of immobilization
  • Maximize safety
  • Maximize level of function
  • Ambulation if they are able
  • Maximize nutritional intake
  • Education
  • Address psychosocial stressors
  • Assist in discharge recommendations
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17
Q

Barriers in acute hospitalization

A
  • Rapid changes in medical
    condition
  • Lack of knowledge of the role of rehabilitation among healthcare providers
  • Delay in identification and
    initiation of rehabilitation
  • Gaps in communication
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18
Q

Barriers to Post-Acute Inpatient Rehabilitation

A
  • Medical fragility of patient and increased likelihood of emergent discharge back to acute care
  • Logistical and financial implications of rehabilitation with chemotherapy
  • Challenges in Achieving 3 hours of therapy a day
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19
Q

Barriers to Therapy at Any Level

A
  • Fatigue
  • Poor Appetite
  • Nausea
  • Constipation
  • Insomnia
  • Cognitive Deficits
  • Depression and Anxiety
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20
Q

Cerebral Edema/ Herniation

A

Cerebral edema is often association with brain tumors. Increase in ICP may cause brain herniation or
compromise of brain’s blood supply

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21
Q

Cerebral Edema/Herniation Signs

A
  • increase in lethargy/unable to arouse, dilated pupils, headache, change in posture, change in reflexes, coma
  • Hyperventilation – decrease the partial pressure of CO2
  • Dexamethasone
  • Emergency Surgery to relieve pressure
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22
Q

Epidural Cord Compression

A

most commonly due to
hematogenous spread of tumor cells through bone marrow leading to
vertebral collapse

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23
Q

Epidural Cord Compression Signs

A
  • Pain is present in 95% and usually precedes other symptoms by 1-2 months, weakness (generally symmetric), ascending numbness, autonomic
    dysfunction (commonly urinary retention)
  • Corticosteroids
  • Laminectomy/Vertibrectomy * Radiotherapy
  • Chemotherapy
24
Q

Seizures

A
  • Increase in length of seizures or duration
  • Primary role is to continue to monitor and communicate with team
  • change in anticonvulsant medication or dosage
25
Q

Venous Thromboembolism

A
  • Common in individuals with brain tumor
  • Signs of DVT- heat, swelling, pain
  • IVC filter placement
26
Q

Red flag headache symptoms

A
  • Change in Headache intensity or duration
  • Association with fever
  • Occurring with new neurological signs
27
Q

Paraneoplastic cerebellar degeneration

A
  • Thought to have an autoimmune etiology
  • Most common paraneoplastic syndrome affecting the brain
  • Subacute syndrome that progresses over weeks or months
  • Severe truncal and limb ataxia and dysarthria
28
Q

Hydrocephalus

A
  • Increase in brain tumor mass impacts ventricles or
    normal passage of CSF
  • Confusion, Disorientation, or both
  • Lethargy
  • Headaches
  • Irritability or personality changes
  • Blurred or double vision
  • Seizures
  • Urinary Incontinence
  • Walking difficulties/Balance deficits
29
Q

Fatigue Factors

A
  • Direct Cancer Burden
  • Cancer Treatment Burden- Surgery, Chemotherapy, Radiation, Hormone Therapy
    Medications
  • Psychosocial Burden- Depression, Anxiety, Sleep Disruption, Pain, Expectancy, Self-Efficacy, Cognition, Strain on Relationship, Employment Problems, Financial Concerns
  • Comorbid Conditions- Anemia, Muscle Wasting, Thyroid Disease, Cardiac Disease, Pulmonary Disease, Renal Disease, Malnutrition, Infection
30
Q

Additional contributing factors of fatigue

A

metabolic problems,
deconditioning, anxiety, depression, medication effects

31
Q

What may be affected due to neuroinflammation caused by brain radiation?

A

melatonin production

32
Q

Management for cancer related fatigue

A
  • Addressing pain
  • Addressing psychiatric or metabolic causes
  • Adjusting medication
  • Sleep Hygiene
  • Nutrition
  • Energy Conservation techniques and physical exercise
  • Psychosocial supports
33
Q

Cancer related pain - Nociceptive

A

Pain triggered my activation of peripheral receptive terminals in response to noxious irritants

34
Q

Cancer related pain - neuropathic

A
  • Pain that includes sensory abnormalities such as thermal
    allodynia, paresthesia, hyperalgesia, dysesthesia- may be described as burnings, stabbing, pins and needles
  • Chemotherapy drug- vincristine may result in polyneuropathy and numbness or burning of
    hands and feet
35
Q

Cancer related pain - myofascial

A

pain that arises from myofascial trigger points

36
Q

cancer related pain - thalamic

A

Pain that is a central pain syndrome characterized by a burning, may be activated by changes in temperature

37
Q

Cancer related pain - funicular

A

Pain that is a central pain syndrome characterized by excruciating pain that does not follow any fixed dermatome pattern and occurs caudal to
lesion due to lesion to ascending spinothalamic tracts

38
Q

Cancer related pain medications

A

including morphine, methadone, oxycodone, fentanyl, buprenorphine

39
Q

What is typically prescribed for neuropathic pain

A

gabapentin

40
Q

neuroaxial pump

A

infuse medication to epidural or intrathecal space

41
Q

Cognitive deficits are common with….

A

gliomas and can impair patients’ abilities to comprehend information and specifically their capacity to
provide informed consent for treatment and making plans.
* Power of Attorney, Living Will

42
Q

Education and Information Needs

A
  • Management of Psychological Stress
  • Anxiety (approximately 30-50%) * Depression (5-45%)
  • Caregiver needs and well-being
  • Alternative/Complimentary therapies
  • Sexuality
  • Change in Family and Life Roles
43
Q

Cancer Survivorship

A
  • Focus is on the health and well-being of an
    individual from the time of diagnosis to death
  • Inclusive of the physical, mental, emotional, social,
    and financial effects of cancer * Starts at the time of diagnosis and continue
    through treatment and beyond
44
Q

3 stages of cancer survivorship

A
  • acute
  • extended
  • permanent
45
Q

Acute stage of survivorship

A

focused on cancer treatment and is initiated
at diagnosis through the end of active treatment

46
Q

Extended stage of survivorship

A

occurs after the end of treatment and
focuses on the effects of treatment and follow-up
care

47
Q

Permanent stage of survivorship

A

focuses on the years after
cancer treatment has ended

48
Q

exercise for cancer survivorship

A

NCCN Guidelines recommend cancer survivors participate in
at least 150–300 min of moderate-intensity activity or 75 min of vigorous-intensity activity per week, along with 2–3 sessions of strength/resistance training per week

49
Q

individual strategy for acquiring prognostic information

A

Utilization of all sources of
information on disease and disease process- support groups, Internet, second opinions to the idea of
limited information at a time due to the emotion and personal sense of control (this group was more
capable of accepting greater amount of prognostic information as time passed and disease progressed)

50
Q

Shared hope

A

Courage and motivation
to address the fight, Use
of “we” demonstrated
solidarity, as symptoms
progress hope for
survival may be
redefined as hope for
quality of life or “good
days”

51
Q

engagement in health promotion activities

A

Optimize physical health to optimize therapeutic effect of treatments, could be dietary, smoking/alcohol
consumption changes, exercise, complementary and alternative therapy

52
Q

Adjustment to symptom limitations

A

Reported change regarding role change in
family, activity limitations, working life,
activity out of the home

53
Q

role transition from family member to care giver

A

Caregivers may keep
medical record, impact
of cognitive impairments
or lack of self-awareness
place greater
responsibilities on
caregiver; change in
personality often one of
most difficult

54
Q

discharge planning

A
  • Quality of Life
    (remaining life) vs
    Ongoing Therapy
  • Hospice
  • Shared Decision
    Making
55
Q

definition of palliative care

A
  • Approach that improves the quality of
    life of patients and their families facing life threatening illness
  • Addresses suffering by providing
    support to patients and families addressing practical needs and providing bereavement counselling
  • Person centered
56
Q

essential components of palliative care

A
  • Pain * Dyspnea * Fatigue * Sleep Impairment * Mood and distress * Anxiety * Depression * Nausea * Constipation
57
Q

essential components of palliative care - managing symptoms:

A
  • Pain * Dyspnea * Fatigue * Sleep Impairment * Mood and distress * Anxiety * Depression * Nausea * Constipation

neuro eval ii (16 decks)

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