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N4- Test 3 > Neuro Tumors > Flashcards

Neuro Tumors Flashcards

1
Q
  • Neurological tumors affect the brain and _______
A

spinal cord.

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2
Q

Brain tumors are more common in what population and age group?

A
  • males
  • middle-aged individuals but can occur in ANY age
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3
Q

Brain Tumor incidents increase with ___.

A

age.

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4
Q

WHO and National Cancer Institute Tumor Grading:

Grade I tumor is considered

A

Discrete/Slow growing

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5
Q

WHO and National Cancer Institute Tumor Grading:

Grade III tumor is considered

A

Infiltrating/Likely to spread

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6
Q

WHO and National Cancer Institute Tumor Grading:

Grade IV tumor is considered

A

Highly Malignant/Aggressive growth

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7
Q

What are the main 3 signs for Cushings Triad

A
  1. Increase SYSTOLIC BP
  2. Decrease BP
  3. Decrease Irregular RR
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8
Q

3 Main signs for IICP

A
  1. Altered LOC (#1 sign)
  2. Restlessness
  3. Vomit NO nausea
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9
Q

Q: Which organ is a frequent site for metastatic cancers?

A

Brain

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10
Q

Q: Where can brain tumors develop?

A

can occur in any part of the brain or spinal cord

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11
Q

4 types of Intracranial Tumors

A
  1. Primary tumor
  2. Secondary tumor
  3. Benign tumor
  4. Malignant tumor
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12
Q

Tumor that originates in the brain

A

Primary Tumor

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13
Q

Tumor that metastasized from another organ/site

A

Seconday Tumor

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14
Q
  • Non-cancerous
  • slow-growing tumor
A

Benign Tumor

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15
Q
  • Cancerous
  • Aggressive Tumor
A

Malignant Tumor

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16
Q

Q: What is the only confirmed risk factor for brain tumors?

A

Ionizing radiation

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17
Q

What is Ionizing Radiation

A
  • An ENVIRONMENTAL risk factor
  • This type of radiation can damage DNA in cells, leading to mutations that may result in uncontrolled cell growth and tumor formation.
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18
Q

Clinical Manifestations for Brain Tumors

A

Depending on size, location, and mitotic rate

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19
Q

What is mitotic rate?

A

How quick cells divide and make new ones- how fast the tumor is growing

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20
Q

S/S common to ALL tumors:

A
  • Increased Intracranial Pressure (IICP) → Headache, seizures, altered mental status.
  • Vomiting (no nausea)
  • Visual disturbances.
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21
Q

Why do seizures occur with Brain tumors

A

Puts pressure in Brain stem

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22
Q

List 8 effects of UNILATERAL frontal lobe damage?

A
  • Behavioral & emotional changes.
  • Impaired judgment.
  • Impaired sense of smell.
  • Memory loss.
  • Paralysis on ONE SIDE of body (hemiplegia)
  • Communication difficulty.
  • Lack of inhibition (overexcitation or hyperactivity of neural circuits, disrupting normal brain and body functions)
  • Hard to concentrate.

SUDDEN ONSET!

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23
Q

Q: What are the effects of BILATERAL frontal lobe damage?

1 key difference.

A

ALL of the UNILATERAL PLUS ATAXIC GAIT

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24
Q

What are the 4 effects of Parietal Lobe damage

A
  • Impaired speech.
  • Inability to write.
  • sensory misinterpretation.
  • Spatial disorders: unable to understand where things are in space affecting how they move, draw, or find their way around.
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25
Q

The main effect with Occipital Lobe damage.

A
  • Visual loss
    (sudden, occurs overnight)
  • Photosensitivity
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26
Q

Q: What condition can parietal lobe damage resemble?

A

can mimic stroke symptoms

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27
Q

Review:

What DX is used for Strokes?

A

CT scan

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28
Q

What are the 4 effects with Temporal Lobe damage?

A
  • Asymptomatic
  • Long term memory loss
  • Difficulty recognizing new objects
  • Hearing difficulty.
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29
Q

What are the 6 effects of Cerebellum damage?

A
  • Loss of balance/equilibrium
  • muscle coordination & control (ataxia)
  • Blurry vision
  • Loss of motor learning
  • Tiredness
  • Difficulty swallowing

Think of SAFETY!- SAFETY ISSUES

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30
Q

What are the 8 effects of Brainstem damage?

A
  • Visual & Pupil abnormalities
  • Swallowing & speech difficulties
  • Facial Weaknes: drooping eyelid (ptosis) or crossed eyes (strabismus)
  • Respiratory & temperature dysregulation
    -Autonomic NS starts to shut down
  • Bradycardia (Low HR)
  • Vomit
  • Drowsiness
  • Headache in the A.M or upon awakening.

Autonomic functions: Resp, Cardio, Eating, Sleeping

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31
Q

3 main complications of Brain Tumors in ADULTS

(occurs bc of tumors)

A
  • Hydrocephalus: Tumor mass blocks (obstructs) ventricles or occludes the outlet (CSF flow).
  • IICP: Tumor growth increases pressure leading to IICP s/s.
  • Brain Herniation: Caused by IICP.
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32
Q

Infants with Brain Tumors will present with:

A
  1. Widening cranial sutures
  2. wide fontanels
  3. constant pain
  4. Not eating or playing
  5. KEY: will not tilt their heads to the side of tumor.
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33
Q

DX studies for Brain Tumors

A
  • Hx and Physical
  • Imaging: CT, MRI, PET scan, cerebral angiography.
  • Neurological exams: EEG
    -ANY CHANGES= REPORT HCP!!
  • Biopsy- rarely done
  • Endocrine studies: Pituitary gland- major hormone control center
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34
Q

What imaging is specific to CANCER?

A

PET Scan
(only used to determine stage and guide tx)

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35
Q

Q: What is the preferred treatment for brain tumors for ADULTS?

A

Surgical therapy
* removal of the tumor, reduces pressure on the brain and improve symptoms.

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36
Q

In adults, is surgical treatment used for malignant or benign tumors?

A

BOTH malignant and benign

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37
Q

In Pediatrics, is surgery an option?

A

No. Radiation is tx of choice. Shrink tumor is goal.

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38
Q

What is major s/s of radiation

A
  • very dry mouth (oral care important)
  • weakness

-Radiation absorbs lots of energy and fluids.

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39
Q

2 types of SURGERY for tumor removal

A
  1. Stereotactic surgery
  2. Intracranial surgery
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40
Q

Can brain cancer (malignant tumors) be cured?

A

No.

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41
Q

Which tumor removal surgery is LEAST INVASIVE?

A

stereotactic surgery

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42
Q

Which tumor removal surgery is MOST INVASIVE?

A

Intracranial surgery

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43
Q

Q: What is stereotactic surgery used for?

A

Used for
* small tumors and abscesses
* biopsies
* minimizes damage to surrounding tissue

Pt wear halo/clamp over head and surgeon drills a hole- GENERAL ANESTHESIA (complete)

44
Q

What is intracranial surgery?

A
  • A procedure often involving opening the skull (craniotomy) to access and treat brain conditions: tumors, bleeding, or injuries.
45
Q

There are 4 types of Intracranial surgeries.

Name them

A
  • Craniotomy
  • Craniectomy
  • Cranioplasty
  • Burr holes
46
Q

What is Craniotomy used for?

A

Skull opening for:

  • tumor removal
  • ICP relief
  • remove blood clot
  • control hemorrhage

-Conscious sedation

47
Q

What is craniectomy used for?

A
  • Skull portion excision.
  • Used for emergency situations.
  • Skull portion is NOT IMMEDIATELY replaced.

-skull removed and put back LATER

48
Q

What is Cranioplasty used for?

A

Skull defect repair using plastic or metal plate.

49
Q

What are burr holes used for?

A

Small openings for
* access
* drainage
* decompression.

-Head is shaved

50
Q

What is included in medical management for preoperative brain surgery care?

MEDS- KNOW!!

A

Medical management includes the use of:
* corticosteroids & Diuretics to reduce cerebral edema: DEXAMETHASONE, FUROSEMIDE
* Fluid restriciton
* Hyperosmotic agent: MANNITOL
* Antibiotics to prevent infection
* Anti-seizure meds:KEPRA
* Anxiolytics: DIAZEPAM for anxiety relief
* Pre-op diagnostic procedures: CT scans, MRI, angiography, or transcranial doppler flow studies.

51
Q

Main 3 s/s of CORTICOSTEROIDS

A
  1. HIGH BG
  2. Agitation
  3. Insomnia
52
Q

Nursing Management for Pre-operative Care

A
  • Neurological baseline assessment
  • Preoperative education: preparation for surgery
  • Emotional support: fears, concerns
  • ICU monitoring post-op for close monitoring
  • Head will be shaved- important to educate women.
53
Q

What is the definition of “tentorium” in the context of neuro tumors?

A
  • its a fold of the dura mater (a tough membrane covering the brain) that separates the cerebellum (the part of the brain responsible for coordination) from the cerebrum (the large part of the brain responsible for higher functions like thinking and movement).
  • the tentorium plays an important role in the location and type of tumor, as tumors can develop in the spaces between the cerebrum and cerebellum, affecting the brain’s function.
54
Q

Nursing Care: Post Cranial Surgery

Q: why is positioning AFTER cranial surgery important?

A

Proper positioning depends on the surgery location to promote healing and prevent increased intracranial pressure (ICP)

55
Q

The 2 main types of CEREBRUM Surgeries depending on tentorium location

A
  1. Supratentorial surgery
  2. Infratentorial surgery
56
Q

Patient positioning for:

Supratentorial surgery
(Above the Tentorium - Cerebrum)

  • supratentorial region is your brain’s thinking cap
A

HOB flat: elevated 30-45°
* promote venous output-per surgeon orders!!!!

57
Q

What 4 lobes are in the SUPRATENTORIAL region?

A
  • frontal
  • temporal
  • occipital
  • parietal
58
Q

Why we do elevated HOB 30-45° in Supratentorial surgeries

A

Promote venous drainage and reduce swelling- per HCP!

59
Q

Type of positioning for:

Infrantentorial surgery
(Below the Tentorium - Cerebellum, Brainstem)

A

HOB flat: max 10-15°

60
Q

Why do we ONLY elevate HOB max 10-15° for Infranterial surgery.

A

to prevent pressure on the brainstem and allow proper CSF drainage.

61
Q

After cranial surgery, we should NOT position the patient on what side?

A

The operated side
* It increases pressure on the surgical site, affecting healing and circulation.

62
Q

Q: What movement should be avoided after Cranial tumor surgery?

A

Hyperflexion- Elevates ICP

63
Q

Cranial surgery:

Example: If surgery was on the LEFT occipital area, the patient should be positioned on what side?

A

On the RIGHT side with the head of bed (HOB) elevated at 30°

64
Q

Q: What assessments are essential POST cranial surgery?

A
  • Vital signs, pain, and oxygen saturation monitoring.
  • Observing for signs of increased ICP (e.g., headache, nausea, altered LOC).
  • Monitor CSF leakage
  • Monitor bleeding at the surgical site.
  • Neurological status: changes in consciousness or function.
  • Monitoring genitourinary status - Fluid balance esp with MANNITOL
  • Ensuring the client can eat as soon as they can tolerate regular food.- Assess gag reflex!!
65
Q

Q: Why is CSF leakage or bleeding after cranial surgery concerning?

A

CSF leakage increases the risk of infection (such as meningitis)
* can lead to intracranial pressure changes, causing headaches and neurological deficits

66
Q

How do we test CSF drainage?

A
  • Glucose Test – CSF contains glucose, while normal nasal secretions do not. A positive glucose test suggests CSF.
  • Halo Sign – When CSF is mixed with blood and placed on gauze or a tissue, it forms a ring-like “halo” pattern with a clear outer ring.
  • Beta-2 Transferrin Test – A definitive lab test for CSF, as beta-2 transferrin is found only in CSF.
67
Q

Why is bleeding post Cranial surgery concerning?

A

Bleeding can result in:
* hematomas (blood pooling)
* increased intracranial pressure (ICP)
* and potential brain damage

68
Q

When giving MANNITOL, how do you measure fluid balance EFFECTIVELY?

69
Q

Q: Why might a patient experience an fever during Cranial surgery?

A
  • Stimulation of the hypothalamus during surgery
  • This is a NORMAL physiological response
70
Q

Pain drug of choice for Neuro Tumors?

71
Q

Med of choice for seizures in Neuro Tumors?

72
Q

Med of choice for Nause in Neuro tumors

73
Q

Is facial edema common post Cranial surgery?

A

Yes. Provide cool damp compresses

74
Q

Med of choice for Edema in Neuro Tumors

A

Furosemide

75
Q

What med is given for fever post cranial surgery?

A

Acetaminophen RECTAL
(onset 15 mins, duration 6 hrs, very few side effects)

76
Q

Q: Is a raspy voice normal after cranial surgery?

A

Yes, a raspy voice post-surgery is a normal finding, often due to irritation from the endotracheal tube used during anesthesia.

77
Q

Post-Cranial Precautions that we need to educate patients about

(long list)

A
  • Do not hold your breath during activity
  • Do not blow your nose
  • Use humidifier because humidified air will prevent drying of the nasal passages.
  • No heavy activity that makes your head feel full or increases headache
  • No lifting: Nothing heavier than a loaf of bread
  • Do not bend too far forward
  • Do not lie with your head flat, always use a pillow to prop your head up
  • Take care combing your hair to avoid pulling at the incision with a comb or brush
  • Use gentle shampoo, such as baby shampoo, until your head has healed
  • Instruct client to use caution when brushing teeth if they have had a tumor removed in area close to oral cavity. (transphenoidal hypophysectomy)
78
Q

Review:

MAP should be

79
Q

Rare type of Tumors

A

Spinal Cord tumors

80
Q

Spinal Cord tumors can be __ or __

A

Primary or secondary tumors

81
Q

Q: What is the classification of spinal cord tumors based on?

A

A: It’s based on their location in relation to the spinal cord and its surrounding structures.

82
Q

Q: What are the 2 types of spinal cord tumors based on their location?

A
  1. Extradural
  2. Intradural extramedullary
83
Q

Type of Spinal cord tumor:

Tumors located outside the spinal cord.

A

Extradural

84
Q

Type of Spinal cord tumor:

Tumors within the dura mater but outside the actual spinal cord.

A

Intradural extramedullary

85
Q

Type of Spinal cord tumor:

Tumors within the substance of the spinal cord itself.

A

Intradural intramedullary

86
Q

What is the rate of growth of a spinal tumor

A

tend to be slow-growing

87
Q

What symptoms are associated with spinal cord tumors?

A

Symptoms are related to the mechanical effects of the tumor, such as:
* slow compression
* irritation of nerve roots
* displacement of the cord
* gradual obstruction of the vascular supply.

-These effects can lead to pain, weakness, numbness, or other neurological deficits over time.

88
Q

Q: What problems can spinal cord tumors cause?

A

Can cause both sensory and motor problems

89
Q

1 S/S for Spinal cord tumors

A

Back pain and it radiates

90
Q

What type of back pain is associtated with spinal cord tumors?

A
  • Back pain with radicular pain (pain that radiates along a nerve)
  • Intercostal neuralgia (pain between the ribs, often due to nerve involvement)
  • Angina (chest pain, if the tumor affects certain spinal areas)
  • Herpes zoster (shingles, when the tumor affects specific nerve roots.
91
Q

Q: When does pain from a spinal cord tumor tend to worsen?

A
  • Worsens with activity, coughing, straining, or when lying down.
    -This is often due to increased pressure or irritation on the spinal cord, nerve roots, or surrounding structures during these activities.
92
Q

Q: What are 4 signs of motor weakness in spinal cord tumors?

A

Include slowly increasing:
* clumsiness
* weakness
* spasticity
* in severe cases, paralysis.

93
Q

If a pt has:
Loss of reflex with progressive loss of motor function (walking, etc), and sensory deficit- can no longer urinate or control it…

Where is this tumor located in the body?

A

Below Thoracic level

94
Q

Q: What are the symptoms of bladder & bowel dysfunction in spinal cord tumors?

A

include urgency, which may progress to incontinence

95
Q

Q: What sensory disruptions can occur with spinal cord tumors?

List 4

A
  • coldness
  • numbness
  • tingling in one or more extremities.
  • Over time, this may lead to progressive loss of motor function and paralysis.

THIS IS AN EMERGENCY- REPORT TO HCP!!!!

96
Q

Q: What are 2 types of treatments for spinal cord tumors?

A
  • Laminectomy: removal of a portion of the vertebrae to relieve pressure on the spinal cord.
  • Corticosteroids: Medications like dexamethasone (Decadron)
97
Q

Why is the corticosteroid dexamethasone (Decadron) prescribed in LARGE doses?

A

To treat tumor-related edema and reduce inflammation.

98
Q

Q: When is dexamethasone typically administered for spinal cord tumors?

A

typically administered immediately after diagnosis of spinal cord tumors

99
Q

What are some pain management and positioning strategies AFTER spinal cord tumor surgery?

A
  • Positioning: Keep the bed flat initially and have the patient lie on their side.
  • Log rolling: Use log rolling to keep the back straight and aligned during movement.
  • Sensory function assessment: Regularly assess sensory function by pinching the arms and legs to check for loss of feeling.
  • Cervical area surgery: If surgery was performed on the cervical area, closely monitor for respiratory compromise due to postoperative edema.
100
Q

Therapies used for BOTH brain and spinal

List 3

A
  1. Radiation Therapy: follow up after surgery
  2. Radiosurgery: high doses directly at tumor
  3. Chemotherapy:
101
Q

MAJOR Side effect of radiation and how do we treat it?

A
  • Edema
  • Managed with corticosteroid (dexamethasone)
  • MAX dose given over 6-8 weeks
102
Q

Why is chemotherapy limited in treating both spinal and brain?

A

Chemotherapy is limited by the blood-brain barrier (BBB), which restricts many drugs from reaching the brain and spinal cord CSF.

103
Q

Neuro Tumors: Brain and Spinal Meds

  • Edema
  • Corticosteroids
  • PPIs for Peptic ulcer disease (due to high levels of stress)
  • Seizure meds
  • Antidepressants
  • Anti-nausea
A
  • Mannitol/Furosemide (lasix)
  • Dexamethasone
  • PPI: pentoprazole
  • SSRIs
  • Ondansetron
104
Q

List 3 risks related to Neuro Tumors (brain/spinal)

A
  • Glucose intolerance
  • Increase infx
  • bleeding
105
Q

Q: Whats the nursing plan for clients with a neuro tumors?

A
  • Maintain normal ICP
  • Maximize neurologic functioning
  • Achieve control of pain and discomfort
  • Have relief of spinal cord compression
  • Maintain bladder function
  • Be aware of prognosis and long-term changes in cognitive and physical functioning
106
Q

Expected outcomes for clients with a neuro tumors

A
  • Achieve control of pain, nausea, vomiting, vertigo
  • Maintain ICP within normal limits
  • Demonstrate maximal neurologic function for type and location of tumor
  • Maintain optimal nutritional status
  • Accept long-term consequences of tumor and treatment
  • Maintain bladder function
  • No injuries from falls

N4- Test 3 (7 decks)

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