Test 2 Flashcards
Glioblastoma multiforme
fast-growing, star-shaped, WORST form of glioma, aka stage IV astrocytoma
Most common brain tumor complaint
headache
Meningioma
- middle aged adults (female most common)
- encapsulated (compression rather than invasion)
- usually benign
- increased ICP
Acoustic Neuroma
- CN VIII (acoustic)
- slow growing
- benign
- s/sx: hearling loss, tinnitus, vertigo`
Hemangioblastoma
- from a vessel
- risk of CVA
- people <40 w/ hemorrhage
Pituitary Adenoma
- women of child-bearing ages higher risk
- s/sx of pituitary hormonal dysfunction
- usually small, benign, encapsulated, slow-growing
- report changes of smell
Primary CNS Lymphoma
- immune compromised pts. = high risk
- diffuse large B-cell lymphoma (DLBCL), a type of non-Hodgkin
Brain Tumor Assessment Findings
- headache, reported as “different” (most common)
- seizures
- nausea/vomiting
- altered mentation
Meningeal Tumor Most Common S/Sx
severe HA and photosensitivity (also for ruptured aneurysm)
Goal of Brain Tumor Diagnostics
preserve remaining normal brain tissue
Medical Brain Tumor Management
- radiation (remember proper shield placement)
- chemotherapy
- steroids
- benzos (effective at decreasing nausea)
Surgical Brain Tumor Management
- removal of all or part of tumor
- shunts
Bone Flap Rationale for Cerebral Edema
reduce swelling
Craniotomy Nursing Interventions
- assess for changes in LoC
- HOB 30*
- treat HA/nausea
- keep dressing in place, assess drainage, bleeding, odor
Post-op craniotomy pt. is weak/lethargic
checks ABCs
Diabetes Insipidus (DI)
- no ADH leads to excessive U/O (>300 mL/hr)
- urine specific gravity low (diluted) <1.005
DI Priority Assessments and Interventions
- assess electrolyte imbalance
- I/O
- fluid replacement
- DDAVP (desmopressin acetate)
Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)
- too much ADH leads to decreased U/O (<20 mL/hr)
- urine specific gravity high (concentrated) >1.025
SIADH Priority Assessments and Interventions
- post-op brain surgery: call MD immediately
- assess electrolyte imbalance frequently (particularly sodium)
- I/O
- fluid restriction
- diruretics
- s/sx of dehydration or overload
Crani surgery post-op care 1
- Meningitis (#1 culprit)
- prophylactic ABx
- assess drain/incision sites
- Respiratory problems
- encourage IS/deep breathe, but NOT coughing
- prepare room for suctioning
- Seizures
Crani surgery post-op: CSF leak
call MD and check for glucose
Crani surgery post-op: IICP
- proper positioning (consider drains and location of surgery)
- no restraints or enemas
Crani surgery post-op care: Trans-sphenoidal
- damage to CN III common, assess visual field loss or deterioration
- monitor I/O, assess for DI
- call MD for excessive drainage
Trans-sphenoidal pt. education
- avoid (4 weeks): blowing nose, coughing, sneezing, straws, bending over, straining on toilet
- no driving for 2 weeks
Left-frontal lobe tumor expected findings
personality/judgement/emotional changes
Swallow problems interventions
- high Fowler’s position
- chin to chest
- reduce distractions
Penumbra
area surrounding the minimally-perfused dead core, ability to save depends on timely re-circulation, volume of toxins released by dead cells, degree of edema
Stroke Risk Factors
- TIA (warning sign) or previous stroke
- HTN
- A-Fib
- Heart disease
- DM
- Oral contraceptives
- smoking, obesity, sedentary lifestyle
- hyperlipidemia/atherosclerosis
TIA
temporary stroke symptoms, thrombotic stroke, few minutes up to 24 hours, neuro deficits are reversible (find out baseline from family)
Ischemic vs. Hemorrhagic Stroke
- ischemic most common (87%), can be thrombotic or embolic
- hemorrhagic usually caused by HTN
Thrombotic AIS
- atherosclerosis #1 risk factor
- vessels: lose elasticity, harden, narrow
- symptoms: sudden, often during sleep or in morning
- may be gradual process (buildup)
Embolic AIS
- A-Fib #1 risk factor
- travelling blood clot lodges in small vessels or middle cerebral artery
- sudden onset of symptoms
Hemorrhagic Stroke
- vessel integrity interrupted (bleeding into tissue or subarachnoid space
- CT STAT to find/rule out bleed
Middle Cerebral Artery (MCA)
- most often occluded in a stroke
- largest branch of internal carotids
MCA Stroke S/Sx
hemiparesis, sensory loss (face/arm > leg), gaze deficits (eye deviation), aphasia
Anterior Cerebral Artery Stroke
Presents with motor/sensory loss (leg > arm)
Hemorrhagic Stroke: Arterio-Venous Malformation
- looks like vessels are tangled/clumped
- congenital anomaly
- age 10-40
- surgery: ligation (vasospasm/rebleed)
Hemorrhagic Stroke: SAH
- cerebral aneurysm leak or burst
- bleeding occurs in sub-arachnoid space
- tests find: blood on LP, aneurysm on CT/MRI
- most common symptom: “worst HA I’ve ever had”
Ruptured Aneurysm S/Sx
- sudden, extremely severe HA, photosensitivity (also for meningeal tumor)
- change in LoC
- blurred/double vision
- drooping eyelid
- seizure
Unruptured Aneurysm S/Sx
- pain above and behind one eye
- dilated pupil
- change in vision/double vision
- unilateral facial numbness
Code Stroke Protocol
- last known well time
- complete assessment with NIH scale
- blood sugar
- CT
- IV start with blood draw
- report any changes immediately
Time is Brain Protocol
- 3-4.5 hour window from onset of symptoms
- CT non-contrast within 25 min to r/o bleed
- bleed: hemorrhagic/no bleed: ischemic
- screen for tPA
- begin fibrinolytic Tx
tPA (alteplase)
- ischemic only (gold standard)
- dissolves the clot
- given 24 hours after onset of Sx
SAH Tx
- endovascular therapy/coiling
- surgical aneurysm clipping
- medical Tx
SAH Complications
- rebleed
- vasospasms
- hydrocephalus
Cerebral Vasospasm Management
- balloon angioplasty
- nimodipine 60 mg q4h for 21 days
- SBP 160-200 if clipped or 120-150 if unclipped
- central venous pressure 10-12 mmHg
Nimodipine
- SAH/cerebral vasospasm treatment
- calcium channel blocker
- reverses body’s immediate reaction to vasoconstrict (would lead to further damage)
- allows blood to flow more easily to non-damaged tissue
Post-Stroke Interventions
- ALWAYS clarify MD’s desired parameters for BP
- usual maintenance level 120-150
