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203D Custom > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Glioblastoma multiforme

A

fast-growing, star-shaped, WORST form of glioma, aka stage IV astrocytoma

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2
Q

Most common brain tumor complaint

A

headache

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3
Q

Meningioma

A
  • middle aged adults (female most common)
  • encapsulated (compression rather than invasion)
  • usually benign
  • increased ICP
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4
Q

Acoustic Neuroma

A
  • CN VIII (acoustic)
  • slow growing
  • benign
  • s/sx: hearling loss, tinnitus, vertigo`
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5
Q

Hemangioblastoma

A
  • from a vessel
  • risk of CVA
  • people <40 w/ hemorrhage
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6
Q

Pituitary Adenoma

A
  • women of child-bearing ages higher risk
  • s/sx of pituitary hormonal dysfunction
  • usually small, benign, encapsulated, slow-growing
  • report changes of smell
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7
Q

Primary CNS Lymphoma

A
  • immune compromised pts. = high risk

- diffuse large B-cell lymphoma (DLBCL), a type of non-Hodgkin

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8
Q

Brain Tumor Assessment Findings

A
  • headache, reported as “different” (most common)
  • seizures
  • nausea/vomiting
  • altered mentation
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9
Q

Meningeal Tumor Most Common S/Sx

A

severe HA and photosensitivity (also for ruptured aneurysm)

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10
Q

Goal of Brain Tumor Diagnostics

A

preserve remaining normal brain tissue

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11
Q

Medical Brain Tumor Management

A
  • radiation (remember proper shield placement)
  • chemotherapy
  • steroids
  • benzos (effective at decreasing nausea)
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12
Q

Surgical Brain Tumor Management

A
  • removal of all or part of tumor

- shunts

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13
Q

Bone Flap Rationale for Cerebral Edema

A

reduce swelling

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14
Q

Craniotomy Nursing Interventions

A
  • assess for changes in LoC
  • HOB 30*
  • treat HA/nausea
  • keep dressing in place, assess drainage, bleeding, odor
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15
Q

Post-op craniotomy pt. is weak/lethargic

A

checks ABCs

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16
Q

Diabetes Insipidus (DI)

A
  • no ADH leads to excessive U/O (>300 mL/hr)

- urine specific gravity low (diluted) <1.005

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17
Q

DI Priority Assessments and Interventions

A
  • assess electrolyte imbalance
  • I/O
  • fluid replacement
  • DDAVP (desmopressin acetate)
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18
Q

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)

A
  • too much ADH leads to decreased U/O (<20 mL/hr)

- urine specific gravity high (concentrated) >1.025

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19
Q

SIADH Priority Assessments and Interventions

A
  • post-op brain surgery: call MD immediately
  • assess electrolyte imbalance frequently (particularly sodium)
  • I/O
  • fluid restriction
  • diruretics
  • s/sx of dehydration or overload
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20
Q

Crani surgery post-op care 1

A
  • Meningitis (#1 culprit)
    • prophylactic ABx
    • assess drain/incision sites
  • Respiratory problems
    • encourage IS/deep breathe, but NOT coughing
    • prepare room for suctioning
  • Seizures
21
Q

Crani surgery post-op: CSF leak

A

call MD and check for glucose

22
Q

Crani surgery post-op: IICP

A
  • proper positioning (consider drains and location of surgery)
  • no restraints or enemas
23
Q

Crani surgery post-op care: Trans-sphenoidal

A
  • damage to CN III common, assess visual field loss or deterioration
  • monitor I/O, assess for DI
  • call MD for excessive drainage
24
Q

Trans-sphenoidal pt. education

A
  • avoid (4 weeks): blowing nose, coughing, sneezing, straws, bending over, straining on toilet
  • no driving for 2 weeks
25
Q

Left-frontal lobe tumor expected findings

A

personality/judgement/emotional changes

26
Q

Swallow problems interventions

A
  • high Fowler’s position
  • chin to chest
  • reduce distractions
27
Q

Penumbra

A

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

28
Q

Stroke Risk Factors

A
  • TIA (warning sign) or previous stroke
  • HTN
  • A-Fib
  • Heart disease
  • DM
  • Oral contraceptives
  • smoking, obesity, sedentary lifestyle
  • hyperlipidemia/atherosclerosis
29
Q

TIA

A

temporary stroke symptoms, thrombotic stroke, few minutes up to 24 hours, neuro deficits are reversible (find out baseline from family)

30
Q

Ischemic vs. Hemorrhagic Stroke

A
  • ischemic most common (87%), can be thrombotic or embolic

- hemorrhagic usually caused by HTN

31
Q

Thrombotic AIS

A
  • atherosclerosis #1 risk factor
  • vessels: lose elasticity, harden, narrow
  • symptoms: sudden, often during sleep or in morning
  • may be gradual process (buildup)
32
Q

Embolic AIS

A
  • A-Fib #1 risk factor
  • travelling blood clot lodges in small vessels or middle cerebral artery
  • sudden onset of symptoms
33
Q

Hemorrhagic Stroke

A
  • vessel integrity interrupted (bleeding into tissue or subarachnoid space
  • CT STAT to find/rule out bleed
34
Q

Middle Cerebral Artery (MCA)

A
  • most often occluded in a stroke

- largest branch of internal carotids

35
Q

MCA Stroke S/Sx

A

hemiparesis, sensory loss (face/arm > leg), gaze deficits (eye deviation), aphasia

36
Q

Anterior Cerebral Artery Stroke

A

Presents with motor/sensory loss (leg > arm)

37
Q

Hemorrhagic Stroke: Arterio-Venous Malformation

A
  • looks like vessels are tangled/clumped
  • congenital anomaly
  • age 10-40
  • surgery: ligation (vasospasm/rebleed)
38
Q

Hemorrhagic Stroke: SAH

A
  • 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”
39
Q

Ruptured Aneurysm S/Sx

A
  • sudden, extremely severe HA, photosensitivity (also for meningeal tumor)
  • change in LoC
  • blurred/double vision
  • drooping eyelid
  • seizure
40
Q

Unruptured Aneurysm S/Sx

A
  • pain above and behind one eye
  • dilated pupil
  • change in vision/double vision
  • unilateral facial numbness
41
Q

Code Stroke Protocol

A
  • last known well time
  • complete assessment with NIH scale
  • blood sugar
  • CT
  • IV start with blood draw
  • report any changes immediately
42
Q

Time is Brain Protocol

A
  • 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
43
Q

tPA (alteplase)

A
  • ischemic only (gold standard)
  • dissolves the clot
  • given 24 hours after onset of Sx
44
Q

SAH Tx

A
  • endovascular therapy/coiling
  • surgical aneurysm clipping
  • medical Tx
45
Q

SAH Complications

A
  • rebleed
  • vasospasms
  • hydrocephalus
46
Q

Cerebral Vasospasm Management

A
  • 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
47
Q

Nimodipine

A
  • 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
48
Q

Post-Stroke Interventions

A
  • ALWAYS clarify MD’s desired parameters for BP

- usual maintenance level 120-150

203D Custom (6 decks)

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