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nursing 272: final semester > Unit 1: Brain Tumors > Flashcards

Unit 1: Brain Tumors Flashcards

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1
Q

Primary Brain Tumors

A
  • originate in the brain; brain cells, brain meninges, nerves, and glands
  • range from slow growing, benign tumors to highly malignant, aggressive tumors
  • can spread to the CNS in 3 locations: the brain tissue (parenchyma), the spinal cord, and the CSF = now called metastasis
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2
Q

Metastatic Tumors

A
  • most common type of brain tumor
  • commonly caused by lung, melanoma, renal, breast, and colorectal cancer
  • spreads to the CNS
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3
Q

Brain Tumor Grades

A

> Grade 1:
-benign, slow growing, long term survival

> Grade II:
-relatively slow growing, can spread to nearby tissue, can come back as a higher grade tumor

> Grade III:
-malignant, actively reproduces abnormal cells, tends to come back as a higher grade tumor

> Grade IV:
-most malignant, rapid growth w/ formation of new blood vessels, easily spreads to nearby normal parts of the brain

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4
Q

Common Tumor Types

A
  • Glioma
  • Meningiomas
  • Oligodendrogliomas
  • Acoustic Neuromas
  • Pituitary
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5
Q

Glioma

A
  • originate in the cerebrum
  • glial cells provide the physical structure of the brain and supports the endothelial cells of the blood-brain barrier (BBB)
  • glial cells provide nutrients and ionic balance; involved in the repair and scarring process
  • Gliomas develop along the curved areas of the brain, making frontal lobes more susceptible
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6
Q

Meningiomas

A
  • arises in ages 40-70 years
  • arise from the meninges (layers of the brain)
  • usually benign
  • can still cause devastating damage b/c they are space-occupying lesions that can increase ICP
  • damage based on tumor size and location
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7
Q

Oligodendrogliomas

A
  • arise from oligodendrocytes, or oligodendroglia, and their main functions are to provide support and insulation to axons in the CNS
  • slow-growing
  • generally do not spread to surrounding tissue
  • arising from the fatty covering that protects nerves, they generally occur in the cerebrum
  • found in middle-aged patients
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8
Q

Acoustic Neuromas

A
  • “schwannomas”
  • slow-growing, benign
  • generally do not invade other tissue
  • compression on other cranial nerves and tissue can manifest in severe complications of these
  • originate from the protective covering around nerve fibers (CN VIII) at the anatomical location of the cerebellopontine angle
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9
Q

Pituitary Tumors

A
  • found in anterior lobe of the pituitary
  • benign
  • clinical manifestations of pituitary adenomas are r/t hypersecretion of hormones by the pituitary gland
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10
Q

Clinical Manifestations of Brain Tumors

A
  • r/t size and location in the brain
  • dependent upon compression of associated structures
  • may have S/S of increased ICP
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11
Q

Malignant Brain Tumors are associated with what?

A

swelling as the rapid growth damages brain tissue

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12
Q

What are Brain Tumors often referred to as?

A

space-occupying lesions that may cause increased ICP depending on rate of tumor growth and location

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13
Q

Presenting Clinical Manifestations of a Brain Mass: Locations and Symptoms associated

A

> Frontal motor cortex: motor weakness
Parietal sensory cortex: sensory loss
Left inferior frontal lobe (Broca’s area): speech (expressive)
Left temporal lobe (Wernicke’s area): speech (recessive)
Optic nerve: loss of vision in one eye
Optic chiasm: bitemporal field cuts
Optic tract, Occipital lobe: loss of visual field on the same side in both eyes
Pineal gland: loss of upward gaze, loss of light reflex
Brainstem: loss of cranial nerves on one side w/ loss of motor or sensory on contralateral side

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14
Q

Clinical Manifestations of Increased ICP

A
  • papilledema (swelling of the optic nerve)
  • headache
  • nausea and vomiting
  • decreased alertness
  • cognitive impairment
  • personality changes
  • ataxia
  • hemiparesis
  • abnormal reflexes
  • cranial nerve palsies
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15
Q

Medical Management

A

-Chemotherapy
-Radiation
>used in place or in conjunction w/ surgery depending on type and location of tumor

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16
Q

Chemotherapeutic Agents

A
  • must have the ability to cross the blood-brain barrier
  • nursing care= neuro assessment, standard care of the oncology pt receiving chemotherapy
  • side effects: diarrhea, nausea, vomiting, weight loss, mucositis, hair loss, and fatigue
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17
Q

Radiation Therapy

A
  • destroys both tumor and normal cells by damaging cellular DNA
  • monitor for fatigue, reddening of the skin, headache, swelling, facial numbness, and any sensory or neurologic changes, visual changes
  • CyberKnife is a type of radiation that more precisely targets the cancerous site, avoiding healthy brain tissue
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18
Q

Nursing Interventions for Complications of Radiation Therapy

A
  • Fatigue nutritional supplements (i.e. boost, ensure)
  • Skin utilization of sunscreens, sun-protectant coverings, and skin emollients
  • Dexamethasone (Decadron) used to reduce swelling
  • Ondansetron (Zofran) used to reduce nausea/vomiting
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19
Q

Surgical Management

A
  • Brain Biopsy

- Craniotomy

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20
Q

Brain Biopsies

A

biopsies of brain masses to sample tissue within the mass so that the cells can be examined and a specific diagnoses can be made
-performed using radiological techniques that allow the neurosurgeon to map the location of the mass in multiple dimensions

21
Q

Craniotomy

A
  • most common for all types of brain tumors
  • section of the skull is removed (bone flap) to provide access to the brain
  • can be done to biopsy brain tissue or to excise (remove) a tumor
  • if the entire tumor cannot be removed, the tumor is debulked, removing as much as the tumor as possible
22
Q

Complications of Brain Tumors

A
  • Increased Intracranial Pressure
  • Bleeding
  • Cerebral Edema
  • Diabetes Insipidus
  • SIADH
  • Seizures
  • Venous Thromboembolism
23
Q

Complications: Increased ICP

A

-can hamper cerebral blood flow; causing decreased in cerebral perfusion pressure (CPP) and leading to secondary injury of the brain via cytotoxic and anoxic injury and herniation of the brain

24
Q

Complications: Bleeding

A
  • risk of intracranial bleeding post-op is variable and dependent on features of the tumor, location in the brain, proximity of the tumor to blood vessels, ad the surgical approach
  • when changes in the neurological assessment are detected, healthcare team is alerted for further assessment and CT scan to determine whether there is a structural change such as bleeding
  • can occur in the area where the tumor was resected
  • can occur above or below the dural covering while blood vessels are manipulated during the surgical approach
25
Q

Complications: Cerebral Edema

A
  • Vasogenic edema: blood brain barrier becomes increasingly permeable
  • most common after brain tumor resection; secondary to changes to the usually tightly controlled blood-brain barrier that becomes inflamed and more permeable in the area of the tumor and surgical resection
  • serial neurological assessments to monitor a patients response to the surgical procedure, and deterioration of that assessment can be caused by cerebral edema
  • edema can be located in and around the area where the tumor was resected
  • edema can be located along the path taken by the surgeon to expose and resect the tumor
  • Emergent TX: osmotic diuretics, hyperventilation, and HOB elevated 30-45 degrees
  • Increase the dose of glucocorticoids; decrease the inflammatory process associated with damage in and around the tumor
26
Q

Complications: Seizures

A
  • may occur as a presenting sign of a brain tumor and episodically thereafter
  • may occur post-operatively
  • locations closer to the upper regions of the brain are at greater risk for seizure activity
  • Immediate Tx: benzodiazepines to stop the seizure; antiepileptics to prevent reoccurrence
27
Q

Complications: Venous Thromboembolism

A
  • occurrence of a malignancy, surgical procedure, and immobility place pts w/ brain tumors at higher risk of VTE
  • Prevention measures: mechanical VTE prevention devices (sequential compression devices), pharmacological (heparin subcutaneously)
28
Q

Complications: Diabetes Insipidus/ SIADH

A
  • at risk for DI manifested by large volume of dilute urine

- at risk for SIADH manifested by fluid overload and scant urine output

29
Q

Nursing Management: Assessment + Analysis

A
  • clinical manifestations observed in the patient w/ a brain tumor are r/t the location of the tumor, pressure on adjacent structures, and increased ICP
  • change in LOC
  • headache
  • pupillary changes secondary to compression of CN III (oculomotor)
  • vision changes
  • seizure activity
  • elevated BP w/ widening pulse pressure
  • decreased HR
  • nausea and vomiting
  • numbness and tingling
30
Q

Nursing Assessments

A
  • Neurological Assessment
  • Vital Signs
  • Estimated blood loss
  • Laboratory Studies (electrolytes)
  • Intake and Output w/ specific gravity
  • Pain
31
Q

Assessments: Neurological Assessment

A
  • LOC
  • Orientation
  • Motor Strength
  • Sensation
  • Cranial nerve assessment
32
Q

Assessment: Estimated Blood Loss

A
  • not large in craniotomy

- but, can be greater than expected

33
Q

Assessment: Intake and Output

A
  • who have undergone a craniotomy in which the pituitary gland has been manipulated
  • risk for diabetes insipidus
  • monitor urine specific gravity and osmolality, serum sodium and osmolality
34
Q

Assessments: Electrolytes

A

(serum sodium and glucose)

  • Serum sodium should be maintained within normal values; possibly on the higher end to prevent fluid moving into the cells potentially raising ICP
  • Glucose monitored b/c dexamethasone may lead to elevated serum glucose levels
35
Q

Assessments: Pain

A
  • experience post-op pain associated w/ the incision and positioning of head and neck during surgery
  • use of opioid medications w/ maintaining neurological assessments
  • NSAIDs not preferred in post-op period b/c of concern for increase in bleeding risk
36
Q

Diabetes Insipidus

A
  • increased urinary output
  • decreased urine specific gravity (<1.005)
  • increased serum sodium concentration (>145)
  • increase in serum osmolality (>280 mOsm/kg)
  • urine osmolality (<200 mOsm/kg)
37
Q

Nursing Actions

A
  • Administer Glucocorticoids
  • Replace urine loss and electrolytes
  • HOB 30-45 degrees
  • Administer Stool softeners (decrease straining)
  • Administer antiepileptic medications
  • Apply VTE prophylaxis
38
Q

Nursing Actions: Administer Glucocorticoids as ordered

A
  • to treat and prevent further cerebral edema

- dexamethasone: stabilize cell membranes to prevent the occurrence of cerebral edema; given post-op

39
Q

Nursing Actions: Replace urine loss and electrolytes

A

-dehydration can lead to hemodynamic instability (hypotension, tachycardia, dysrhythmias), and decreased cerebral perfusion

40
Q

Nursing Actions: Administer antiepileptic medications as ordered

A

-based on tumor location and hx or risk of seizure activity

41
Q

Nursing Actions: Apply VTE prophylaxis

A

presence of cancer and tissue injury during surgery increases risk of VTE
-pharmacological prevention may not be implemented immediately after surgery b/c concern for bleeding risk but may be implemented further into hospital course

42
Q

Nursing Teachings

A
  • Tapering of steroids
  • monitoring of glucose
  • compliance with antiepileptic medications
  • fall prevention
  • hat or head covering as needed
  • mouth care w/ chemotherapy
43
Q

Teaching: Tapering of Steroids

A
  • rapid withdrawal of glucocorticoids can cause adrenal crisis
  • provide clear direction
44
Q

Teaching: Monitoring of glucose

A
  • can become hyperglycemic w/ steroid use and require home testing of glucose levels while receiving glucocorticoids
  • temporary until medication is tapered off
45
Q

Teaching: Compliance w/ antiepileptic medications

A

-some may require serum medication levels to ensure that they are maintained at a therapeutic level

46
Q

Teaching: Fall Prevention

A
  • b/c of previous or new motor weakness or visual deficits

- discuss fall or tripping hazards in hospital and home

47
Q

Teaching: hat or head covering

A
  • parts of the head may be shaved for surgery
  • w/ chemotherapy pt is at risk for alopecia (blading)
  • head coverings can decrease heat loss from the head
48
Q

Teaching: Mouth care secondary to effects of chemotherapy and/or radiation therapy for brain tumor

A
  • chemotherapeutic agents affect cells that divide quickly; makes pt at risk for sores in the mouth
  • soft toothbrush and non-alcohol containing mouthwash decreases discomfort
49
Q

Interventions after brain surgery

A
  • no coughing
  • no incentive spirometry
  • turn q 2 hours
  • when mobile, start walking
  • interventions to help spread lungs other than causing pressure

nursing 272: final semester (79 decks)

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