Week 10 - Brain Tumours and Abscesses

Question 1

what are 4 types of brain tumours

Answer 1

• primary
• secondary
• benign (encapsulated)
• malignant (invasive)

Question 2

what is a primary brain tumour

Answer 2

• arises from tissues inside the brain

Question 3

what is a secondary brain tumour

Answer 3

• results from malignant neoplasm/tumour elsewhere

Question 4

what are clinical manifestations of brain tumours (7)

Answer 4

• HA (dull)
• S&S of IICP
• seizures
• NV
• cognitive problems
• mood problems
• personality changes

*depend on location of tumour)

Question 5

what is included in collab care for brain tumour (6)

Answer 5

• meds
• ventricular shunts
• surgery
• radiation (internal, external)
• chemo
• nursing care for IICP

Question 6

what med if used for brain tumour? what effect does it have

Answer 6

• corticosteroids ex. dexamethsone

- decreases edema surrounding the tumour

Question 7

what is a ventricular shunt

Answer 7

• drains CSF from ventricles to R atrium or peritoneum

Question 8

what surgery may be done for brain tumours? (3)

Answer 8

• surgery to debulk or remove mas
• craniotomy
• stereotactic radiosurgery (high dose radiation precisely delivered)

Question 9

what is a brain abscess

Answer 9

• accumulation of pus within the brain tissue

Question 10

what can a brain abscess result in?

Answer 10

• local or systemic infection

Question 11

what are the primary causes of brain abcess (2)

Answer 11

• strep
• staph aureus
  ex. ear, tooth, jaw, or sinus infection/surgery

Question 12

what is used as a diagnostic for brain abscess

Answer 12

• CT scan

Question 13

what are S&S of brain abscess (8)

Answer 13

• similar to meningitis & encephalitis
• HA
• fever
• nausea
• confusion
• drowsiness
• seizures
• focal symptoms

Question 14

describe collab care/treatment for brain abscess (3)

Answer 14

• antibiotic therapy long term (>6 weeks)
• surgery to drain or remove abcess
• nursing care for IICP

Question 15

describe the process of a craniotomy (4)

Answer 15

1. remove bone flap
2. remove clot, tumor, or fix problem
3. establish drain
4. re-attach bone flap (later time, not urgent)

Question 16

what is a safety consideration with a craniotomy

Answer 16

• do not turn pt on the side where there is no bone

Question 17

what is the overall goal of post-op care for craniotomy

Answer 17

• foster independence to the highest degree possible

Question 18

where will post-op care be completed for craniotomy

Answer 18

• in ICU or stepdown for close monitoring

Question 19

what is included in post-op care for craniotomy (9)

Answer 19

• monitor/treat IICP
• maintain CPP
• prevent, assess, and treat any complications
• infection prevention
• care of dressing to head
• pain & nausea control
• nutrition
• bloodwork
• med admin

Question 20

what are potential complications of post-op craniotomy (5)

Answer 20

• pneumonia
• stress gastric ulcer
• DVT/PE
• constipation
• fluid and electrolyte balance

Question 21

how long are sutures/staples in place for post-op craniotomy

Answer 21

• 7-10 days

Question 22

at what point is rehab potential determined

Answer 22

• once cerebral edema and IICP subside

Question 23

what specialists may be consulted post-op craniotomy

Answer 23

• physio
• ot
  etc.

Question 24

describe the rehab process post-craniotomy

Answer 24

• long process: weeks, months, years
• the younger the person is, the better the recovery will be
• may never be the “same person/personality” as before

Question 25

what are burr holes often used for

Answer 25

- subdural hematoma

Question 26

what are burr holes (5)

Answer 26

involves: - incision site over left frontal area - drilling of hole at skull (one or two holes drilled) - opening of dura - evacuation of subdural fluid (hematoma) - placement of drain tube ( can be in for few days)

Question 27

what stereotactic methods may be used for brain tumour (2)

Answer 27

- stereotactic radiosurgery | - stereotactic Bx/surgery

Question 28

what is stereotactic radiosurgery

Answer 28

- use of high dose of radiation (Gamma knife) to destroy brain tumor

Question 29

how is the pt's head held still during stereotactic mthods

Answer 29

- by a stereotactic frame

Question 30

what are stereotactic bx/surgery used for (3)

Answer 30

- brain biopsies - small tumours - abscesses

Question 31

describe stereotactic bx/surgery

Answer 31

- apparatus and computer used to find precise area of the brain - surgeon enters w fine instruments

Question 32

decsribe the pt during stereotactic methods

Answer 32

- pt may be aware during the surgery | - may assist w brain mapping by speaking, moving, etc. to indicate to their surgeon where they are touching

Question 33

a nursing diagnosis r/t cranial surgery is acute pain. what nursing interventions may be done for this (4)

Answer 33

- assess pain - admin pain meds as ordered - use pain control measures before pain becomes severe - position pt comfortably

Question 34

a nursing diagnosis r/t cranial surgery is risk for infection. what nursing interventions may be done for this (9)

Answer 34

- maintain aseptic technique during surgical procedures - change IV and central line sites according to guidelines - hand hygiene before and after each pt care activity - encourage rest so nutrition is used for healing purposed - monitor for S&S of infection - monitor WBC - inspect surgical incisions for signs of infection - change craniotomy dressings as ordered w strict sterile technique - obtain blood and wound for cultures