Week 10 - Brain Tumours and Abscesses Flashcards
what are 4 types of brain tumours
- primary
- secondary
- benign (encapsulated)
- malignant (invasive)
what is a primary brain tumour
- arises from tissues inside the brain
what is a secondary brain tumour
- results from malignant neoplasm/tumour elsewhere
what are clinical manifestations of brain tumours (7)
- HA (dull)
- S&S of IICP
- seizures
- NV
- cognitive problems
- mood problems
- personality changes
*depend on location of tumour)
what is included in collab care for brain tumour (6)
- meds
- ventricular shunts
- surgery
- radiation (internal, external)
- chemo
- nursing care for IICP
what med if used for brain tumour? what effect does it have
- corticosteroids ex. dexamethsone
- decreases edema surrounding the tumour
what is a ventricular shunt
- drains CSF from ventricles to R atrium or peritoneum
what surgery may be done for brain tumours? (3)
- surgery to debulk or remove mas
- craniotomy
- stereotactic radiosurgery (high dose radiation precisely delivered)
what is a brain abscess
- accumulation of pus within the brain tissue
what can a brain abscess result in?
- local or systemic infection
what are the primary causes of brain abcess (2)
- strep
- staph aureus
ex. ear, tooth, jaw, or sinus infection/surgery
what is used as a diagnostic for brain abscess
- CT scan
what are S&S of brain abscess (8)
- similar to meningitis & encephalitis
- HA
- fever
- nausea
- confusion
- drowsiness
- seizures
- focal symptoms
describe collab care/treatment for brain abscess (3)
- antibiotic therapy long term (>6 weeks)
- surgery to drain or remove abcess
- nursing care for IICP
describe the process of a craniotomy (4)
- remove bone flap
- remove clot, tumor, or fix problem
- establish drain
- re-attach bone flap (later time, not urgent)
what is a safety consideration with a craniotomy
- do not turn pt on the side where there is no bone
what is the overall goal of post-op care for craniotomy
- foster independence to the highest degree possible
where will post-op care be completed for craniotomy
- in ICU or stepdown for close monitoring
what is included in post-op care for craniotomy (9)
- 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
what are potential complications of post-op craniotomy (5)
- pneumonia
- stress gastric ulcer
- DVT/PE
- constipation
- fluid and electrolyte balance
how long are sutures/staples in place for post-op craniotomy
- 7-10 days
at what point is rehab potential determined
- once cerebral edema and IICP subside
what specialists may be consulted post-op craniotomy
- physio
- ot
etc.
describe the rehab process post-craniotomy
- 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
what are burr holes often used for
- subdural hematoma
what are burr holes (5)
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)
what stereotactic methods may be used for brain tumour (2)
- stereotactic radiosurgery
- stereotactic Bx/surgery
what is stereotactic radiosurgery
- use of high dose of radiation (Gamma knife) to destroy brain tumor
how is the pt’s head held still during stereotactic mthods
- by a stereotactic frame
what are stereotactic bx/surgery used for (3)
- brain biopsies
- small tumours
- abscesses
describe stereotactic bx/surgery
- apparatus and computer used to find precise area of the brain
- surgeon enters w fine instruments
decsribe the pt during stereotactic methods
- 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
a nursing diagnosis r/t cranial surgery is acute pain. what nursing interventions may be done for this (4)
- assess pain
- admin pain meds as ordered
- use pain control measures before pain becomes severe
- position pt comfortably
a nursing diagnosis r/t cranial surgery is risk for infection. what nursing interventions may be done for this (9)
- 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
