19 terms

Nursing 22: Oncology - Exam 3 (Brain Tumor)

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Primary Brain Tumors
These types of brain tumors originate within the CNS and rarely metastasize outside this area.
Secondary Brain Tumors
These types of brain tumors result from metastasis from other areas of the body.
Acoustic Neuroma
This deals with a benign tumor from cranial nerve 8 (s/t: 5,7,9,10)
- These compress the brain tissue
- Surgery is difficult and can cause permanent brain damage
Acoustic Neuroma Signs and Symptoms
These signs and symptoms include:
- Hearing loss, tinnitus, dizziness, vertigo
Supratentorial Classification
This is within the cerebral hemisphere
Infratentorial Classification
This is the area of the brain stem structures and cerebellum.
Supratentorial Signs and Symptoms
These signs and symptoms include:
- Headache (MOST COMMON)
- Vomiting
- Paralysis
- Seizures
- Memory loss
- Cognitive Changes
- Aphasia
- Visual Problems (Causes by papilledema)
- Change in personality or behavior
Infratentorial Signs and Symptoms
These signs and symptoms include:
- Facial pain and weakness
- Ataxia
- Dysphagia: DECREASED GAG REFLEX
- Hoarseness
- Drooling
- Hearing Loss (Acoustic Neuroma)
- Nystagmus (Involuntary Eye Movement)
Diagnosis of Brain Tumors
This is done through:
- CAT Scans, MRI
- Cerebral Angiography
- EEG
- PET Scan
- Lab Tests
Non-Surgical Interventions
The outcome of this is that you want patients to maintain a normal ICP and Vital signs, as well as good ABG's and an improvement in LOC. You follow patients the same, whether the tumor is benign or malignant, as either can cause an increased ICP.
Radiation
This is used to shrink a tumor, alone or as adjunctive therapy.
Chemotherapy
This is used as 'direct drug therapy'. It is delivered directly into the cavity of the brain when the tumor is removed.
Surgical Interventions: Craniotomy
This is done to improve symptoms related to the lesion or to decrease pressure on the tumor.
Post-Op Craniotomy Management
With this, assess neurological and vital signs Q15-30 minutes for 4-6 hours. Then, Q1 hour. Periorbital edema and ecchymosis of one or both eyes is not uncommon. Place a cold compress to decrease swelling.
Post-Op Craniotomy: Positioning - Supratentorial
With this post-op consideration, elevate the HOB 30 Degrees to promote venous drainage from the head. Position the patient to avoid extreme hip or neck flexion and maintain the head in midline, neutral position to prevent increased ICP.
Post-Op Craniotomy: Positioning - Infratentorial
With this post-op consideration, have the patient lay flat and positioned on either side for 24 to 48 hours.
Post-Op Craniotomy: Normal JP or Hemovac Drainage
The normal range for this is greater 50ml/8 hours. If it is greater than this, call the MD and observe for hypovolemic shock.
Post-Op Craniotomy: Labs to Monitor For
With this, observe for Hyponatermia and Hyperkalemia.
Prevention of Post-Op Complications
Watch for:
- Increased ICP from cerebral edema, hemorrhage, or obstruction or normal flow of CSF.
- Hydrocephalus
- Infection
Meningitis
Would Infection
- F&E Management - Avoid fluid overload and watch for SIADH and DI
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