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aneurysm and brain tumor
Terms in this set (40)
aneurysm-compression of what CN?
What is a common symptom of a Saccular (Berry) aneurysm?
"worst headache of my life"
associated with wide spread atherosclerosis; rarely rupture; can lead to herniation
rare; septic emboli--bacterial endocarditis; arteritis from spasm--arterial wall weakens
CN III Palsy
pupils dilated and ptosis
sudden, severe onset, aseptic meningitis, ICP, temp, EKG changes, worst headache of my life
What can happen if you do a LP with an aneurysm?
It can lead to herniation. The brain material shifts toward the site of the LP and the brain goes through the foramen magnum. Instead, GET A CT to differeniate.
NO ATROPINE. Vagus stimulation, exacerbation of nerve fibers.
Clinical grading--when is the most important day?
on day of operation! higher the grade, worse the prognosis
nursing care for aneurysm?
calm, quiet, dim lighting--peaceful environment. BP at least qh. Minimal suctioning. Normothermic temperature. HOB elevated 30-45. Seizure precautions. Monitoring S/S for ^ ICP. PCA for pain meds.
most common for berry
wool. reinforces dome to make thicker
70% mortality rate
operative. why is there a potential for rebleed after 7-10 days?
It takes 7-10 days for fibrin to be removed. Platelets regenerate q7-10 days.
constriction of the artery on the other side of the aneurysm.highest morbidity and mortality complication.
what is the first sign of vasospasm?
global or focal neuro defects: confusion, deterioration of sensorium and LOC, inappropriate behavior, focal motor paresis, speech impairment, visual defect, worsening h/a, seizures, INCREASE IN BP
most common drug therapy for vasospasm. CCB. can lower BP, which can also lead to vasospasm (be careful)
triple-h therapy: hypervolemia, hypertension, hemodiltion
what fluids for hypervolemia? what should the CVP be at? PCWP?
Crystalloids (LR, NS), Colloids (albumin)
CVP 10-12 (normal is 2-6)
what is used for hypertension?
vasopressors: dopamine, dobutamine, neosynephrine
SBP 160-200 IF CLIPPED
SBP 120-150 IF NOT CLIPPED
thought to decrease viscosity and improve cerebral blood flow
what are some complications of the triple-h therapy?
pulmonary edema, CHF, MI
hemorrhage into an area of infarction from the vasospasm
increased ischemic edema
rupture of unclipped aneurysm
after craniotomy, how do you position?
on the opposite side of where the bone flap is..
nursing care post craniotomy
assess neuro qh, monitor cv/renal (I/Os, labs, BP, ECG), alleviate h/a (morphine, sedation), administer meds (psych meds if at home), head dressing (pink is okay, red is bad), hemovac (aseptic technique), respiratory (no coughing), temp normothermic
complications after craniotomy
vasospasm, infection, swelling
frequent site of brain tumor metastasis
breast and lungs
brain tumor complications
cerebral edema, ^ICP, direct pressure on brain tissue, hemorrhage, fluid accumulation, alters electrical potential of cell
headaches (worse at night from compression on vessels)
seizures (affects 50% of brain tumor pts)
invasive, terminal, easily manipulated, go into a "rage"
behavior, cognitive, intellectual, personality
4th vent or brain stem
ONSET OF LOWER EXTREMITY WEAKNESS..numbness and tingling
oral chemotherapy. monitor neutrophil and plt counts
steroids given when?
only with brain tumor..not for brain injury
assessment how often and what for?
at least qh. for increased icp
ineffective tissue perfusion
potential complications: seizures and increased ICP
help with coping, listening to fears, encouragement to eat, assess nutritional status, communication system, minimization of environmental stimuli, seizure precautions, close supervision (may be confused), padded rails
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