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Terms in this set (42)

*Collections of blood in the brain that may be epidural (above the dura), subdural (below the dura) or intracerebral/cranial (within the brain).
-epidural are arterial (dura pulled away from skull) and subdural are venous

Epidural Hematomas:
-Between the inner side of the skull and the dura (dura pulled away)
-More common in younger people; dura less attached
-Blood in the epidural space between the skull and the dura
-Usually arterial
-Causes rapid pressure on the brain
-Symptoms are caused by expanding hematoma:
--restless, agitated, confused
-Good prognosis only if hematoma is removed before loss of consciousness
-***Brief loss of consciousness followed by a lucid period
--Lucid
Patient is awake and conversant
Brain is compensating
--Altered mental status
Brain stops compensating
Rapid deterioration

Subdural Hematomas:
-Collection of blood between the dura and the brain which should normally be occupied by a thin cushion of fluid
-Progress rapidly and have a high mortality rate (associated with uncontrolled ICP increase, loss of consciousness, decerebrate posturing)
-No lucid state; may be a period of unconciousness followed by deterioration
-Trauma is the most common cause
-More frequently venous
-Symptoms develop over 24 - 48 hours (sometimes weeks):
--Change in LOC
--Pupillary signs
--Hemiparesis
--Expanding hematoma
--Coma
--Increasing blood pressure
--Decreasing heart rate
--Decreasing respiratory rate
*as hemotoma gets bigger, more neurological deterioation
Classification system is based on the approximate time before appearance of symptoms

Intracerebral Hematomas:
-Bleeding into the parenchyma of the brain
-Occur more frequently in older persons and alcoholics, whose cerebral vessels are more friable
-Single or multiple
-Head injuries with significant force; HTN; rupture of aneurysm
-S/S depend on size and location
-Most are adenocarcinomas
-Begin as adenomatous polyps
-Typically few effects until spread
-Metastasis to regional lymph nodes common
-Seeding of tumor

Etiology:
-Third most common cancer diagnosed
-Earlier diagnosis improves survival rate
-Occurs most often after age 50, but recently younger adults are being diagnosed
-Incidence continues to rise with increasing age

!Risk Factors
• Increasing age!
• Family history of colon cancer (Lynch syndrome) or polyps (familial adenomatous polyposis)
• Previous colon cancer or adenomatous polyps
• High consumption of alcohol
• Cigarette smoking
• Obesity
• History of gastrectomy
• History of inflammatory bowel disease
• High-fat, high-protein (with high intake of beef), low-fiber diet
• Genital cancer (e.g., endometrial cancer, ovarian cancer) or breast cancer (in women)rs:

S/S:
-The most common presenting symptom is a change in bowel habits
-The passage of blood in or on the stools is the second most common symptom
-Late symptoms may also include unexplained anemia, anorexia, weight loss, and fatigue

Prevention:
-Yearly fecal occult blood test
-Stool DNA test
-Flexible sigmoidoscopy every 5 years
-Barium enema every 5 years
-Colonoscopy every 10 years
-CT colonography every 5 years

Diagnosis:
*Include sigmoidoscopy, colonoscopy
Radiological examinations to detect metastases
*Chest x-ray, CT, MRI, ultrasound
*Laboratory tests:
-Fecal occult blood
-CBC
-CEA tumor marker
-DRE

Complication:
-Tumor may cause bowel obstruction

Treatment:
*Surgical resection of colon
-Anastomosis of remaining bowel
*Colostomy
-Sigmoid colostomy—most common
-Double-barrel colostomy
-Transverse loop colostomy
-Hartmann procedure
*Laser photocoagulation


Nursing MGMT:
*Colorectal cancer is often advanced at diagnosis
-Show no evidence of infection
-Prepare patients for surgery
-Educate
-Provide emotional support
-Post op care
-Maintaining optimal nutrition (avoid foods excessive in odor and gas)
-Wound care
-Colostomy care
--irrigating the stoma at a consistent time
--avoid high gas foods
--irrigate above head; use mild soap and water
-Skin integrity