Med Surg 2 Module 9

Brian tumors- medical management surgical treatment

-cranitotomy -transsphenoidal hypophysectomy

Craniotomy interventions prep

-treat anxiety -opening skill, head shaved, possible neuro deficits) -provide reassurance -teach post op expectations

Neurodegenrative disorders

-disorders of the central and peripheral nervous system -deterioration of cells or the function of the nervous system -slwo onset of signs an symptoms

brain tumors interventions

-focus on nutrition, reduce anxiety, enhance coping skills and prevent complications -treat symptoms -goal: compensate for self care deficits, improve nutrition, reduce anxiety, enhance coping skills, free of complications -frequent neuro and symtpom assessments -treat headaches (analgesics, upright position) -treat n/v -medication management -cognittion (reorientation, orienting decices, monitoring and intervention for prevention of injury) -aspiration precautions -seizure precautions -educate risk of seizures and prophylactic anticonvulsants -emotional support

brain tumors s/s

-headaches -n/v -seizures -impaired sensory perception: facial numbness or tingling, visual changes (papilledema) -loss of bale or dizziness vertigo -weakness or paralysis: one part or side of body (hemiparesis, hemiplegia) -difficulty thinking, speaking or articulating words (aphasia) -changes in cognition, emanation or personality

craniotomy interventions post op

-monitor for changes in status, prevent complications -VS and neuro checks q15-30 min x 4-6 hours, then q1hr x24 hr -report immediately decreased LOC, weakness or paralysis, aphasia, decreased sensory perception, sluggish pupil reaction to light, personality changes -periorbital edema and bruising around eyes (cold compresses) -cardiac monitoring (potential for dysrrhtmia s -monitor dressing for drainage (report immediately saturated dressing or drainage over 50 ml in 8 hrs -record I & O (fluid restriction if SIADH develops) -treat electrolyte imbalance -manage airway, ventilator -medications -standard post op care

Brain Tumors- recognizing cues

-obtian pt and family hx -neuro assessment -common symptoms - certain cancers that metastasize to the brain: ex is lung -do a really thorough neuro assessment to recognize deficits -if they have increased ICP they will have papilledema -vertigo: constant feeling of spinning

Overview Brain Tumors

-patients with brain tumors are at high risk for seizures (even if they aren't having seizures were giving anticonvulsants) -pituitary gland tumor: it can cause Diabetes Insipidus and SIADH -biopsy determines if its benign or malignant -can do lumbar punctures to analyze CSF to look for malignant cells -neurologic symptoms can also mimic intoxication-occupies space within the skull -primary tumors: benign or malignant, arise in the brain, relatively uncommon -secondary : metasasi, more common -malignant brain tumors: low survival rate -effects of Brian tumors are caused by nfalmamtion, compression dn infiltration of tissue (cerebral edema, increased ICP, neurological deficits, seizures, altered pituitary function) -diagnosis: CT, MRI, PET, biopsy, EEG, CSF analysis, toxicology to r/o substance use as cause

brain tumors interventions part 2

-talk about care decisions early before there is a cognitive decline (code status, tube feedings, mechanical ventilation, CPR, etc) -encourage independence for as long as possible -measures to improve cardiac function -allow patient to participate in decision making -allow patient to express fears and concerns -presence of family, friends, spiritual advisor and health care personnel -referall for hospice -imporve nutrition (oral hygiene before meals, plan meals for times when patient is comfortable and well rested, measures to make mealtimes as pleasant as possible, offer preferred foods, dietary supplements, daily weight, record daily intake)

A nurse is completing an assessment of a client who has increased intercranial pressure (ICP). Which of the following are expected findings? (Select all that apply). A.Increasing disorientation to time and place B.Restlessness and irritability CEqual pupils D.Headache

A.B.D

A nurse is caring for a client who has just undergone a craniotomy for a brain tumor and has a respiratory rate of 12 breaths per minute. Which of the following postoperative prescriptions shoulf the nurse clarify with the provider? A.Dexamethasone 30mg IV Push BID B.Morphine 2mg IV Push q2 hours PRN Pain C.Ondansetron 4mg IV Push q4 hours PRN Nausea D.Phenytoin 100mg IV Push TID

B

A client diagnosed with a brain tumor is receiving phenytoin. The client's partner questions the use of the drug, since there is no history of a seizure disorder. What response will the nurse provide to be best address the partner's concern? A. "Preventing febrile seizures with a tumor is important." B."This drug is used to sedate with a brain tumor." C."Increased pressure from the tumor can cause seizures." D."Seizures always occur in clients with brain tumors."

C.

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to: A. prevent extension of the tumor. B. identify the precise location of the tumor. C. facilitate regeneration of neurons. D. reduce cerebral edema.

D

Brain tumors_ medical management Nonsurgical

Nonsurgical management: drug therapy (chemo, hormone suppressing meds, corticosteroids, osmotic diuretics, anticonvulsants, non opioid analgesics) , radiation therapy, tumor treating fields -neuroendocrine tumor releasing hormones you use hormone suppressing meds to prevent the tumors from growing and from releasing excess hormone -corticosteroids to decrease inflammation -osmotic diuretics to decrease ICP -anticonvulsants to prevent seizures -NSAIDs to manage pain -do no want to suppress neurologic system anymore so you want to stay away from opioids but if they have significant pain you may give them this (hospice, etc) -tumor treating fields: patches of electrodes on head that provide alternating electric field therapy and inhibits replicating process of the cells

The client with a brain tumor may be at increased risk for aspiration. What does the nurse determine is the most important nursing intervention? A.Evaluation of gag reflex and ability to swallow B.Assistance with self-care C.Frequent reorientation D.Monitoring vital signs

a