203D Custom > Test 2 > Flashcards

Test 2 Flashcards

(48 cards)

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1
Q

Glioblastoma multiforme

A

fast-growing, star-shaped, WORST form of glioma, aka stage IV astrocytoma

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2
Q

Most common brain tumor complaint

A

headache

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3
Q

Meningioma

A
  • middle aged adults (female most common)
  • encapsulated (compression rather than invasion)
  • usually benign
  • increased ICP
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4
Q

Acoustic Neuroma

A
  • CN VIII (acoustic)
  • slow growing
  • benign
  • s/sx: hearling loss, tinnitus, vertigo`
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5
Q

Hemangioblastoma

A
  • from a vessel
  • risk of CVA
  • people <40 w/ hemorrhage
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6
Q

Pituitary Adenoma

A
  • women of child-bearing ages higher risk
  • s/sx of pituitary hormonal dysfunction
  • usually small, benign, encapsulated, slow-growing
  • report changes of smell
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7
Q

Primary CNS Lymphoma

A
  • immune compromised pts. = high risk

- diffuse large B-cell lymphoma (DLBCL), a type of non-Hodgkin

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8
Q

Brain Tumor Assessment Findings

A
  • headache, reported as “different” (most common)
  • seizures
  • nausea/vomiting
  • altered mentation
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9
Q

Meningeal Tumor Most Common S/Sx

A

severe HA and photosensitivity (also for ruptured aneurysm)

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10
Q

Goal of Brain Tumor Diagnostics

A

preserve remaining normal brain tissue

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11
Q

Medical Brain Tumor Management

A
  • radiation (remember proper shield placement)
  • chemotherapy
  • steroids
  • benzos (effective at decreasing nausea)
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12
Q

Surgical Brain Tumor Management

A
  • removal of all or part of tumor

- shunts

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13
Q

Bone Flap Rationale for Cerebral Edema

A

reduce swelling

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14
Q

Craniotomy Nursing Interventions

A
  • assess for changes in LoC
  • HOB 30*
  • treat HA/nausea
  • keep dressing in place, assess drainage, bleeding, odor
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15
Q

Post-op craniotomy pt. is weak/lethargic

A

checks ABCs

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16
Q

Diabetes Insipidus (DI)

A
  • no ADH leads to excessive U/O (>300 mL/hr)

- urine specific gravity low (diluted) <1.005

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17
Q

DI Priority Assessments and Interventions

A
  • assess electrolyte imbalance
  • I/O
  • fluid replacement
  • DDAVP (desmopressin acetate)
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18
Q

Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH)

A
  • too much ADH leads to decreased U/O (<20 mL/hr)

- urine specific gravity high (concentrated) >1.025

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19
Q

SIADH Priority Assessments and Interventions

A
  • post-op brain surgery: call MD immediately
  • assess electrolyte imbalance frequently (particularly sodium)
  • I/O
  • fluid restriction
  • diruretics
  • s/sx of dehydration or overload
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20
Q

Crani surgery post-op care 1

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A
  • Meningitis (#1 culprit)
    • prophylactic ABx
    • assess drain/incision sites
  • Respiratory problems
    • encourage IS/deep breathe, but NOT coughing
    • prepare room for suctioning
  • Seizures
21
Q

Crani surgery post-op: CSF leak

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A

call MD and check for glucose

22
Q

Crani surgery post-op: IICP

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A
  • proper positioning (consider drains and location of surgery)
  • no restraints or enemas
23
Q

Crani surgery post-op care: Trans-sphenoidal

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A
  • damage to CN III common, assess visual field loss or deterioration
  • monitor I/O, assess for DI
  • call MD for excessive drainage
24
Q

Trans-sphenoidal pt. education

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A
  • avoid (4 weeks): blowing nose, coughing, sneezing, straws, bending over, straining on toilet
  • no driving for 2 weeks
25
Left-frontal lobe tumor expected findings
personality/judgement/emotional changes
26
Swallow problems interventions
- high Fowler's position - chin to chest - reduce distractions
27
Penumbra
area surrounding the minimally-perfused dead core, ability to save depends on timely re-circulation, volume of toxins released by dead cells, degree of edema
28
Stroke Risk Factors
- TIA (warning sign) or previous stroke - HTN - A-Fib - Heart disease - DM - Oral contraceptives - smoking, obesity, sedentary lifestyle - hyperlipidemia/atherosclerosis
29
TIA
temporary stroke symptoms, thrombotic stroke, few minutes up to 24 hours, neuro deficits are reversible (find out baseline from family)
30
Ischemic vs. Hemorrhagic Stroke
- ischemic most common (87%), can be thrombotic or embolic | - hemorrhagic usually caused by HTN
31
Thrombotic AIS
- atherosclerosis #1 risk factor - vessels: lose elasticity, harden, narrow - symptoms: sudden, often during sleep or in morning - may be gradual process (buildup)
32
Embolic AIS
- A-Fib #1 risk factor - travelling blood clot lodges in small vessels or middle cerebral artery - sudden onset of symptoms
33
Hemorrhagic Stroke
- vessel integrity interrupted (bleeding into tissue or subarachnoid space - CT STAT to find/rule out bleed
34
Middle Cerebral Artery (MCA)
- most often occluded in a stroke | - largest branch of internal carotids
35
MCA Stroke S/Sx
hemiparesis, sensory loss (face/arm > leg), gaze deficits (eye deviation), aphasia
36
Anterior Cerebral Artery Stroke
Presents with motor/sensory loss (leg > arm)
37
Hemorrhagic Stroke: Arterio-Venous Malformation
- looks like vessels are tangled/clumped - congenital anomaly - age 10-40 - surgery: ligation (vasospasm/rebleed)
38
Hemorrhagic Stroke: SAH
- cerebral aneurysm leak or burst - bleeding occurs in sub-arachnoid space - tests find: blood on LP, aneurysm on CT/MRI - most common symptom: "worst HA I've ever had"
39
Ruptured Aneurysm S/Sx
- sudden, extremely severe HA, photosensitivity (also for meningeal tumor) - change in LoC - blurred/double vision - drooping eyelid - seizure
40
Unruptured Aneurysm S/Sx
- pain above and behind one eye - dilated pupil - change in vision/double vision - unilateral facial numbness
41
Code Stroke Protocol
- last known well time - complete assessment with NIH scale - blood sugar - CT - IV start with blood draw - report any changes immediately
42
Time is Brain Protocol
- 3-4.5 hour window from onset of symptoms - CT non-contrast within 25 min to r/o bleed - bleed: hemorrhagic/no bleed: ischemic - screen for tPA - begin fibrinolytic Tx
43
tPA (alteplase)
- ischemic only (gold standard) - dissolves the clot - given 24 hours after onset of Sx
44
SAH Tx
- endovascular therapy/coiling - surgical aneurysm clipping - medical Tx
45
SAH Complications
- rebleed - vasospasms - hydrocephalus
46
Cerebral Vasospasm Management
- balloon angioplasty - nimodipine 60 mg q4h for 21 days - SBP 160-200 if clipped or 120-150 if unclipped - central venous pressure 10-12 mmHg
47
Nimodipine
- SAH/cerebral vasospasm treatment - calcium channel blocker - reverses body's immediate reaction to vasoconstrict (would lead to further damage) - allows blood to flow more easily to non-damaged tissue
48
Post-Stroke Interventions
- ALWAYS clarify MD's desired parameters for BP | - usual maintenance level 120-150
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