[Exam 5] Chapter 68 and 70: Mx of Patients with Neurologic Trauma Flashcards
(187 cards)
1
Q
Head Injury is a broad term that refers to what?
A
Injury of the scalp skull or brain.
2
Q
Head Injuries: Most common cause?
A
Falls, Motor Vehicle Crash, Being Struck By Blunt Object
3
Q
Head Injuries: Age associations with this include who?
A
0-7
15-19
> 65
These are who are most prone to this
4
Q
Head Injuries: What is key for this?
A
Preventing. If riding a bike, wearing a helmet. Always trying to protect your head.
5
Q
Patho of Brain Damage: What is a primary injury?
A
The initial damage to the brain. May have contusions, lacerations.
6
Q
Patho of Brain Damage: What is a secondary injury?
A
This will develop hours to days after initial insult. Due to inadequate delivery of nutrients or oxygen to brain cell. May have hemorhage, cerebral edema, increased ICP
7
Q
Patho of Brain Damage: What is a scalp injury?
A
These are minimal injuries. Vessels have poor constriction with scalp and do tend to bleed more
8
Q
Patho of Brain Damage: What is a skull fracture?
A
A break in the skull somewhere. It can cause damage to the brain but you can still have skull fracture and there not be a brain injury associated with it
9
Q
Patho of Brain Damage: What are the types of skull fractures?
A
Simple, Comminuted, Depressed
10
Q
Patho of Brain Damage: What are the locations of skull fractures?
A
Frontal, Temporal, Basal
11
Q
Patho of Brain Damage: What are the two forms of injuries?
A
Primary injury or secondary injury
12
Q
Patho of Brain Damage: Bleeding within skull is going to increase what?
A
Contents inside of the cranium. Blood is going to increase, increasing ICP and causing brain damage.
13
Q
Patho of Brain Damage: What is a simple fracture?
A
Simple break within the skull.
14
Q
Patho of Brain Damage: What is comminuted fracture?
A
There are multiple fractures within skull, they are splintering.
15
Q
Patho of Brain Damage: What is a depressed fracture?
A
Thats a bone skull fracture where the fracture is forced down into the brain tissue.
16
Q
Patho of Brain Damage: What is a basilar skull fracture?
A
Happens at the base of the skull, right near the ear drum. With this, you will see battle sign.
May also see CSF leaking from the nose or external auditory canal.
17
Q
Patho of Brain Damage: Why is a basilar or all skull fractures bad?
A
This is when the blood-brain barrier can be broke. CSF can escape through ear and nose.
18
Q
Patho of Brain Damage: What is battle sign?
A
This is bruising around the mastoid process with racoon eyes.
19
Q
Patho of Brain Damage: How to determine if fluid is CSF?
A
You can place drops of that fluid on a absorbent filter. If you get double ring sign, then you have clear ring on the outermost, that is likely CSF.
20
Q
Patho of Brain Damage: What tests are not conclusive for CSF?
A
Total Protein, Glucose, Chloride. It may be a good indication but not guaranteed.
21
Q
Head Injuries: With any head injury, you need to consider what
A
That there is a brain injury.
22
Q
Head Injuries: Why is a brain injury bad?
A
Because they do not store oxygen or nutrients. Need to make sure that they are not deprived.
23
Q
Head Injuries: What is the Patho of this after brain suffers injury??
A
Brain swelling/bleeding increases cranial volume
Right cranium allows no room for expansion so ICP increases
Pressure on blood vessels within brain cause blood flow to slow
Cerebral Hypoxia and Ischemia
ICP continues to rise. Brain may herniate.
Cerebral blood flow ceases.
24
Q
Head Injuries - CMs: This includes what for patients that comes in?
A
Pain associated with fracture.
Basillar Skull Fracture - Mastoid process bruising and racoon eyes are the battle sign.
25
Head Injuries: Diagnostics include what?
CT or MRI
If they expect that skull fracture seems severe, they may jump straight to MRI
GCS Assessment
Neuro Assessment
26
Head Injuries - Med Mx: If this is not depressed, what will patient require?
They will not need any surgery and patient will just be observed.
27
Head Injuries - Med Mx: If there is a depression of skull fracture into brain, what do patients need?
Surgery to pull the piece of skull out of brain and debriding the brain tissue of any remaining skull fractures.
28
Types of Brain Injuries: What is a closed (blunt) injury?
This means that head will rapidly accelerate and decelerate. Its going to happen when it has collided with a object. Get hit in the head and head whips back and forth with brain shifting.
29
Types of Brain Injuries: What is a open brain injury?
An object has penetrated the skull and entered the brain. Got hit with a sharp object.
30
Types of Brain Injuries: What is a concussion?
This is damage to the protective layer of the brain. Dura membrane gets damaged graded from 1-3 scale. There is no structural damage.
31
Types of Brain Injuries: What is a contusion
This is a moderate to severe head injury. Brain is basically bruised here and there is damage to a specific area. Will have LOC, confused, loss of stuporedness. Will peak after 18-36 hours.
32
Types of Brain Injuries: What is a diffuse axonal injury
Shearing damage from the brain to the axons in the brain. Those patients are in prolonged coma
33
Types of Brain Injuries: What is a intracranial hemorrhage?
All of the hematomas. Collection of blood in one of the epidural, subdural, intracerebral areas.
34
Types of Brain Injuries: What is included under intracranial hemorrhage?
Epidural Hematoma
Subdural Hematoma
Intracerebral Hemorrhage and Hematoma
35
Types of Brain Injuries: What is Chronic Traumatic Encephalopathy?
Occurs from repeated concussions that happen. Causes problems later on in life
36
Types of Brain Injuries: What is epidural hematoma
This is when an artery has been severed. Miniature artery severed. Will experience brief loss of consciousness and then will be lucid, awake, conversing. Able to compensate through monro kelley hypothesis
37
Types of Brain Injuries: What is subdural hematoma
Blood between the dura and brain. Will be seen from ruptured aneurysm. Do tend to be more venous in nature. Can be acute or chronic.
38
Types of Brain Injuries: What is intracerebral hemorrhage and hematoma?
You have a bleed right in the tissue of the brain. This is from stab wound or gunshot wound to the head.
39
Types of Brain Injuries: What is the Monro Kelley Hypothesis?
If one of the three components in the skull within that cranium increases then the other one will decrease.
40
Types of Brain Injuries: How will patients compensate with epidural hematoma?
May see a Burr Hole created or a craniotomy to help relieve some of that pressure building.
41
Types of Brain Injuries: Where is the epidural hematoma located?
This will be located above the dura mater
42
Types of Brain Injuries: Where is the subdural hematoma located?
This will be located below the dura mater
43
Types of Brain Injuries: What is a acute subdural hematoma?
Thats a major head injury. Will need immediate craniotomy. High mortality rate.
44
Types of Brain Injuries: What is a chronic subdural hematoma?
Minimal head injury. Tends to develop over time over weeks to months if a vein has ruptured.
45
Types of Brain Injuries: How is a chronic subdural hematoma fixed?
Will be treated by suctioning the clot, evacuating that way.
May do Burr Holes or Craniotomies to relieve pressure
46
Types of Brain Injuries: How to fix intracerebral hemorrhage?
Srugery can be difficult depending on location.
Supportive care. Monitoring Respiratory System. Monitoring ICEP by trying to keep it down as much as possible. Monitoring electrolytes
47
Mx of Brain Injuries: Anytime a patient with a head injury occurs, you need to suspect what
cervical injury unless proven otherwise
48
Mx of Brain Injuries: All treatment aimed at what
primary injury to prevent secondary injury from happening
49
Mx of Brain Injuries: Treatment will focus on what?
The increased ICP
50
Mx of Brain Injuries: How is ICP managed?
By getting head of bed up and not allowing twisting of head or neck. Allows blood to flow from head and not back on
51
Mx of Brain Injuries: What specific support can be given here?
Advance Trauma Life Support (ATLS)
52
Mx of Brain Injuries: What is ATLS?
These is activated once a GCS score of less than 8 is gotten. Is an emergency dignosis .
53
Mx of Brain Injuries: GSC should be rated at what ?
8 or less that activates ATLS
54
Mx of Brain Injuries: What is included in ATLS once activated?
Patients are intubated, receive fluid and resuscitation, go on ventilator to keep CO2 between 30-35 to decrease ICP.
Will be receiving oxygenation, sedation to decrease O2 demand, and might be given paralysis for short acting.
55
Mx of Brain Injuries: Once ATLS has been activated and interventions have been started, what is evaluated next?
Is there any herniation or Deterioration?
If yes, you give more hyperventilating and give them Mannitol (0.9 mg/kg) to dehydrate the brain and pull more fluid off.
56
Mx of Brain Injuries: If the herniation or deterioration has not resolved, what is done next?
Will be sent to the operating room to see where bleeding is coming from
57
Mx of Brain Injuries: What is done if there is resolution from mannitol reatment?
Will be given a CT scan to look for surgical lesion. If not present, will be sent to ICU where ICP will be monitored and intracranial hypertension will be treated
58
Mx of Brain Injuries: Normal ICP range?
0-15
59
Mx of Brain Injuries: What supportive measures can be done?
Respiratory patients will be on vent. Seizure precautions. Nutrition. Monitor fluids and electrolytes
60
Mx of Brain Injuries: How will nutition be done?
Through feeding tube.
61
Mx of Brain Injuries: If sedated, will need to help deal with what?
Making sure that a feeding tube is placed and helping deal with anxiety that the patient may be having.
62
Mx of Brain Injuries: May experience brain death, which is what
Brain injury is so severe, it is incompatible with life. They can be potential organ donors however.
63
Mx of Brain Injuries: What is the role of the nurse and organ donation?
It is never the nurses responsibility to go in and talk about organ donation to that patient's family. You will call Indiana Donor Network and they will come in to family.
64
Mx of Brain Injuries: What are the three cardinal signs of brain death?
Coma, Absence of brain stem reflexes and apnea.
65
Mx of Brain Injuries: Absence of brain stem reflexes include what?
If the patient has a gag reflex.
66
Brain Injury Diagnostic Evaluation: What is teh first thing done for physical and neurologic exam?
GCS and see what they can do.
67
Brain Injury Diagnostic Evaluation: If brain dead, GCS will be scored at what?
3
68
Brain Injury Diagnostic Evaluation: What does this include?
Skull/Spinal X-Ray
CT Scan
MRI
PET Scan (May be if they have a brain tumor)
69
Brain Injury Diagnostic Evaluation: What Brain Death testing can be done?
EEG
| Cerebral Blood Flow Studies.
70
Brain Injury Diagnostic Evaluation: EEG would show what
GOing to check the waveforms of the brain.
71
Brain Injury Diagnostic Evaluation: How does cererbal blood flow study work?
Will inject a dye and look for that to flow through the brain. Radiologist can look at that and see if there is blood flow in the brain.
72
Traumatic Brain Injury - Nursing Process: What assessments will be made initially?
You will be asking when injury occured, what caused injury, how did head get hit direction wise.
73
Traumatic Brain Injury - Nursing Process: Neuro assessment will include what?
Doing a GCS and pupils. ALso checking airway to make sure it is in place.
74
Traumatic Brain Injury - Nursing Diagnosis: This focuses on what?
Ineffective Airway Clearance (Maintain Airway)
Ineffective Cerebral Tissue Perfusion
Deficient Fluid Volume
75
Traumatic Brain Injury - Nursing Diagnosis: This will be related to what?
Increased ICP and the level of consciousness.
76
Traumatic Brain Injury: Goals for this will be what for increased ICP?
Head of bed elevated
No twisting of neck and head
No vagal maneuvers.
Focused on controlling the ICP
77
Traumatic Brain Injury: We will want to minimize O2 consumption of brain how?
If shivering because of hyperthermic, we may want to put cooling blankets on them.
78
Traumatic Brain Injury: Why is shivering bad
because it increases o2 consumption which causes ischemia. May further sedate and paralyse them to prevent shivering. Also want to keep SpO2 above 90.
79
Traumatic Brain Injury: Cerebral perfusion pressure is normal in what range?
Is usually anywhere from 70-100
80
Traumatic Brain Injury: What happens to cerebral perfusion pressure when there is a severe brain injury?
You just need to keep the pressure above 50. It will decrease but you'll want to keep it up.
81
Traumatic Brain Injury - Problems/Complications: What is included here?
```
Decreased cerebral perfusion
Cerebral edema and herniation
Impaired oxygenation and ventilation
impaired fluid, electrolyte, and nutritional balance
Risk of post-traumatic seizures
```
82
Traumatic Brain Injury - Problems/Complications: Cerebral perfusion peaks when?
48-72 hours after injury. CPP needs to be above 50 for this injury
83
Traumatic Brain Injury - Problems/Complications: Treatment for this is the same as what
Managing the increased ICP
84
Spinal Cord Injury (SCI): What is paraplegic?
Paralysis of the lower body
85
Spinal Cord Injury (SCI): What is quadriplegic?
Now called tetraplegia, which is paralysis of all 4 extremities
86
Spinal Cord Injury (SCI): What gender does this affect more?
Males, 80%
87
Spinal Cord Injury (SCI): What age groups account for over half of this?
People aged 15-35
88
Spinal Cord Injury (SCI): What ethnicity is at a higher risk?
African Americans
89
Spinal Cord Injury (SCI): Risk factors?
Alcohol and drug use
90
Spinal Cord Injury (SCI) - Patho: This is a result of what?
Concussion, contusion, laceration or compression of the spinal cord.
91
Spinal Cord Injury (SCI) - Patho: Primary injury is a result of what
the initial trauma
92
Spinal Cord Injury (SCI) - Patho: Secondary injury is usually the result of what?
ischemia, hypoxia, and hemorrhage, which destroys the nerve tissues
93
Spinal Cord Injury (SCI) - Patho: Treatment thoughts for secondary injuries?
They are thought to be reversible and preventable during the first 4-6 hours after injury.
If we can get blood flow flowing back, hopefully damage can be reversed
94
Spinal Cord Injury (SCI) - Patho: Treatment is needed to prevent what?
Partial injury from developing into more extensive permanent damage
95
Spinal Cord Injury (SCI) - Patho: Location of injury will equate into what?
The type of manifestations you see
96
Spinal Cord Injury (SCI) - Patho: What will you see if injury happens lower than the lumbar?
There will be a greater range of mobility
97
Spinal Cord Injury (SCI) - Patho: If injury happens higher up in cervical, what type of movementw ill you see
will not have that much movement
98
Spinal Cord Injury (SCI) - CMs: What are the two different types you can have?
Incomplete and Complete Spinal Cord Lesion
99
Spinal Cord Injury (SCI) - CMs: What are the sections of the spinal cord?
Cervical -> Thoracic -> Lumbar -> Sacrum and Coccyx
100
Spinal Cord Injury (SCI) - CMs: If Cervical injuried, you're at risk for what injury?
Quadriplegia
101
Spinal Cord Injury (SCI) - CMs: If thoracic injured, you are at risk for what injury?
Paraplegia
102
Spinal Cord Injury (SCI) - CMs: If lumbar injured, you are at risk for what injury?
Paraplegia
103
Spinal Cord Injury (SCI) - CMs: What is a incomplete spinal cord lesion?
This is going to be the sensory/motor fibers preserved below the lesion. May still have function
104
Spinal Cord Injury (SCI) - CMs: What is a complete spinal cord lesion?
This will be the total loss of sesnation and voluntary muscle control below the lesion which can result in paraplegia . May see respiratory difficulties
105
Spinal Cord Injury (SCI) - Assessment/Diagnostic: What will be done?
Imaging: MRI, CT.
Telemetry because we want to monitor since it can affect the heart rate and develop asystole.
106
Spinal Cord Injury (SCI) - Mx: What are the phases?
Emergent
Medical (Acute)
Surgical
107
Spinal Cord Injury (SCI) - Mx: What is the emergent phase?
This is the initial mx. Will need proper handling, will need to be put on backboard and c-collar. Rapid assessment and then taking into hospital
108
Spinal Cord Injury (SCI) - Mx: What is the medical (Acute) phase
Medical tx. Primary goal is to prevent secondary injury. Will want to monitor for progression of neurological deficits and prevent complications.
109
Spinal Cord Injury (SCI) - Mx: During the medical (acute ) Phase, you may see what given?
Medications.
High dose corticosteroid like Solu-Medrol. This is controversial.
110
Spinal Cord Injury (SCI) - Medical (Acute) Phase: What will occur with respiratory?
Will be giving O2. Will increase the PaO2 level if they're struggling to breathe. May get intubated.
111
Spinal Cord Injury (SCI) - Medical (Acute) Phase: May have Diaphragmatic Pacing, which is what?
The stimulation of the phrenic nerve, stimulate the diaphragm to take a beath
112
Spinal Cord Injury (SCI) - Medical (Acute) Phase: Skeletal fraction reduction includes what?
This is done to immobilize the spinal column and helps basically decompress. Immobilize a reduction of dislocation. Can also put weights on to help pull the spine into place and straighten everything out and relieve pressure
113
Spinal Cord Injury (SCI) - Medical (Acute) Phase: What happens as amount of weight increases?
Space between the vertebrae widen and gives the vertebrae the chance to go back into alignment.
114
Spinal Cord Injury (SCI) - Medical (Acute) Phase: What is a therapy youll see a lot with these people
Traction
115
Spinal Cord Injury (SCI) - Surgical: When would you see this done?
If there's cord compression. If the spinal cord or vertebrae or unstable or fractured. Also if bone fragments within cord.
116
Spinal Cord Injury (SCI) - Surgical: What happens if patient in traction and theres a decline in neuro status?
They may have better outcomes the earlier they get into surgery so they may go there to help correct that.
117
Spinal Cord Injury (SCI) - Complications: What complications can occur?
Spinal Shock
Neurogenic Shock
Autonomic Dysreflexi
VTE
118
Spinal Cord Injury (SCI) - Complications: WHy is VTE a complication?
Because they are immobile
119
Spinal Cord Injury (SCI) - Complications: How to prevent VTE?
Low-dose anticoagulant and put on STDs. Maybe Ted Hose and Anti-Embolic Stockings to help with venous return and decrease change of getting VTE.
120
Spinal Cord Injury (SCI) - Complications, Neurogenic Shock: What is neurogenic shock
Distributive shock that causes you to have venous blood pooling. Loss of autonomic nervous system, lose function below the level of the lesion.
121
Spinal Cord Injury (SCI) - Complications, Neurogenic Shock: Loss of ANS below the lesion causes what to happen
Lose the sympathetic and parasympathic nervous system balance. PSNS going to cause vasodilation which will cause decreased vascular resistance and decrease in heart rate to decrease tissue perfusion
122
Spinal Cord Injury (SCI) - Complications, Neurogenic Shock: How do you treat this?
Stabilizing the spinal cord so positioning the spinal cord. Thats why traction is important. Helps with decompression of spinal cord and releases pressure on spine
Also support BP, HR. Patients need pressors like dopamine, vasopressin, Atropine to increase HR.
123
Spinal Cord Injury (SCI) - Complications, Neurogenic Shock: What do you not want to give these patients?
Phenylephrine. This is a pressor but will reduce the heart rate even more and will be a side effect of that.
124
Spinal Cord Injury (SCI) - Complications, Spinal Shock: What is this associated with?
Spinal cord injury as well
125
Spinal Cord Injury (SCI) - Complications, Spinal Shock: What is this?
Sudden onset reflex activity that is depressed below the level of injury. No reflexes, no sensation, they are paralyzed.
126
Spinal Cord Injury (SCI) - Complications, Spinal Shock: What does this affect?
Bowel and bladder function. May cause paralytic ileus so may need NG tube in place.
127
Spinal Cord Injury (SCI) - Complications, Spinal Shock: How can this be treated?
With Solumedrol. It is in shock and just needs time to recover
128
Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: What is this?
SCI above T6. Severe exaggerated response. Some type of painful stimulus like bladders full or developed pressure ulcer. Discomfort sensed by ANS and sends this signals causing vasoconstriction. Signals are supposed to relax the body but are not passed beyond the spinal cord.
129
Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: When does this happen?
After spinal shock has subsided and these patients could be in rehab or at home.
130
Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: What happens above and below the injury?
Above T6, you will see vasodilation because the body has received the signal to this point
Below T6 or site of injury, there will be vasoconstriction because signal has not been received.
131
Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: How will these patients appear?
```
Headache because of vasodilation above injury
Goosebumps
Flushed Face
Diaphoresis (Sweating)
Hypertension , sudden onset
Nauseated
Nasal Congestion
Bradycardia
```
132
Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: What interventions can be done for this?
Raise the HOB.
Find the stimulus that is causing this. Can be ulcer, fecal mass, distended bladder.
Administer meds to lower BP like nitro, hydrolyzine.
133
Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: What will be done for education?
If getting discharged, education about this. Need to teach signs of how to identify and prevent.
134
Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: Early signs will include what
Headache
135
Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: Patients need to learn to do what?
Self-Cath themselves to prevent bladder from being distended. If distended, will cause painful stimulus and signal will be disruptive and not be able to go down spinal cord.
136
Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: Patients need to do what with constipation?
Prevent this. Make sure to have a lot of fiber.
137
Spinal Cord Injury (SCI) - Complications, Autonomic Dysreflexia: What three examples can cause this?
Bladder distended, constipation, and skin care from ulcers
138
Spinal Cord Injury (SCI) - Nursing Process: Assessment includes what?
Monitoring sensory/motor function. Monitor breathing. Monitor for development of spinal shock.
139
Spinal Cord Injury (SCI) - Nursing Process: Nursing Diagnosis?
Ineffective breathing pattern and ineffective airway clearance. Goal will be to maintain airway and acceptable breathing pattern. May need to be intubated or sedated.
Skin breakdown, impaired mobility, urinary elimination
140
Spinal Cord Injury (SCI) - Nursing Process: Goals/Interventiosn will be what?
Focus on diagnosis. If breathing pattern affected, make sure to monitor respiratory status and lung sounds.
Make sure airway is patent
Impaired mobility -> make sure you to range of motio
Impaired skin integrity -> turning patient every 2hours.
Urinary elimination -> monitor this and bowel function
141
Spinal Cord Injury (SCI) - Nursing Process: What complications can occur?
VTEs, Neurogenic Shock, Spinal Shock, Autonomic Dysreflexia
142
Spinal Cord Injury (SCI) - Halo Systems: Used for what injury?
Cervical and thoracic injuries
143
Spinal Cord Injury (SCI) - Halo Systems: What do the pins do?
They are placed above eyebrow to hold the system in place.
144
Spinal Cord Injury (SCI) - Halo Systems: What do they do?
They immobilize the spinal column
145
Spinal Cord Injury (SCI) - Halo Systems: If patient going home, education will be on what?
Education on pin care, vest care, signs and symptoms of infection because pins poking into head,
146
Spinal Cord Injury (SCI) - Halo Systems: THis is basically what?
Traction. Provides decompression therapy that releases and relieves pressure on the spine.
147
Spinal Cord Injury (SCI) - Long-Term complications: What do these include?
```
Premature Aging
Disuse Syndrome
Autonomic Dysreflexia
Bladder/Kidney Infection
Spasticity
Depression
Pressure Ulcers; Osteomyelitis and Sepsis
Heterotopic Ossification
```
148
Spinal Cord Injury (SCI) - Long-Term complications: Goal of rehab is what?
Maintain independence
149
Spinal Cord Injury (SCI) - Long-Term complications: Disuse syndrome occurs why
Because they are not using the extremity.
150
Spinal Cord Injury (SCI) - Long-Term complications: What is autonomic dysreflexia
exaggerated response to a stimulus
151
Spinal Cord Injury (SCI) - Long-Term complications: Why are bladder/kidney infections common?
Because they cannot go to the bladders sometimes. Quadriplegics often come in with raging UTIs.
152
Spinal Cord Injury (SCI) - Long-Term complications: What is heterotopic ossification
The bone forming into the tissue.
153
Spinal Cord Injury (SCI) - Long-Term complications: Often seen with what injury?
The complete lesion injury
154
NCP for Patient with Tetraplegia or Paraplegia: Nursing Diagnosis includes what?
Impaired Bed/Physical Mobility and Impaired Skin Integrity : Big Two!
```
RF Disuse Syndrome
Impaired Urinary Elimination
Constipation
Sexual Dysfunction
Ineffective Coping
Knowledge Deficit
```
155
Oncologic tumors: What are brain tumors?
They grow as a mass and infiltrate the brain tissue. Can cause increased ICP, seizures, hydrocephalus. Can be pretty debilitating.
156
Oncologic tumors: What are the different types of primary tumors?
They originate from the cell within the brain. It is not from metastasis.
157
Oncologic tumors: What is a mengiomas?
Theres a tumor within the covering of the brain either in dura, arachnoid, or pia mater.
158
Oncologic tumors: What are angiomas?
Masses of abnormal blood vessels
159
Oncologic tumors: What is a metastatic tumor?
These are secondary tumors. They are more common than the actual primary tumors. Sometimes, its the secondary metastatic tumors that help reveal the primary cancer when they have neurological changes.
160
Brain Tumor - CMs: What does this include?
Increased ICP
| Localized Symptoms
161
Brain Tumor - CMs: What symptoms may be caused by increased ICP?
Headache from sudden movement
Vomiting (Not related to food intake, is projectile)
Visual Disturbances (May be pressure on occipital lobe)
Seizures
162
Brain Tumor - CMs: What are the localized symptoms?
Signs related to the area of the brain. That is why its important to understand the different lobes of the brain
163
Brain Tumor - CMs: If there is a cerebellular tumor, what changes may occur?
Ataxia, dizziness
164
Brain Tumor - CMs: If frontal lobe tumor, may have changes with what
emotional state and personality
165
Brain Tumor - Diagnostic: How is this diagnosed?
Neurologic Exam
CT Scan
MRI
PET Scan - Supplements MRI to help diagnose and guide treatment
EEG
Cytologic Study of CSF - To detect malignant cells
Biopsy - To see if cancerous or not.
166
Brain Tumor - Med Mx: Specific treatment depends on what?
Type, location, and accessibility of the tumor
167
Brain Tumor - Med Mx: What are some different examples?
Surgery
Radiation Therapy
Chemotherapy
168
Brain Tumor - Med Mx: What falls under radiation therapy?
External Beam Radiation
| Brachytherapy
169
Brain Tumor - Med Mx: Surgery is best why
Because you want to remove as much as possible without causing any deficits
170
Brain Tumor - Med Mx: What is external beam radiation?
Where they use this beam to help destroy the tumor
171
Brain Tumor - Med Mx: What is brachytherapy?
Internal dosing. May place seeds or rods within tumor itself.
172
Brain Tumor - Med Mx: Why would chemotherapy be used?
To help destroy those cancer cells
173
Brain Tumor - Med Mx: What meds may be given?
Decadron to help reduce the brain tumor size. Is a steroid.
174
Cerebral Metastases: Med treatment will be what?
Palliative. Will get baseline medical characteristics of headache.
175
Cerebral Metastases: What education will be given?
The need for them to adhere to prophylactic anti-seizure medications since they are at risk for seizures.
176
Cerebral Metastases: What will be assessed?
Their baseline medical characteristics of the headache and also vital signs.
Also want to assess nutritional status to help prevent nausea and vomiting in these patients.
Assess how they are functioning.
177
Cerebral Metastases: Nursing Assessment includes what?
Checking on patient, nutrition status, neuro status.
178
Cerebral Metastases: Nursing diagnoses will focus on what?
Self-care deficit, imbalanced nutrition, anxiety, interrupted family process.
179
Spinal Cord Tumors: How are they classified?
According to their anatomic relation to the spinal cord
180
Spinal Cord Tumors: What are the different classifications?
Intramedullary
| Extramedullary, extradural
181
Spinal Cord Tumors: What is intramedullary?
Within the cord
182
Spinal Cord Tumors: What is extramedullar?
Outside of the dural membrane
183
Spinal Cord Tumors: CMs incldue what?
Pain, Weakness
Loss of Motor Function
Loss of Reflexes
Loss of Sensation
184
Spinal Cord Tumors: Treatment depends on what
Type of tumor and location
185
Spinal Cord Tumors: What is most often done for treatment?
Surgical Removal if they are able to
186
Spinal Cord Tumors: Other than surgical removal, what else can be done for treatment?
Measures to relieve compression:
Dexamethasone combined with radiation to help reduce the tumor size.
This is done to help give patients back some motor function that they lost due to tumor pressing on spinal cord.
187
Spinal Cord Tumors: Dose of Dexamethasone?
will be a high dose. This is associated with a tumor of some sort whether it be a brain tumor or spinal cord tumor.
Same thing for decadron.
