Neuro Tumors Flashcards
(104 cards)
1
Q
- Neurological tumors affect the brain and _______
A
spinal cord.
2
Q
Brain tumors are more common in what population and age group?
A
- males
- middle-aged individuals but can occur in ANY age
3
Q
Brain Tumor incidents increase with ___.
A
age.
4
Q
WHO and National Cancer Institute Tumor Grading:
Grade I tumor is considered
A
Discrete/Slow growing
5
Q
WHO and National Cancer Institute Tumor Grading:
Grade III tumor is considered
A
Infiltrating/Likely to spread
6
Q
WHO and National Cancer Institute Tumor Grading:
Grade IV tumor is considered
A
Highly Malignant/Aggressive growth
7
Q
What are the main 3 signs for Cushings Triad
A
- Increase SYSTOLIC BP
- Decrease HR
- Decrease Irregular RR
8
Q
3 Main signs for IICP
A
- Altered LOC (#1 sign)
- H/A, Restlessness
- Vomit NO nausea
9
Q
Q: Which organ is a frequent site for metastatic cancers?
A
Brain
10
Q
Q: Where can brain tumors develop?
A
can occur in any part of the brain or spinal cord
11
Q
4 types of Intracranial Tumors
A
- Primary tumor
- Secondary tumor
- Benign tumor
- Malignant tumor
12
Q
Tumor that originates in the brain
A
Primary Tumor
13
Q
Tumor that metastasized from another organ/site
A
Seconday Tumor
14
Q
- Non-cancerous
- slow-growing tumor
A
Benign Tumor
15
Q
- Cancerous
- Aggressive Tumor
A
Malignant Tumor
16
Q
Q: What is the only confirmed risk factor for brain tumors?
A
Ionizing radiation
17
Q
What is Ionizing Radiation
A
- An ENVIRONMENTAL risk factor
- This type of radiation can damage DNA in cells, leading to mutations that may result in uncontrolled cell growth and tumor formation.
18
Q
Clinical Manifestations for Brain Tumors
A
Depending on size, location, and mitotic rate
19
Q
What is mitotic rate?
A
How quick cells divide and make new ones- how fast the tumor is growing
“Mito” - mitosis = cell division
20
Q
S/S common to ALL tumors:
A
- Increased Intracranial Pressure (IICP) → Headache, seizures, altered mental status.
- Vomiting (no nausea)
- Visual disturbances
21
Q
Why do seizures occur with Brain tumors
A
Puts pressure in Brain stem
22
Q
List 8 effects of UNILATERAL frontal lobe damage?
A
- Behavioral & emotional changes.
- Impaired judgment.
- Impaired sense of smell.
- Memory loss.
- Paralysis on ONE SIDE of body (hemiplegia)
- Communication difficulty.
- Lack of inhibition (overexcitation or hyperactivity of neural circuits, disrupting normal brain and body functions)
- Hard to concentrate.
SUDDEN ONSET!
23
Q
Q: What are the effects of BILATERAL frontal lobe damage?
1 key difference.
A
ALL of the UNILATERAL PLUS ATAXIC GAIT
24
Q
What are the 4 effects of Parietal Lobe damage
A
- Impaired speech.
- Inability to write.
- sensory misinterpretation.
- Spatial disorders: unable to understand where things are in space affecting how they move, draw, or find their way around.
25
The main effect with **Occipital Lobe** damage.
* Visual loss
(**sudden**, occurs overnight)
* Photosensitivity
26
Q: What **condition** can parietal lobe damage resemble?
can mimic **stroke** symptoms
27
*Review*:
What **DX** is used for **Strokes**?
CT scan
28
What are the 4 effects with **Temporal Lobe** damage?
* Asymptomatic
* Long term memory loss
* Difficulty recognizing new objects
* Hearing difficulty.
29
What are the **6** effects of **Cerebellum** damage?
* Loss of balance/equilibrium
* muscle coordination & control (ataxia)
* Blurry vision
* Loss of motor learning
* Tiredness
* Difficulty swallowing
**Think of SAFETY!- SAFETY ISSUES**
30
What are the 8 effects of **Brainstem** damage?
* Visual & Pupil abnormalities
* Swallowing & speech difficulties
* **Facial Weakness**: drooping eyelid (ptosis) or crossed eyes (strabismus)
* Respiratory & temperature dysregulation
-*Autonomic NS starts to shut down*
* Bradycardia (Low HR)
* Vomit
* Drowsiness
* **Headache in the A.M or upon awakening**
**Autonomic functions: Resp, Cardio, Eating, Sleeping**
31
**3** main **complications** of Brain Tumors in **ADULTS**
*(occurs bc of tumors)*
* **Hydrocephalus**: Tumor mass blocks (obstructs) ventricles or occludes the outlet (CSF flow).
* **IICP**: Tumor growth increases pressure leading to IICP s/s.
* **Brain Herniation**: Caused by IICP.
32
**Infants** with Brain Tumors will present with:
1. Widening cranial sutures
2. wide fontanels
3. constant pain
4. Not eating or playing
5. **KEY: will not tilt their heads to the side of tumor.**
33
**DX studies** for Brain Tumors
* **Hx and Physical**
* **Imaging**: CT, MRI, PET scan, cerebral angiography.
* **Neurological exams**: EEG
-ANY CHANGES= REPORT HCP!!
* **Biopsy**- rarely done
* **Endocrine studies**: Pituitary gland- major hormone control center
34
What **imaging** is specific to **CANCER**?
PET Scan
(only used to determine stage and guide tx)
35
Q: What is the **preferred treatment** for brain tumors for ADULTS?
**Surgical therapy**
* removal of the tumor, reduces pressure on the brain and improve symptoms.
36
In adults, is surgical treatment used for malignant or benign tumors?
BOTH malignant and benign
37
In Pediatrics, is surgery an option?
No. Radiation is tx of choice. Shrink tumor is goal.
38
What is major s/s of radiation
* very dry mouth (oral care important)
* weakness
-*Radiation absorbs lots of energy and fluids.*
39
**2** types of SURGERY for **tumor removal**
1. **Stereotactic** surgery
2. **Intracranial** surgery
40
Can brain cancer (malignant tumors) be cured?
No.
41
Which tumor removal surgery is **LEAST INVASIVE**?
stereotactic surgery
42
Which tumor removal surgery is **MOST INVASIVE**?
Intracranial surgery
43
Q: What is **stereotactic surgery** used for?
Used for
* **small** tumors and abscesses
* biopsies
* minimizes damage to surrounding tissue
*Pt wear halo/clamp over head and surgeon drills a hole- GENERAL ANESTHESIA (complete)*
44
What is **intracranial surgery**?
* A procedure often involving **opening the skull** (craniotomy) to access and treat brain conditions: tumors, bleeding, or injuries.
45
There are **4** types of **Intracranial surgeries**.
Name them
* Craniotomy
* Craniectomy
* Cranioplasty
* Burr holes
46
What is **Craniotomy** used for?
Skull opening for:
* tumor removal
* ICP relief
* remove blood clot
* control hemorrhage
-*Conscious sedation*
47
What is **craniectomy** used for?
* Skull portion excision.
* Used for emergency situations.
* Skull portion is NOT IMMEDIATELY replaced.
-*skull removed and put back LATER*
48
What is **Cranioplasty** used for?
Skull defect repair **using plastic or metal plate.**
49
What are **burr holes** used for?
**Small** openings for
* access
* drainage
* decompression.
-*Head is shaved*
50
What is included in **medical management** for **PRE-operative** cranial (brain) surgery care?
MEDS- KNOW!!
Medical management includes the use of:
* **corticosteroids & Diuretics** to reduce cerebral edema: *DEXAMETHASONE*, *FUROSEMIDE*
* **Fluid restriciton**
* **Hyperosmotic agent**: *MANNITOL*
* **Antibiotics** to prevent infection
* **Anti-seizure** meds:*KEPRA*
* **Anxiolytics**: *DIAZEPAM* for anxiety relief
* **Pre-op diagnostic procedures**: CT scans, MRI, angiography, or transcranial doppler flow studies.
51
Main 3 s/s of **CORTICOSTEROIDS**
1. HIGH BG
2. Agitation
3. Insomnia
52
**Nursing Management** for **Pre-operative** Care
* Neurological **baseline** assessment
* **Preoperative education**: preparation for surgery
* **Emotional support**: fears, concerns
* ICU monitoring post-op for close monitoring
* Head will be shaved- *important to educate women.*
53
What is the definition of "**tentorium**" in the context of **neuro tumors**?
* its a **fold** of the **dura mater** (a tough membrane covering the brain) that separates the **cerebellum** (the part of the brain responsible for coordination) from the **cerebrum** (the large part of the brain responsible for higher functions like thinking and movement).
* the tentorium plays an important role in the location and type of tumor, as tumors can develop in the spaces between the cerebrum and cerebellum, affecting the brain’s function.
54
*Nursing Care: Post Cranial Surgery*
Q: why is **positioning** AFTER cranial surgery important?
Proper positioning depends on the **surgery location** to **promote healing and prevent increased intracranial pressure (ICP)**
55
The **2** main types of **CEREBRUM Surgeries depending on tentorium location**
1. Supratentorial surgery
2. Infratentorial surgery
56
*Patient positioning for*:
**Supratentorial surgery**
(Above the Tentorium - Cerebrum)
* supratentorial region is your brain’s thinking cap
HOB: **elevated 30-45°**
* promote venous output-per surgeon orders!!!!
57
What **4 lobes** are in the **SUPRATENTORIAL** region?
* frontal
* temporal
* occipital
* parietal
58
Why we do **elevated** HOB 30-45° in Supratentorial surgeries
Promote **venous drainage and reduce swelling**- per HCP!
59
*Type of positioning for*:
**Infrantentorial surgery**
(Below the Tentorium - Cerebellum, Brainstem)
HOB flat: **max 10-15°**
60
Why do we ONLY elevate HOB **max 10-15°** for **Infranterial** surgery.
to **prevent pressure on the brainstem** and allow proper **CSF drainage**.
61
**After** cranial surgery, we should **NOT** position the patient on what side?
**The operated side**
* It **increases pressure** on the surgical site, affecting healing and circulation.
62
Q: What **movement** should be **avoided** after Cranial tumor surgery?
**Hyperflexion**- Elevates ICP
63
*Cranial surgery:*
**Example**: If surgery was on the LEFT occipital area, the patient should be positioned on what side?
On the **RIGHT side** with the head of bed (HOB) elevated at 30°
64
Q: What **assessments** are essential **POST cranial surgery**?
* **Vital signs, pain, and oxygen saturation monitoring.**
* Observing for **signs of increased ICP** (e.g., early signs: headache, pupillary changes, altered LOC).
* **Monitor CSF leakage**
* **Monitor bleeding** at the surgical site.
* **Neurological status**: changes in consciousness or function.
* **Monitoring genitourinary status** - Fluid balance esp with MANNITOL (osmotic diuretic)
* **Ensuring the client can eat as soon as they can tolerate regular food.**- Assess gag reflex!!
65
Q: Why is **CSF leakage** or bleeding **after** cranial surgery concerning?
**CSF leakage increases the risk of infection** (such as meningitis)
* can lead to intracranial pressure changes, causing headaches and neurological deficits
66
How do we test CSF drainage?
* **Glucose Test** – CSF contains glucose, while normal nasal secretions do not. A positive glucose test suggests CSF.
* **Halo Sign** – When CSF is mixed with blood and placed on gauze or a tissue, it forms a ring-like "halo" pattern with a clear outer ring.
* **Beta-2 Transferrin Test** – A definitive lab test for CSF, as beta-2 transferrin is found only in CSF.
67
Why is **bleeding** post Cranial surgery concerning?
Bleeding can result in:
* hematomas (blood pooling)
* increased intracranial pressure (ICP)
* and potential brain damage
68
When giving **MANNITOL**, how do you **measure fluid balance EFFECTIVELY**?
I&Os by measuring daily weights
69
Q: Why might a patient experience a **fever** during Cranial surgery?
* Stimulation of the hypothalamus during surgery
* This is a NORMAL physiological response
70
**Pain** drug of choice for Neuro Tumors?
morphine
71
Med of choice for Nause in Neuro tumors
ZOFRAN
72
Is **facial edema** common post Cranial surgery?
Yes. Provide **cool** damp compresses
73
Med of choice for **Edema** in **Neuro Tumors**
Furosemide
74
What **med** is given for fever **post** cranial surgery?
**Acetaminophen RECTAL**
(onset 15 mins, duration 6 hrs, very few side effects)
75
Q: Is a **raspy voice** normal after cranial surgery?
Yes, a raspy voice post-surgery is a normal finding, often due to irritation from the endotracheal tube used during anesthesia.
76
**Post-Cranial** Precautions that we need to educate patients about
(long list)
* Do not hold your breath during activity
* Do not blow your nose
* Use humidifier because humidified air will prevent drying of the nasal passages.
* No heavy activity that makes your head feel full or increases headache
* No lifting: *Nothing heavier than a loaf of bread*
* Do not bend too far forward
* Do not lie with your head flat, always use a pillow to prop your head up
* Take care combing your hair to avoid pulling at the incision with a comb or brush
* Use gentle shampoo, such as baby shampoo, until your head has healed
* Instruct client to use caution when brushing teeth if they have had a tumor removed in area close to oral cavity. (transphenoidal hypophysectomy)
****NOTHING that can cause pressure to the head or incision****
77
Review:
**MAP** should be
65 or >
78
Rare type of Tumors
Spinal Cord tumors
79
Spinal Cord tumors can be __ or __ tumors.
Primary or secondary
80
Q: What is the **classification** of spinal cord tumors based on?
A: It's based on their location in relation to the spinal cord and its surrounding structures.
81
Q: What are the **2 types of spinal cord tumors** based on their location?
1. Extradural
2. Intradural extramedullary
82
*Type of Spinal cord tumor:*
Tumors located **outside** the spinal cord.
Extradural
83
*Type of Spinal cord tumor:*
Tumors within the dura mater but outside the actual spinal cord.
Intradural **extra**medullary
84
What is the **rate of growth** of a **spinal tumor**
tend to be **slow-growing**
85
What symptoms are associated with **spinal cord tumors**?
Symptoms are related to the mechanical effects of the tumor, such as:
* slow compression
* irritation of nerve roots
* displacement of the cord
* gradual obstruction of the vascular supply.
*-These effects can lead to pain, weakness, numbness, or other neurological deficits over time*.
86
Q: What problems can spinal cord tumors cause?
Can cause both **sensory and motor problems**
87
**No. 1 S/S** for Spinal cord tumors
**NEW ONSET** of:
1. BILATERAL lower extremity weakness (legs always shaky, unstable)
2. Back pain that radiates
KNOW THIS!!
88
What type of **back pain** is associtated with spinal cord tumors?
* Back pain with **radicular pain** (pain that radiates along a nerve)
* **Intercostal neuralgia** (pain between the ribs, often due to nerve involvement)
* **Angina** (chest pain, if the tumor affects certain spinal areas)
* **Herpes zoster** (shingles, when the tumor affects specific nerve roots.
89
Q: When does pain from a **spinal cord tumor** tend to **worsen**?
* Worsens with activity, coughing, straining, or when lying down.
*-This is often due to increased pressure or irritation on the spinal cord, nerve roots, or surrounding structures during these activities.*
90
Q: What are **4** signs of **motor** weakness in spinal cord tumors?
Include **slowly increasing**:
* clumsiness
* weakness
* spasticity
* in severe cases, paralysis.
91
If a pt has:
**Loss of reflex with progressive loss of motor function (walking, etc), and sensory deficit- can no longer urinate or control it**...
Where is this tumor located in the body?
Below Thoracic level
92
Q: What are the symptoms of **bladder & bowel dysfunction** in spinal cord tumors?
include **urgency**, which may **progress to incontinence**
93
Q: What **sensory disruptions** can occur with **spinal cord** tumors?
List 4
* coldness
* numbness
* tingling in one **or** more extremities.
* Over time, this may lead to progressive loss of motor function and paralysis.
**THIS IS AN EMERGENCY- REPORT TO HCP!!!!**
94
Q: What are 2 types of treatments for **spinal cord** tumors?
* **Laminectomy**: removal of a portion of the vertebrae to relieve pressure on the spinal cord.
* **Corticosteroids**: Medications like *dexamethasone* (Decadron)
95
Why is the corticosteroid **dexamethasone** (Decadron) prescribed in LARGE doses?
To treat tumor-related edema and reduce inflammation.
- MAX dose usually given over 6-8 weeks.
96
Q: **When** is **dexamethasone** typically administered for spinal cord tumors?
typically administered **immediately after diagnosis** of spinal cord tumors
97
What are some **pain management and positioning strategies** POST **spinal cord** tumor surgery?
* **Positioning**: Keep the bed **flat** initially and have the patient lie on their side.
* **Log rolling**: Use log rolling to keep the back straight and aligned during movement.
* **Sensory function assessment**: Regularly assess sensory function by pinching the arms and legs to check for loss of feeling.
* **Cervical area surgery**: If surgery was performed on the cervical area, closely monitor for respiratory compromise due to postoperative edema.
98
Therapies used for **BOTH** brain and spinal
List 3
1. **Radiation Therap**y: follow up after surgery
2. **Radiosurgery**: high doses directly at tumor
3. **Chemotherapy**
99
**MAJOR Side effect** of **radiation** and how do we treat it?
* Edema
-Managed with corticosteroid (**dexamethasone**)
-MAX dose given over 6-8 weeks
100
Why is **chemotherapy** limited in treating both spinal and brain?
Chemotherapy is **limited by the blood-brain barrier (BBB)**, which **restricts many drugs from reaching the brain and spinal cord CSF**.
101
*Neuro Tumors: Brain and Spinal Meds*
* Edema
* Corticosteroids
* PPIs for Peptic ulcer disease (due to high levels of stress)
* Seizure meds
* Antidepressants
* Anti-nausea
* **Mannitol/Furosemide** (lasix)
* **Dexamethasone**
* PPI: **pentoprazole**
* **seizures: brain=Kepra, Spinal=phenytoin**
* **SSRIs**
* Ondansetron
102
List 3 **risks** related to Neuro Tumors (brain/spinal)
* Glucose intolerance
* Increase infx
* bleeding
103
Q: Whats the **nursing plan** for clients with a neuro tumors?
* Maintain normal ICP
* Maximize neurologic functioning
* Achieve control of pain and discomfort
* Have relief of spinal cord compression
* Maintain bladder function
* Be aware of prognosis and long-term changes in cognitive and physical functioning
104
Expected outcomes for clients with a neuro tumors
* Achieve control of pain, nausea, vomiting, vertigo
* Maintain ICP within normal limits
* Demonstrate maximal neurologic function for type and location of tumor
* Maintain optimal nutritional status
* Accept long-term consequences of tumor and treatment
* Maintain bladder function
* No injuries from falls
