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Neurosensory: Stroke/Brain tumors

Neurosensory: Stroke/Brain tumors . Part # 2 Brain Tumors. A. Pathophysiology/etiology Primary brain tumors. Arise from support cells, neurogilia cells; the meninges; or blood vessels Do not metastasize outside cranium Cause unknown.

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Neurosensory: Stroke/Brain tumors

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  1. Neurosensory: Stroke/Brain tumors Part # 2 Brain Tumors

  2. A. Pathophysiology/etiology Primary brain tumors • Arise from support cells, neurogilia cells; the meninges; or blood vessels • Do not metastasize outside cranium • Cause unknown

  3. Pathophysiology/etiology Primary brain tumors • Grade I and II gilomas (astrocytoma) made up of astrocytes; are benign, slow-growing tumors • Grade II and IV gliomas (glioblastoma Multiforme are invasive and fast-growing • Meningiomas arise from the meninges; slow-growing; benign, encapsulated and compress the brain • Brain tumors may be lethal due to their location

  4. Pathophysiology/etiology Metastatic (secondary) brain tumors • Originate from outside the brain- lung and breast most common sites • Single or multiple tumors within the brain tissue • Becoming more common as individuals with cancer in other parts of the body are living longer

  5. B. Common manifestations/complications • Brain tumor symptoms occur due to their ability to compress or destroy brain tissue • From edema that forms around the tumor • From hemorrhage • From obstruction of CSF flow • General increased intracranial (IICP) symptoms (refer to module # ), headache usually worse in AM

  6. Common manifestations/complications Local (anatomical) as interfere with function • Frontal lobe: personality changes; inappropriate behavior; inability to concentrate; impaired judgment; headache; expressive aphasia if dominant hemisphere; motor weakness or paralysis from motor strip • Parietal lobe: sensory deficits- paresthesia, visual field deficits; contralateral sensory disturbances from sensory strip; loss of interpretation and discrimination for sensing input; perceptual problems

  7. Common manifestations/complications Local (anatomical) • Occipital lobe: visual disturbances; visual agnosia • Temporal lobe: complex partial (psychomotor) seizures; auditory hallucinations; memory problems; Wernicke aphasia if dominant hemisphere • Cerebellum: gait distrubances; balance and coordination problems • Brain stem: cranial nerve dysfunction; vital signs

  8. C. Therapeutic interventions for brain tumors • Diagnostic tests: CT/MRI; EEG • Medications • Chemotherapy: IV; intraventricular (ommaya Reservoir) or by wafer implanted • Corticosteroids to treat brain edema • Anticonvulsants to prevent seizures

  9. Therapeutic interventions for brain tumors- Surgery • To remove tumor or for symptom relief • Supratentorial- cranial surgery above the tentortium (double fold dura between cerebrum & cerebellum) • Infratentorial- surgery below the tentortium • Stereotaxic surgery to localize tumor/remove

  10. Therapeutic interventions for brain tumors • Radiation therapy • Used alone or with other therapies • Gamma Knife- shielded helmet containing cobalt directed to tumor to shrink the tumor • Rehabilitation • Outpatient or in-house • Coping adapting with neuro deficits

  11. D. Nursing assessment specific brain tumors • Health history: progression of symptoms; other cancers, disease • Physical exam • Neuro vital signs • Specific signs of the local functions of different parts of the brain • Similar neuro deficits as the individual with a stroke • Signs of increased intracranial pressure/herniation

  12. E. Pertinent nursing problems & interventions • 1. Anxiety: brain is the essence of an individual; individual/family support and education • 2. Risk for infection- post crani: assess for CSF leak; meningitis; other infections • 3. Ineffective protection post surgery: assess for IICP from cerebral edema or bleeding • 4. Acute pain: assess for pain; R/O meningitis as cause for pain; medication; HOB 30 degrees

  13. Pertinent nursing problems & interventions • 5. Disturbed self-esteem: individual support • 6 Home care: rehabilitation; home evaluation for neuro deficits; support groups

  14. Nursing Care Plan: A Client with a Brain Tumor LeMone p. 1397 http://wps.prenhall.com/wps/media/objects/737/755395/brain_tumor.pdf http://wps.prenhall.com/chet_lemone_medicalsurg_3/0,7859,757263-,00.html

  15. Added critical thinking questions: Nursing Care Plan: A Client with a Brain Tumor LeMone p. 1394 • 1. Where is the frontal lobe and what is its functions? • 2. What is the pathophysiology of Clair Langes’ symptoms? • 3. Why would the nursing diagnosis of altered cerebral perfusion pressure be important? • 4. What type of seizure did Clair have? • 5. What are the different types of gliomas? • 6. Why does lying in a flat position and coughing increase Clair’s headache?

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