Classify brain tumors according to type and location
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Transcript of Classify brain tumors according to type and location
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• Classify brain tumors according to type and location
• Discuss unique characteristics of primary and metastatic brain tumors
• Recognize common signs and symptoms• List 3 types of spinal cord tumors• Discuss 3 spinal cord tumors according to
histology, location, and clinical manifestations• Discuss nursing care re: management of S/S and
treatment interventions
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• Incidence of primary brain tumors(benign or malignant) 12.8/100,000• 10%–15% of cancer patients developbrain metastases
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• Primary – unknown• Genetic – hereditary• Metastatic
o 35% - lungo 20% - breasto 10% - kidneyo 5% - gastrointestinal tract
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• Often unknown• Under investigation:
o Genetic changeso Heredityo Errors in fetal developmento Ionizing radiationo Electromagnetic fields (including cellular phones)o Environmental hazards (including diet)o Viruseso Injury or immunosuppression
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• Tissue of origin• Location• Primary or secondary (metastatic)• Grading
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• Microscopic appearance• Growth rate• Different for other types of CA• For CNS, per WHO:
o GX Grade cannot be assessed (Undetermined)o G1 Well-differentiated (Low grade) o G2 Moderately differentiated (Intermediate grade) o G3 Poorly differentiated (High grade) o G4 Undifferentiated (High grade)
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• Depends on location, size, and type of tumor• Neurological deficit 68%
o 45% motor weaknesso Mental status changes
• HA 54%• Seizures 26%
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• Generalo Cerebral edemao Increased intracranial pressureo Focal neurologic deficitso Obstruction of flow of CSFo Pituitary dysfunctiono Papilledema (if swelling around optic disk)
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• Cerebral Tumorso Headacheo Vomiting unrelated to food intakeo Changes in visual fields and acuityo Hemiparesis or hemiplegiao Hypokinesiao Decreased tactile discriminationo Seizures o Changes in personality or behavior
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• Brainstem tumorso Hearing loss (acoustic neuroma)o Facial pain and weaknesso Dysphagia, decreased gag reflexo Nystagmuso Hoarsenesso Ataxia (loss of muscle coordination) and dysarthria (speech
muscle disorder) (cerebellar tumors)
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• Cerebellar tumorso Disturbances in coordination and equilibrium
• Pituitary tumorso Endocrine dysfunctiono Visual deficitso Headache
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• Frontal Lobeo Inappropriate behavioro Personality changeso Inability to concentrateo Impaired judgmento Memory losso Headacheo Expressive aphasiao Motor dysfunctions
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• Parietal lobeo Sensory deficits
Paresthesia Loss of 2 pt discrimination Visual field deficits
• Temporal lobeo Psychomotor seizures – temporal lobe-judgment,
behavior, hallucinations, visceral symptoms, no convulsions, but loss of consciousness
• Occipital lobeo Visual disturbances
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• Gliomaso Astrocytoma (Grades I & II)o Anaplastic Astrocytomao Glioblastoma Multiforme
• Oligodendroglioma • Ependymomas• Medulloblastoma• CNS Lymphoma
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• Grade I• Non-infiltrating
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• Grade II• Infiltrating • Slow growing
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• Grade III• Infiltrating• Aggressive
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• Grade IV• Highly infiltrative• Rapidly growing• Areas of necrosis
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• Grades II-IV• Mixed astro/glio
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• Slow growing• Benign• HCP/ICP• Surgery, RT, Chemo
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• Small cell embryonal neoplasms
• Malignant• HCP/ICP
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• Primary CNS lymphoma• B lymphocytes• Increased ICP• Brain destruction
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• Meningioma• Metastatic• Acoustic neuromas (Schwannoma)• Pituitary adenoma• Neurofibroma
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• Usually benign• Slow growing• Well circumscribed• Easily excisable
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• Peritumoral edema• Necrotic center
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• Benign• Schwannoma cells• CN VIII
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• Benign• Anterior pituitary• Endocrine dysfxn
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• Cystic tumor• Hypothalamic-pituitary axis dysfunction
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• Radiological Imagingo Computed Tomography scan (CT scan) with/without
contrasto Magnetic Resonance Imaging (MRI) with/without
contrasto Plain filmso Myelographyo Positron Emission Tomography scan (PET scan)
• LP/CSF analysis• Pathology
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• Resection • Craniotomy• Stereotaxis Surgery• Biopsy• Transsphenoidal
http://youtu.be/d95K3unaNCs
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• Drug therapy – Palliative o Done for symptom treatment and to prevent
complications NSAIDs Analgesics – Vicodin, Lortab, MS Contin Steroids (Decadron, medrols, prednisone) Anti-seizure medications (phenytoin) Dilantin &
Cerebyx Histamine blockers Anti-emetics Muscle relaxers (for spasms) Mannitol for ICP –New Hypertonic saline
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• Pre-op care• Post-op care• Patient teaching
o Activityo Wound careo Dieto Medso F/U
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• Neuro assessment • Vital signs• H & P• Teaching
o Diagnostic test infoo Pre & Post-op careo ICUo Dressings, edema, bruising, hair removalo Sensations if done partially awakeo Emotional supporto Avoid false hope
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• Anxiety• Risk for infection• Risk for injury: seizures • Pain (Acute) • Impaired cognitive ability• Impaired physical mobility• Altered nutrition: less than body requirements• Urinary retention• Risk for constipation• Disturbed self-esteem
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• Increased ICP• Hematoma• Hypovolemic shock• Hydrocephalus• Atelectasis• Pulmonary edema• Meningitis• Fluid and electrolyte
imbalances (ADH)
• Wound infection• Seizures• CSF leak• Edema
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• Follow-up appointments and procedures• Medications• Exercise• Diet
o Patient may need referral to dietician to help with diet planning while undergoing chemotherapy
• Seizures o Are a risk for 1 or more years following surgery
• If expecting long term changes, coordinate discharge planning with appropriate members of health care team
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• Damages DNA of rapidly dividing cells• 4000–6000 Gy total dose• Duration of 4–8 weeks• Brachytherapy• Stereotactic radiosurgery
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• Side Effectso Skin burns, hair loss, fatigue, local swelling
• Patient teaching o Do not erase markingso Steroidso S/S of cerebral edema
• Radiation necrosis
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• Slows cell growth• Cytotoxic drugs
o CCNU, BCNU, PCV, Cisplatin, Etoposide, Vincristine, Temozolomide (Temodar)
• Gliadel wafers• Ommaya Reservoir
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• Side effectso Oral mucositis, bone marrow suppression,
fatigue, hair loss, nausea/vomiting, anxiety, peripheral neuropathy
• Patient teachingo Meds/MVo Nutrition/hydration/activityo Avoid pregnancyo Resources
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• Ineffective Tissue Perfusion• Ineffective Airway Clearance• Impaired Communication• Decreased Intracranial Adaptive Capacity• Activity Intolerance• Disturbed Sensory disturbance• Acute Confusion
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• Subjective data?
• Interventions?
• Goals?
• Evaluation?
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• A patient is being directly admitted to the medical-surgical unit for evaluation of a brain mass seen in the frontal lobe on a diagnostic CT scan. Which of the following signs and symptoms would the patient most likely present with?a. Personality changes
b. Visual field cuts
c. Difficulty hearing
d. Difficulty swallowing
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• The nurse is evaluating the status of a client who had a craniotomy 3 days ago. The nurse would suspect the client is developing meningitis as a complication of surgery if the client exhibits
a. A positive Brudzinski’s sign
b. A negative Kernig’s sign
c. Absence of nuchal rigidity
d. A Glascow Coma Scale score of 15
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• AANN Core Curriculum for Neuroscience Louis, MO. Nursing, 4th Ed. 2004. Saunders. St.
• Greenberg, Mark. (2006). Handbook of Neurosurgery. Greenberg Graphics, Tampa, Florida.