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BRAIN TUMOR

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48 Hour Cram

Sheets for Med Surg

BRAIN TUMOR

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BRAIN TUMOR

• 1. CANCER (ONCOLOGY) Table of Contents
  • BRAIN TUMOR......................................................................................................................................
  • COLON CANCER....................................................................................................................................
  • LEUKEMIA.............................................................................................................................................
  • OVARIAN CANCER
  • PROSTATE CANCER
  • PANCREATIC CANCER
• 2. NEURO: CNS
  • ALZHEIMERS
  • BRAIN TUMORS
  • CEREBERAL VASCULAR ACCIDENT (CVA)
  • EPILEPSY
  • HEAD INJURY
  • MULTIPLE SCLEROSIS (MS).................................................................................................................
  • MENINGITIS........................................................................................................................................
  • PARKINSON’S
  • SEIZURE
  • SPINAL INJURY....................................................................................................................................
• 3. NEURO: PNS
  • GUILLAIN-BAR SYNDROME
  • MYASTHENIA GRAVIS
• 4. GASTRO INTESTINAL (Lower)
  • APPENDICITIS
  • SBO (SMALL BOWEL OBSTRUCTION)
  • CONSTIPATION
  • HERNIA
  • PARALYTIC ILEUS
  • ISCHEMIC BOWEL/COLITIS
  • VOLVULUS
  • DIVERTICUITIS
  • RESECTION OF INTESTINES
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    • INFLAMMATORY BOWEL DISEASE
    • COLORECTAL CANCER
• 5. ORTHOPEDICS (BONES)
     • HIP FRACTURE
     • TOTAL KNEE REPLACEMENT (TKR)
     • LONG BONE INJURY
     • OSTEOARTHRITIS (OA)
     • RHUMATOID ARTHRITIS (RA)
     • GOUT
• 6. VASCULAR DISORDERS
     • PAD (PERIPHERAL ARTERY DISEASE)
     • PVD (PERIPHERAL VASCULAR DISEASE)
     • ANEURYSMS
• 7. RESPIRATORY
     • ASTHMA
     • BRONCHITIS
     • COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE)
     • EMPHYSEMA
     • HEMOTHORAX
     • PNEUMOTHORAX...............................................................................................................................
     • PNEUMONIA
     • PULMONARY EMBOLISM
     • RESPIRATORY FAILURE
     • TUBERCULOSIS
     • URI (UPPER RESPIRATORY INFECTION)
• 8. CARDIAC (HEART)
     • ANGINA
     • ARRHYTHMIAS
     • ACUTE CORONARY SYND. (ACS)
     • ATRIAL FIBRILLATION (A-FIB)
     • CARDIOGENIC SHOCK.........................................................................................................................
     • CABG (Coronary Artery Bypass Graft)
  • CHF (Congestive Heart Failure) Page 4 of 106 Simplenursing.com Less Study Time HIGHER test scores!
  • CAD (Coronary Artery Disease)
  • HTN (Hypertension)
  • HYPERLIPIDEMIA (High Cholesterol)
• 9. ENDOCRINE
  • DIABETES TYPE I
  • DIABETES TYPE II
  • HYPOGLYCEMIA
  • HYPERGLYCEMIA
  • DIABETIC KETOACIDOSIS (DKA)..........................................................................................................
• 10. GALLBLADDER & LIVER & APPENDIX..........................................................................................
  • APPENDICITIS
  • CHOLECYSTITIS
  • HEPATITIS
  • PANCREATITIS
  • CIRRHOSIS
• 11. KIDNEY (RENAL)..........................................................................................................................
  • ACUTE RENAL FAILURE (ARF)
  • CHRONIC RENAL FAILURE (CRF)
  • CHRONIC RENAL INSUFFICIENCY........................................................................................................
  • NEPHROTIC SYNDROME.....................................................................................................................
  • KIDNEY STONES
  • GLOMERULONEPHRITIS
  • TURP (Trans urethral resection of prostate)
  • URINARY TRACT INFECTION (UTI)
  • BPH (Benign Prostate Hypertrophy)
• 12. WOMEN’s HEALTH
  • UTERINE FIBROIDS
  • OVARIAN CANCER
• 13. Bibliography

BRAIN TUMOR

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With over 8 years in the medical field, Mike Linares has worked both out in the field on an Ambulance in the dangerous streets of Los Angeles County and the in crazy busy the Emergency Rooms. Coupled with his passion for teaching & desire to help other students and mixed with his chronic typpos and bad grammmer, SIMPLEnursing.com was born to not only help his fellow RN students, but nursing students worldwide.

"I hope you enjoy the valuable jewels that Simplenursing.com has to offer. If so please let me know! I am a real person & I´d love to hear your thoughts good or bad on Face book, Twitter, or Youtube."

Committed to Your Success, Mike

P.S.Feel free to Face book, Twitter, or Youtube me!! 

Mike Linares Student Nurse Mentor & Certified EKG Instructor

HOW THIS WHOLE THING CAME TO BE...

Before Helping Multiple Successful Nursing Students Excel I Was The "Drone" Nursing Student Working Too Hard & Eventually I FAILED OUT of Nursing School.

Before Helping Hundreds of Struggling Nursing Students Reach Graduation Day & Before Becoming a Student Nurse Mentor & Certified EKG Instructor, I Myself Was A Struggling "At Risk" Student Nurse Drowning In My Books & Lost In Clinical.

I was that struggling student working full time in the Emergency Room at one of those MEGA hospitals in Orange, California. I worked as an EMT aka a "medic" for 8 years prior to failing out. I knew how to take care patients, I knew the basics of the ABCs of basic life support, I knew how to take vital signs and how to fix minor injuries. I thought I had enough experience to skate right through nursing school, I remember thinking "how hard can it be" right? After two semesters, I FAILED out of the Program.

I felt defeated, depressed and like a loser. It was one of the lowest points of my life.

Sitting in my room practically bawling my eyes out, I remember quotes my mom and dad used to encourage me with, "son, whatever doesn´t kill you, Makes you Stronger" & " Failing is Not a Bad Thing, As long as learn, become better, and NEVER EVER QUIT"

BRAIN TUMOR

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1. CANCER (ONCOLOGY) Table of Contents

DIAGNOSIS/PATHO DATA ACTION RESPONSE

BRAIN TUMOR

 Patho: Defined as an intracranial solid neoplasm, or an abnormal growth of cells in brain or central spinal canal. No known cause or risk factor. Graded as: low, intermediate or high Can be located in several areas of the brain:

• Healthy cells transform/mutate into malignant cells upon exposure to certain etiologic factors such as: Viruses, Chemicals, and Physical agents. When cells are malignant, they can metastasize into tissues surrounding the area, to the lymph nodes and lymphatic system, the

 Assess: Neurological status, ALOC, worsening symptoms/impairment, ↑ICP  Vitals: Normal, until near death  S/S & PHYS. EXAM:

• Headache
• Nausea/Vomiting
• ALOC/Changes in speech, vision or hearing
• Issues with gait, balance or walking
• Changes in mood, personality, ALOC
• Memory problems/inability to concentrate
• Seizures/Convulsions
• Muscle twitching/jerking
• Numbness/Tingling in extremities

 Labs: Spinal tap, biopsy  Dx Tests: Neurological exam, MRI, CT Scan, Angiogram

Nursing Interventions:

 Pharm: ** DEPENDS ON

SIZE & TYPE OF TUMOR, AS

WELL AS OVERALL HEALTH

STATUS:

- Chemotherapy Targeted therapy:

• Avastin /bevacizumab (for glioblastoma)
• Afinitor /everolimus (used to treat a benign brain tumor) Alternative Medicine:
• Acupuncture
• Hypnosis
• Music Therapy
• Relaxation Techniques

 Pt. Ed: Referral to OT, PT,

ST (Speech therapy) and tutoring (if child, and learning/memory problems

 Surgery: Removal of

tumor (If able to)

 Nursing Dx:

- Disturbed Body Image r/t changes in the structure and function of the brain/body

• Fear r/t recent diagnosis and unknown future

 Pt. Goals/ Evaluation:

• Pt will verbalize concerns and fears about body, self perception and change of lifestyle
• Pt will verbalize anxiety as well as ways to reduce it/minimize with it.

COLON CANCER....................................................................................................................................

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blood, and system wide to other organs/cavities.

(Most common types of brain tumors/locations)

COLON CANCER

 Patho: Colon cancer occurs in the lower part of the digestive system. Cancer in the colon can begin as small benign clumps in the colon, known as adenomatous polyps. In time, these polyps can develop into colon cancer.

-Healthy cells transform/mutate into malignant cells upon exposure to certain

 Assess: Last Colonoscopy? RISK FACTORS: -Older Adult men/women -Race (African-American) -Genetic/Family history/Personal Hx -Diet high in red meat and fat and low in fiber -Inflammatory bowel diseases

The American Cancer Society 7 WARNING SIGNS for Cancer: C – Change in bowel/bladder habits A – A sore that that doesn’t heal U – Unusual Bleeding/Discharge T – Thickening/lumps in breast/body I – Indigestion/Difficulty swallowing O – Obvious change in wart/mole N - Nagging, coughing or hoarseness

 Vitals: Normal unless distressed  S/S & PHYS. EXAM:

Nursing Interventions: Pharm: Chemotherapy, Radiation therapy, and Targeted drug therapy (bevacizumab/ Avastin , cetuximab/ Erbitux , panitumumab/ Vectibix and regorafenib/ Stivarga )

Pt. Ed: Maintenance of Colostomy bag/care if needed, returning for testing, side effects of meds/ colostomy bag, support system

Surgery: Removal of polyps (If possible), Partial Colostomy, Full colostomy/surgical removal

 Nursing Dx:

• Anticipated loss of physiological well-being r/t loss of body part, change in body function, change in lifestyle and perceived potential death of patient -Situational low self-esteem r/t disfiguring surgery, chemotherapy or radiotherapy side effects, e.g., loss of hair, nausea/vomiting, weight loss, anorexia, impotence, sterility, overwhelming fatigue, uncontrolled pain

 Pt. Goals/ Evaluation: -Pt will continue daily activities, identify feelings and fears towards lifestyle change and diagnosis, Pt will understand and verbalize the grieving and death process

• Pt will verbalize acceptance of diagnosis, control over health

LEUKEMIA

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Chemicals, and Physical agents. When cells are malignant, they can metastasize into tissues surrounding the area, to the lymph nodes and lymphatic system, the blood, and system wide to other organs/cavities. All cancers are staged between I-IV, with Stage I being the least severe and Stage IV being the most severe.

T – Thickening/lumps in breast/body I – Indigestion/Difficulty swallowing O – Obvious change in wart/mole N - Nagging, coughing or hoarseness

 Vitals: Normal unless distressed  S/S & PHYS. EXAM:

• Fever/Night sweats
• Swollen lymph nodes (usually painless)
• Feelings of fatigue, tiredness
• Easily bleeding or bruising, causing bluish or purplish patches on the skin/nosebleeds
• Frequent infections
• Bone/joint pain
• Unexplained weight loss/Anorexia
• Enlargement of the spleen or liver, which can lead to abdominal pain or swelling
• Red spots on the skin (petechiae) (** If leukemia cells have infiltrated the brain : headaches,
  • Antibiotics
  • Analgesics for Pain
  • Immunoglobulins
  • Red & White cell growth factors

Surgery: Removal of spleen (if inflamed)

OVARIAN CANCER

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seizures, confusion, loss of muscle control, and vomiting may occur)

 Labs: Abnormal blood test, bone marrow tests, genetic testing  Dx Tests: Chest X-Ray, Lumbar puncture, MRI, CT Scan

OVARIAN CANCER

 Patho: Cancer of the ovaries:

-Healthy cells transform/mutate into malignant cells upon exposure to certain etiologic factors such as: Viruses, Chemicals, and Physical agents. When cells are malignant, they can metastasize into tissues surrounding the area, to the lymph nodes and lymphatic system, the blood, and system wide to other organs/cavities. All cancers are staged between I-IV, with Stage I being the least severe and Stage IV being the most severe.

 Assess: Assess for menstrual cycle/ovulation history of patient and family… Most At Risk: -Staring period at young age -Ending period (Menopause) at older age -Never been pregnant (nulliparity) -Frequent cycles **10% are genetic and can be tested for BRCA1 and BRCA2 gene changes (mutations)

The American Cancer Society 7 WARNING SIGNS for Cancer: C – Change in bowel/bladder habits A – A sore that that doesn’t heal U – Unusual Bleeding/Discharge T – Thickening/lumps in breast/body I – Indigestion/Difficulty swallowing O – Obvious change in wart/mole

Nursing Interventions: Pharm: Chemotherapy ( carboplatin and paclitaxel ) Pt. Ed: Educate patient on side effects of chemotherapy, changes in hormone levels due to diagnosis and possible hormonal side effects, as well as ways to prevent infection as patient will be immunocompromised.

Surgery: “Surgical Debulking”, where the abdomen is cleared of all masses, with NONE over the size of 1 cm. Removal of Ovaries/Fallopian tubes ( Salpingo-oophorectomy ), removal of uterus ( hysterectomy ) or omentum ( omenectomy ) and Lymph node dissection may be needed based on

 Nursing Dx:

• Pain r/t enlarged organs/ lymph nodes and treatment for diagnosis -Risk for infection r/t compromised immune system

 Pt. Goals/ Evaluation:

• Pt will report pain at tolerable level and verbalize ways to manage
• Pt will identify signs and symptoms of infection and verbalize ways to minimize chances of infection

PANCREATIC CANCER

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blood, and system wide to other organs/cavities. All cancers are staged between I-IV, with Stage I being the least severe and Stage IV being the most severe.

 S/S & PHYS. EXAM:

• Urinary problems
• Decreased force in the urine stream
• Blood in semen
• Erectile dysfunction
• Pelvic Discomfort
• Pain in Bone

 Labs: PSA (Prostate Specific Antigen) Level, Biopsy  Dx Tests: Ultrasound, DRE (digital rectal exam)

including ERECTILE DYSFUNCTION , and encourage them to utilize support system/ affection/coping skills. Refer to support group. Also ambulation and catheter care after surgery.

Surgery: Freezing Prostate tissue, Removal of Prostate, remove the testicles (orchiectomy)

PANCREATIC CANCER

 Patho: Cancer of the Pancreas, NO KNOWN CAUSE!

-Healthy cells transform/mutate into malignant cells upon exposure to certain etiologic factors such as: Viruses, Chemicals, and Physical agents. When cells are malignant, they can metastasize into tissues surrounding the area, to the

 Assess: Assess for Risk Factors:

• Chronic pancreatitis
• Personal or family history of pancreatic cancer
• Smoking/Excessive drinking
• Obese
• Diabetes
• African-American
• Family history of genetics that can increase cancer risk

The American Cancer Society 7 WARNING SIGNS for Cancer: C – Change in bowel/bladder habits A – A sore that that doesn’t heal U – Unusual Bleeding/Discharge T – Thickening/lumps in breast/body

**Nursing Interventions: THIS CANCER IS USUALLY DIAGNOSED AT VERY LATE STAGES DUE TO IT’S ASYMPTOMATIC NATURE Pharm: Analgesics for pain, Chemotherapy, Targeted therapy, Radiation therapy

Pt. Ed: THE HEALING PROCESS AFTER THE WHIPPLE PROCEDURE IS VERY LONG! Surgery: WHIPPLE PROCEDURE (removal of head of pancreas, and portion of small intestine

 Nursing Dx: -Fear r/t recent diagnosis and unknown future -Risk for infection r/t surgical procedure/immunocompromise

 Pt. Goals/ Evaluation: -Pt will verbalize anxiety as well as ways to reduce it/minimize with it.

• Pt will identify signs and symptoms of infection and verbalize ways to minimize chances of infection

PANCREATIC CANCER

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lymph nodes and lymphatic system, the blood, and system wide to other organs/cavities. All cancers are staged between I-IV, with Stage I being the least severe and Stage IV being the most severe.

I – Indigestion/Difficulty swallowing O – Obvious change in wart/mole N - Nagging, coughing or hoarseness

 Vitals: Normal unless distressed  S/S & PHYS. EXAM: _(Can be asymptomatic)_**

- Yellowing of your skin and the whites of your eyes (jaundice)

• Upper abdominal pain (can radiate to back)
• Weight Loss/ Anorexia
• Depression
• Blood clots

 Labs: Biopsy, Blood tests: CMP, CA 19-9 (Tumor Marker), CEA (Carcinogen Embryonic Antigen), Serum Amylase, Fecal Fat, Lipase, Stool Trypsin  Dx Tests: Ultrasound, MRI, CT Scan, Endoscopic Ultrasound (EUS), Endoscopic retrograde cholangio- pancreatography (ERCP)

(duodenum), gallbladder and part of your bile duct. Part of stomach may be removed in addition. The remaining parts of your pancreas are reconnected to the Patient’s stomach and intestines to allow the digestion of food. -Also, removal of cancer on tail of Pancreas if possible

ALZHEIMERS

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3. Moderate to Severe- Repeated instructions needed. Inability to recognize common items and perform simple tasks. Patient wanders a lot. Client is a danger to himself. TOTAL CARE NEEDED.
4. Late- Client becomes unable to read or write. Bunted emotions, loses ability to talk and walk. **STUPOR AND COMA… **DEATH SECONDARY TO INFECTION AND CHOKING**

 Labs: Genetic testing for gene (APOE-e4) & Autosomal Dominant Alzheimers disease (ADAD) to indicate likelihood of having disease  Dx Tests: Physical exam, Neuro exam, Mental status tests

 Surgery: None available at this

time

assistance with these activities

BRAIN TUMORS

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BRAIN TUMORS

 Patho: Brain tumors may be classified into several groups: those arising from the coverings of the brain (e.g., Dural meningioma), those developing in or on the cranial nerves (e.g., acoustic neuroma), Those originating with in brain tissue and metastatic lesions originating elsewhere in the body. Tumors of the pituitary and pineal glands and of cerebral blood vessels are also types of brain tumors. Relevant clinical considerations include the location and the histology character of the tumor. Tumors may be benign or malignant. A benign tumor CAN BE SERIOUS!! If occurs in a vital area and can grow large enough to have effects as serious as those of a malignant tumor.

 Assess: Neuro exam, Head to toe assessment, Assess coordination  Vitals: Severe headache in the morning, increased when coughing, bending Convulsions Signs of increased intra-cranial pressure: blurred vision, nausea, vomiting, decreased Auditory function, changes in vital signs, aphasia. Changes in personality Impaired memory Natural disturbance of taste Classic triad: o Headache o Papilledema (intra-ocular pressure) o Vomiting  S/S & PHYS. EXAM:  Labs: Blood & Urine tests, Biopsy  Dx Tests: MRI, Functional MRI (fMRI) CT Scan, Angiogram, Brain Scan, Diffusion Tensor Imaging (DTI), Positron Emission technology (PET Scan), Bone Scan

Nursing Interventions: Pharm: (Depends on size and location of the tumor) Radiation Therapy, Chemotherapy, Medications to reduce ICP ( Mannitol ), Anti- convulsants, Analgesics ( **All prn, depending on situation) Pt. Ed: Caregiver information about assistance with ADL’s, keeping up with check-ups, options of care/symptom relief, support groups, communication with medical personnel and sources Surgery: Surgery if possible to remove tumor (Depends on size, location and degree of damage if removed)

 Nursing Dx: -Acute pain r/t tumor and increased intercranial pressure -Anxiety r/t unknown future after surgery, cognitive impairment and health issues.  Pt. Goals/ Evaluation: -Pt will verbalize pain level using numeric chart or “FACES” chart, as well as ways to reduce/treat pain -Pt will verbalize anxiety as well as ways to reduce it/minimize with it.

CEREBERAL VASCULAR ACCIDENT (CVA)

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 Dx Tests: CT Scan, MRI, Carotid Doppler, EKG, ECG, cerebral arteriogram, magnetic resonance angiogram

-Surgical Clipping -Surgical AVM removal -Intracranial bypass

EPILEPSY

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EPILEPSY

 Patho: A disorder involving abnormal, sudden discharge of electrical activity in the brain. Epilepsy is not a singular disease, but is heterogeneous in terms of clinical expression, underlying etiologies, and pathophysiology. As such, specific mechanisms and pathways underlying specific seizure types may vary. Epileptic seizures are broadly classified according to their site of origin and pattern of spread.

 Assess: ASSESS FOR SAFE ENVIRONMENT WHILE PATIENT IS SEIZING! Maintain patent airway (Good to position the patient side-lying) Initiate seizure precautions/protect client from injury. DOCUMENT THE SEIZURE!! (Precipitating factors, type, duration, behavior before, during and after seizure/ aka “Postictal phase”, and if incontinent)

 Vitals: ↑TEMP, ↑HR, ↓BP  S/S & PHYS. EXAM: Sensory/Thought: o Black out/Loss of consciousness o Confusion o Deafness/Sounds o Electric Shock Feeling o Spacing out o Out of body experience o Visual loss or blurring Emotional: o Fear/Panic o Pleasant feeling Physical: o Chewing movements o Convulsion o Difficulty talking/Drooling o Eyelid fluttering/rolling o Falling down o Foot stomping o Hand waving o Inability to move o Incontinence o Lip smacking/Making sounds o Shaking

Nursing Interventions: Pharm: Dilantin, Phenobarbital, Tegretol, Depakote, Valium, Klonopin, Pt. Ed: Adherence to medication regimen as well as contra-indications and side effects! Surgery: Removal of anterior temporal lobe (For partial epilepsy/seizures), Usually in children: hemispherectomy , corpus callosotomy (separating of nerve fibers that connect the two sides of the brain)

 Nursing Dx: -Low self-esteem r/t social role changes, loss of control and stigma associated with disease -Risk for Trauma/Suffocatio n r/t loss of consciousness, coordination, weakness and reduced muscle/sensation

 Pt. Goals/ Evaluation: -Pt will verbalize concerns and fears about body, self perception and change of lifestyle -Pt will verbalize understanding of factors that contribute to trauma during a seizure, pt will be aware of seizure precautions that should be utilized, especially by