Question

F. N. is a 57-year old housewife, happily married with grown children, and 2 new grandchildren. F. N. made an appointment with her optometrist to explore a progressive OS (left eye) visual loss over a 9-month period. Her eye dx was essentially normal, and the optometrist referred her to a neurologist. After workup, a 2.5 cm brain mass was found, and surgery was scheduled. Her only past medical history (PMH) is hypertension, for which she takes nifedipine XL 60 mg qd and potassium chloride (K-dur) 10 mEq bid, and her past surgical history (PSH) includes T&A as a child, cholecystectomy, and a TAH at age 42. She also takes a conjugated estrogen (Premarin) 0.625 mg qd.

1. Name 4 tests that can be done to evaluate for brain tumor.

There is no standardized, universally accepted system of classifying brain tumors. They can be classified according to histologic basis, intraaxial vs. extraaxial, or malignant or benign.

. Using the term benign when discussing brain tumors is somewhat misleading. Why?

. Onset of neurologic symptoms is usually insidious, and they exhibit symptoms in relation to the area of the brain where the tumor is located. List 6 general symptoms associated with many brain tumors.

2. Dexamethasone (Decadron) is commonly prescribed when a tumor is diagnosed and the presence of increased intracranial pressure (IICP) is demonstrated. It is administered preoperatively and postoperatively, and in conjunction with radiation and chemotherapy. Why is Decadron prescribed, and why should it not be abruptly stopped?

. Other common supportive medications include antiseizure, diuretics, antacids and H₂ blockers, analgesics, antiemetics, and antidepressants. Indicate why each is used.

3. Once the diagnosis is made, the patient and family must be involved in the plan for treatment. Treatment depends on the type and location of the tumor and can include surgery, radiation, chemotherapy, or any combination of these. The patient also has the right to refuse treatment. Identify 4 other considerations the medical team, patient and family will consider in devising a treatment plan.

4. Describe common responses to a diagnosis of a brain tumor.

List 2 role-relationship nursing diagnoses for F. N.

5 F. N. drew up a living will and healthcare provider power of attorney after she heard the diagnosis. She also sat down with her family and made her wishes known. Why is this important for F. N. in particular and for everyone in general?

You enter F. N.’s room to take VS and she says, “What if I come out of surgery and I’m different? Or what if I lie? My grandbabies will never know me.” You hear the concern in her voice. Suggest several ways that F. N. can communicate with her loved ones in the event that her surgery is unsuccessful.

. F. N. had the surgery and was admitted to ICU post op. She did very well and remained neurologically intact (q 1h neuro checks), her BP was slightly elevated (147/68), the rest of her VS were normal, she had 2 peripheral IV’s, TED hose, O₂ at 4 L/nc, and a Foley. Postoperatively, F. N.’s K level dropped to 2.7 mEq/L and glucose was 202 mg/dL. Describe possible reasons why these 2 laboratory values are abnormal, and identify what treatment will be ordered to correct each.

F. N. did suffer mild neurologic damage as a result of the surgery. She was discharged to a rehabilitation facility, and eventually was able to recover most of her lost function. She continues to enjoy an active life, and has become involved in helping others facing similar experiences.

Answer 1

1.tests that can be done to evaluate for brain tumor.

CT scan

MRI scan

Cerebral angiogram

Tissue biopsy and analysis

• A neurological test: A neurological test may include, among other things, checking your vision, hearing, balance, coordination, strength and reflexes. Difficulty in one or more areas may provide clues about the part of your brain that could be affected by a brain tumor.

• Imaging tests: Magnetic resonance imaging (MRI) is commonly used to help diagnose brain tumors. In some cases a dye may be injected through a vein in your arm during your MRI study.

Using the term benign when discussing brain tumors is somewhat misleading. Why?

can be misleading in this case, as when benign tumours grow and constrict and affect the brain, they can cause disability and even be life threatening.

List 6 general symptoms associated with many brain tumors.

• Headaches, which may be severe and worsen with activity or in the early morning.
• Seizures. People may experience different types of seizures. Certain drugs can help prevent or control them. ...
• Personality or memory changes.
• Nausea or vomiting.
• Fatigue.
• Drowsiness.
• Sleep problems.

3. Why is Decadron prescribed, and why should it not be abruptly stopped?

Stopping the drug abruptly can cause loss of appetite, upset stomach, vomiting, drowsiness, confusion, headache, fever, joint and muscle pain, peeling skin, and weight loss.

4.Identify 4 other considerations the medical team, patient and family will consider in devising a treatment plan.

Steps to an Effective Treatment Plan

1. Goals (or objectives) Every good treatment plan starts with a clear goal (or set of goals). ...
2. Active participation. A treatment plan then follows up with how each party will work to achieve the goal(s). ...
3. Support. ...
4. Outcomes. ...
5. Client involvement.

5.Describe common responses to a diagnosis of a brain tumor.

• Rufuse to accept
• Denial
• Angry
• Agitation
• Psychological distress
• Depression

List 2 role-relationship nursing diagnoses for F. N

• Anxiey related to Change in health status and a threat to self-concept.
• Risk for injury related to Sensory, integrative, and effector dysfunction.
• First 4 questions answered.