Brain tumor CT map MAnderson PDF

Preview

Summary

notes...

Description

Name Madisyn Anderson ________________ Medical Diagnosis: -

Pathophysiology (In your own words):

Recurrent Brain Mass (L frontal temporal diffuse astrocytoma post craniotomy on 1/21/21. VP shunt placed 2/11/21 related to CSF leaking from treatment site.)

Concept(s): -

Ineffective Tissue Perfusion Intracranial Regulation

Exemplar(s): -

Critical Thinking Map

Increased intracranial pressure

-

-

Brain tumors apply pressure to surrounding brain tissue, resulting in decreased outflow of cerebrospinal fluid, increased intracranial pressure, cerebral edema and neurologic deficits. Astrocytoma is a tumor that arises from starshaped glial cells Craniotomy is the complete or partial resection of brain tumor through surgical opening in the skull.

Complications/Potential Complications (Physiologic Adaptation(s)/Reduction of Risk Potential): -

SIADH DI Stroke Risk for injury R/T increased ICP Constipation/Diarrhea Altered oral mucous membranes Cerebral edema Decreased cerebral perfusion Meningitis Atelectasis Pulmonary edema Hematoma

Date___2/16/2021___ Psychosocial Concerns (Psychosocial Integrity): -

Anxiety Pain Situational Low SelfEsteem Disturbed body image Risk for ineffective coping

Name Madisyn Anderson ________________

Critical Thinking Map

Date___2/16/2021___

Assessment (Physiological Adaptation) **performed by the student

E.E. 48 year old female, nonverbal. Minimal tracking, reflexive to painful stimuli, PERRLA. Spo2 98% on room air, HR 92, normal sinus rhythm, BP 107/59, RR 16, lung sounds clear with good aeration, no adventitious breath sounds, temperature 97.9 Fahrenheit/ 36.6 Celsius. Blood glucose 137. Skin cool, dry, head wound related to treatment dressed in 4x4 gauze and Krillex pad with no drainage noted. PEG tube placed in upper left quadrant of abdomen ruining 40mL/hr. Soft, nontender, nondistended abdomen, bowel sounds hyperactive. Foley catheter in place temporarily to monitor intake and output. Yellow cloudy color and strong odor of urine noted upon drainage, last BM today.

Labs and Diagnostics (Reduction of Risk Potential)

Blood glucose: 137 mg/dL (Normal: 70-110 mg/dL) - Elevated R/T diabetes mellitus diagnosis WBC: 6,370 (Normal: 4,500 – 11, 0000) - Normalizing R/T resolving infection Hgb: 8.8 (Normal female: 12-16 g/dL) - Decreased R/T medication side effects and recent surgery Hct: 27.2% (Normal female: 36-47%) - Decreased R/T medication side effects and recent surgery Platelet: 266 x 103 (Normal: 150,000-400,00 uL) - Decreased R/T medication side effects Sodium: 133 (Normal: 135-145 mEq/L) - Decreased due to dilutional hyponatremia R/T complication of SIADH Creatine: 0.17 (Normal: 0.6-1.2 mg/dL) Calcium: 8.2 (Normal: 8.5-10.5 mg/dL)

Short term Planning and Goals (short term and longterm goals) 1. Patient will be free of severe complications such as seizures and stroke during hospital stay. **Actual priority problems with prioritized goals 2. Patient maintains optimal cerebral tissue perfusion as evidenced by ICP < 10 mmHg and GCS > 13. Long term 1. Patient will continue to participate in cognitive remediation minimum of 1 yr. to

Critical Thinking Map

Name Madisyn Anderson ________________

Date___2/16/2021___

decrease impact of cognitive, behavioral and emotional changes related to brain tumor surgery. 2. Patient free of severe complications, minimize and manage symptoms, successful treatment and removal of tumor without residual, lasting effects. Nursing Interventions (Basic Care and Comfort, Safety and Infection Control) **What did the student/nurse perform throughout the day

-

Evaluation of Interventions

-

Repositioning every 2 hours at least Accu checks every 6 hours Maintain airway Monitor O2 levels Administer oxygen as needed Monitor respiratory status and protect airway as needed Monitor lung sounds Monitor neurologic status, monitoring LOC/neurological deficits/occurrence of seizure frequently Maintain client safety Maintain seizure precautions Administer medications  antiepileptic, chemotherapy, corticosteroids, antiemetics Provide frequent phone support for family contact Maintain HOB 30-45 degrees to minimize intracranial pressure Decrease stimuli Set realistic patient goals Teach patient to avoid coughing or bearing down Evaluate protective reflexes Monitor urine specific gravity Patient pain rating will rate as less than. Patient will appear relaxed with an absence of crying or irritability or facial grimacing Patient will not exhibit signs of increased intracranial pressure. Demonstrate adaptation to changes/events that have occurred as evidenced by setting of realistic goals and participation in activities and relationships as appropriate

Name Madisyn Anderson ________________

Critical Thinking Map

Date___2/16/2021___

Name Madisyn Anderson ________________

Medication Name (Generic) and Drug class

Patient’s Why is patient Dose, Route, receiving this and medication? Frequency

Atorvastatin (Lipitor)

20 mg 1-tab qHS

Drug class: LipidLowering Agents, Statins; HMG-CoA Reductase Inhibitors MOA: Inhibit enzyme HMG-CoA reductase which is responsible for catalyzing an early step in the synthesis of cholesterol

DAPTOmycin (Cubicin) Drug class: Cyclic Lipopeptide Antibiotics MOA: causes rapid

Prescribed to lower cholesterol in patients who have been diagnosed with high cholesterol. Lowers total and LDL cholesterol and triglycerides.

Critical Thinking Map Nursing considerations (labs, assessment, etc.)

-

-

-

800 mg/6 mL IV push Q24hr

Antibiotic used to treat serious bacterial infections.

-

Death of bacteria with resolution of infection

Date___2/16/2021___

Side effects and Major adverse effects

Patient Teaching

-

-

Diarrhea Stomach discomfort or pain Joint pain Insomnia UTI Nausea Loss of appetite

-

Nausea Vomiting Constipation Diarrhea Headache Dizziness Trouble sleeping

-

Increased blood sugar and glycosylated hemoglobin (HbA1c) levels should be reported. Use caution with elderly due to risk of myopathy History of heavy alcohol use can cause liver dysfunction with use of atorvastatin.

-

Prolonged use can result in prolonged or recurrent Monitor for recent vaccinations as the medication could decrease the effectiveness.

-

Not recommend ed for patients that are pregnant or chronic liver disease Lipitor contains atorvastatin, do not consume this medication if allergic. Notify provider of muscle pain, weakness, signs of kidney problems, signs of lung

Name Madisyn Anderson ________________

Critical Thinking Map

Date___2/16/2021___

depolarization of membrane potential following binding to bacterial membrane results in inhibition of protein, DNA and RNA synthesis.

Insulin aspart (NovLog) Drug class: Antidiabetics, Insulins; Antidiabetics, RapidActing Insulins MOA: Lower blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production.

-

4-18 u subQ q6h

Used to control high blood sugar in people with diabetes

-

Assess blood glucose Monitor for signs of hypoglycemia

-

Nasopharyngitis Hypoglycemia Upper respiratory tract infection Diarrhea Back pain Nausea

-

infections. Do not drive, use machinery or do anything that needs alertness until you know how the medication affects you. Patients with hepatic and renal impairment maybe at an increased risk of hypoglycemi a

Name Madisyn Anderson ________________ Lacosamide (Vimpat) 100 mg/2 tabs PO BID Drug class: Anticonvulsants MOA: Mechanism is not known but may involve enhancement of slow inactivation of sodium channels with resultant membrane stabilization. LevETIRAcetam (Keppra) Drug class: Pyrrolidines, Anticonvulsants MOA: Appears to inhibit burst firing without affecting normal neuronal excitability and may selectively prevent hypersynchronization of epileptiform burst firing and

Antiepileptic drug used together with other medications to treat partial-onset seizures

Critical Thinking Map -

Monitor for suicidal ideation

-

Report suicidal thoughts to the provider while taking this medication

-

Somnolence Dizziness Spinning sensation Drowsiness Blurred/double vision Nausea Vomiting

-

Suicidal thoughts Agranulocytosis Aggression Anger Anxiety

-

Notify health care professional If thoughts about suicide or dying, behavior/m ood changes or skin rash occur.

-

Decreased incidence and severity of partial-onset seizures

1500 mg/ 100 mL IV piggyback Q12h

-

Adjunctive therapy for partial onset seizures

-

Decreased incidence and severity of seizures.

-

-

-

Monitor mood changes Assess for suicidal tendencies Monitor for signs and symptoms of DRESS Assess for rash periodically during therapy

Date___2/16/2021___

Name Madisyn Anderson ________________

Critical Thinking Map

Date___2/16/2021___

propagation of seizure activity. Losartan (Cozaar)

25 mg/1 tab NG daily

Drug class: Antihypertensives, Angiotensin II receptor antagonists

Management of hypertension Lowering of BP.

-

Assess BP/pulse Assess for signs of angioedema Monitor daily weight and assess routinely for resolution of fluid overload.

-

Dizziness Hypotension Angioedema Anxiety Impaired real function

-

Notify provider immediately if swelling of face, eyes, lips or tongue occur, or difficulty swallowing or breathing.

Monitor closely for notable changes in behavior that could indicate suicidal thoughts/behavior or depression Monitor for signs and symptoms of DRESS

-

Seizures Suicidal thoughts DRESS Steven-Johnson syndrome Necrolysis Dizziness/vertigo Ataxia Tremor

-

Notify health care professional If thoughts about suicide or dying, behavior/m ood changes

MOA: Blocks vasoconstrictor and aldosteroneproducing effects of angiotensin II at receptor sites including vascular smooth muscle and adrenal glands. OXcarbazepine (Trileptal) Drug class: Anticonvulsants, Carbamazepine analogues MOA: blocks sodium channels in neural membranes,

300 mg/1tab qHS

Adjunctive therapy of partial seizures Decreased incidence of seizures.

-

-

-

Name Madisyn Anderson ________________

Critical Thinking Map

Date___2/16/2021___

stabilizing hyperexcitable states, inhibiting repetitive neuronal firing and decreasing propagation of synaptic impulse

Patient Teaching (Health Promotion, Safety and Infection Control, and Management of Care): - Medication and regimen education. - Medication compliance is essential to preventing complications such as a seizure. - Relaxation techniques to decrease anxiety including breathing techniques. - Measures to minimize effects of disturbed body image such as wigs and scarfs. - Disease process/condition, prognosis, therapeutic choices and regimen understood - Nonpharmacological comfort measures and diversional activities such as massage and music, hot/cold - Use of memory notebook and daily planner - Education and verbal understanding of the signs and symptoms to report to the provider such as infection, stiff neck, hallucinations, unusual fatigue or difficulty waking up - Prepare for possible radiation or chemotherapy - Importance of attending a support group for patient and family - Therapy as needed for anxiety, depression, ineffective coping Patient Summary (SBAR Format):

S- I am Madisyn Anderson, the RN providing handoff report following caring for patient E.D. 48 yr. old female admitted for decreased LOC, postoperative 2 hours from VP shunt placement. Patient is stable, free of pain and resting.

Name Madisyn Anderson ________________

Critical Thinking Map

Date___2/16/2021___

B- admitted for decreased LOC, history of recurrent brain tumor with resection 2006, HTN, DM, Stroke. A- Patient is nonverbal. Minimal tracking, reflexive to painful stimuli, PERRLA. Spo2 98% on room air, HR 92, normal sinus rhythm, BP 107/59, RR 16, lung sounds clear with good aeration, no adventitious breath sounds, temperature 97.9 Fahrenheit/ 36.6 Celsius. Blood glucose 137. Skin cool, dry, head wound related to treatment dressed in 4x4 gauze and Krillex pad with no drainage noted. PEG tube placed in upper left quadrant of abdomen ruining 40mL/hr. Soft, nontender, nondistended abdomen, bowel sounds hyperactive. Foley catheter in place temporarily to monitor intake and output. Yellow cloudy color and strong odor of urine noted upon drainage, last BM today. R- I recommend completion of an EC EEG awake and asleep study to identify brain activity as well as a neurological evaluation. We will also continue to follow up with wound care and case management. Additionally, continue to monitor for complications such as SIADH sodium dilution with random urine sodium collections. Plan for discharge is home with family care.

Name Madisyn Anderson ________________

Critical Thinking Map

Date___2/16/2021___...