pathophysiologic results of neurologic oncologic disorders manifestations depend upon the tissues...
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Pathophysiologic Results of Neurologic Oncologic Disorders
Manifestations depend upon the tissues infiltrated and compressed by the neoplasm
Pathophysiologic events may include:Increase ICPSeizuresHydrocephalusAltered pituitary function
Oncologic TumorsBrain tumors
Benign or malignantClassification is based upon location and
histological characteristicsTypes of primary tumors
Gliomas (arises from glial cells)Meningiomas Acoustic neuromas (tumor of the eighth cranial
nerve)Pituitary adenomas
Angiomas—masses of abnormal blood vesselsMetastatic tumors
Brain TumorsSymptoms are dependent upon the location and size of
the lesion and the compression of associated structuresManifestations:
Localized or generalized neurologic symptomsSymptoms of increased ICPHeadacheVomitingVisual disturbances
Hormonal effects with pituitary adenomaLoss of hearing, tinnitus, and vertigo with acoustic
neuroma
Diagnostic EvaluationNeurologic examinationCT scanMRICytological study of cerebral spinal fluidBiopsy
Medical ManagementSpecific treatment depends upon the type,
location, and accessibility of the tumorSurgery
Goal is removal of tumor without increasing neurologic symptoms or to relieve symptoms by decompression
Radiation therapyExternal beam radiationBrachytherapy
Chemotherapy
Spinal Cord TumorsClassified according to their anatomic relation to
the spinal cordIntramedullary: within the cordExtramedullary: extradural; outside the dural
membraneManifestations include pain, weakness, and loss
of motor function, loss of reflexes, loss of sensation
Treatment depends upon type of tumor and locationSurgical removalMeasures to relieve compression: dexamethasone
combined with radiation
Parkinson’s DiseaseAssociated with decreased levels of dopamine
due to destruction of cells in the substantia nigra in the basal ganglia; this effects the neurotransmission of impulses
Manifestations: tremor, rigidity, bradykinesia, postural instability, depression and other psychiatric changes, dementia, sleep disturbances,
Medical management Pharmacologic treatmentSurgical proceduresOther therapies
Pathophysiology of Parkinson’s Disease
TreatmentLevodopaAnticholinergicsAmantadine hydrochloride (antiviral)Monoamine Oxidase Inhibitors (inhibit
dopamine breakdown)
Nursing diagnosisImpaired physical mobility related to muscle
rigidity and motor weaknessSelf-care deficits (feeding, dressing, hygiene, and
toileting) related to tremor and motor disturbanceConstipation related to medication and reduced
activityImbalanced nutrition, less than body requirements,
related to tremor, slowness in eating, difficulty in chewing and swallowing
Impaired verbal communication related to decreased speech volume, slowness of speech, inability to move facial muscles
Ineffective coping related to depression and dysfunction due to disease progression
Alzheimer's DiseaseThe most common cause of dementiaA chronic, progressive, degenerative brain
disorder that effects 4.5 million people in the United States
Research suggests oxidative stress plays a role in the pathophysiology of this disease
Degenerative Disk Disease Most back problems are related to disk disease.Degenerative changes occur with aging or are
the result of previous trauma. In herniation of the intervertebral disk
(ruptured disk), the nucleus of the disk protrudes into the annulus (the fibrous ring around the disk), with subsequent nerve compression.
Continued pressure may produce degenerative changes in the nerves with resultant changes in sensation and motor responses.
Normal Spinal Vertebral and Ruptured Vertebral Disk
Clinical ManifestationsA herniated disk with accompanying pain
may occur in any portion of the spine: cervical, thoracic (rare), or lumbar.
The clinical manifestations depend on the location, the rate of development (acute or chronic), and the effect on the surrounding structures.
Low back pain with muscle spasms, followed by radiation of the pain into one hip and down into the leg (sciatica).
Paresthesia
ManagementTreatment is usually conservative—rest and
medications.Surgery may be required.Discectomy: removal of herniated or extruded
fragments of intervertebral diskLaminectomy: removal of the bone between
the spinal process and facet pedicle junction to expose the neural elements in the spinal canal; this relieve compression of the cord and roots
Hemilaminectomy: removal of part of the lamina and part of the posterior arch of the vertebra
Partial laminectomy or laminotomy: creation of a hole in the lamina of a vertebra
Nursing Process: The Care of the Patient with Cervical Diskectomy—AssessmentDetermining the onset, location, and
radiation of painAssessing for paresthesia, limited movement,
and diminished function of the neck, shoulders, and upper extremities
Determine whether the symptoms are bilateral
Cervical spine palpated to assess muscle tone and tenderness
Range of motion in neck and shoulders is evaluated
Health issuesPatient education
Nursing Process: The Care of the Patient with Cervical Diskectomy—Diagnoses
Acute pain related to the surgical procedureImpaired physical mobility related to the
postoperative surgical regimenDeficient knowledge about the postoperative
course and home care management
Nursing Process: The Care of the Patient with Cervical Diskectomy—Collaborative Problems/Potential Complications
Hematoma at the surgical site, resulting in cord compression and neurologic deficit
Recurrent or persistent pain after surgery
Nursing Process: The Care of the Patient with Cervical Diskectomy—Nursing InterventionsRelieving painImproving mobilityMonitoring and managing potential
complicationsPromoting home and community-based care
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