Dienizs Labini BSN-3E

BRAIN CANCER ACTIVITIES

PRE-TEST 1. This hypothesis describes the delicate balance of the 3 major components in the
intracranial vault, and if one increases, the other must compensate by reducing or moving to attain
or maintain the intracranial pressure
a. Monro-Kellie Hypothesis
b. Bernouillie’s principle
c. Kernohan’s phenomenon
d. Charcot’s triad
2. A type of brain cancer cell that arise from astrocytes and is considered t be the most aggressive
type of brain cancer
a. Astrocytoma
b. Glioblastoma multiforme
c. Teratoma
d. Schwannoma
3. Focal symptoms of brain tumors are independent of their location in the brain.
a. True
b. False
c. No idea
d. May or may not be
4. All of the following are signs of meningismus except:
a. Nuchal rigidity
b. Photophobia
c. Nystagmus
d. Projectile vomiting
5. All except are chemotherapeutic drugs that can be administered through intrathecal route:
a. Vincristine
b. Methotrexate
c. Dexamethasone
d. Ara-C

POST-MODULE TEST
1. A client arrived in the clinic complaining of the recurrent dull headache aggravated by sudden
movement, deterioration of gait and diplopia. Which of the following should the nurse suspect?
a. CNS infection
b. Drug intoxication
c. Brain tumor
d. Intracranial HTN
2. You are caring for a client diagnosed with lung cancer stage IV, with possible metastasis in the
brain. Which of the following should the nurse include in the plan of care? Select all that apply.
a. Monitor the I and O
b. Evaluate GCS every 4 hours
c. Monitor ABG results as prescribed
d. Provide the client with stimulating and well-lighted room
e. Provide low-residue diet
3. The client is about to undergo intrathecal administration of a steroid, dexamethasone this
afternoon. You are checking the client’s chart when you realize that the oncologist has written
“Ara-C” instead of dexamethasone. You called the oncologist, yet he is out-ofnetwork coverage.
Which of the following should you do?
a. Use a “white-out” ink and correct the order of the oncologist.
b. Call your immediate supervisor and report the findings.
c. Call the Quality Assurance Committee and report the incorrect order of the physician.
d. Go ahead with the procedure, maybe the oncologist changed his mind.
4. A client with glioblastoma multiforme grade IV was about to be discharged. He has gross visual
deficits and is paralyzed from the waist down. He is most of the times, drowsy and is on NGT
feeding. His immediate family members expressed their concerns that they might not be able to
provide the complex care he needs. Which of the following nursing diagnosis is appropriate?
a. Impaired sensory perception
b. Risk for aspiration
c. Interrupted family processes
d. Caregiver role strain
5. A client was admitted due to astrocytoma grade II, stage 3B. He has EVD in place and was on
ICP monitoring. He was prescribed with 12% hypertonic saline 70ml every 4 hours as IV bolus to
control ICP. As you are about to prepare the 10am dose of the 12% HTS, the morning laboratory
result came in showed the client’s serum Na+ is 167mEq/L. which of the following should the
nurse do?
a. Give half of the 10am dose and ask for a repeat serum Na+ prior to the 2pm dose.
b. Give the whole dose but infuse it for 2 hours.
c. Withhold the 10am dose and refer to the physician
d. Ask for a repeat serum Na+ STAT, but give the 10am dose.
6. A client post-intrathecal administration of methotrexate is about to be admitted in your floor.
While assessing the client, which of the following statement, if made by the client should prompt
the nurse an immediate action?
a. “I feel a little pricky pain in the puncture site.”
b. “I feel pins and needles in my toes.”
c. “I feel a little nauseous.”
d. “Can I have some time alone?”
7. You are monitoring a client with metastatic brain lesion deep into the midbrain region. He is
about to undergo stereotactic external beam radiotherapy. Which of the following, if made by the
client, will prompt the nurse further clarification?
a. “I have to lie still as possible as the radiation session is ongoing and throughout the session.”
b. “They will inject a dye into my veins and shoot X-rays to my head. The dye will amplify the
effect of the X-ray to the tumor cells and kill them.”
c. “A powerful beam will be focused to where my tumor is sparing most of the other normal
tissues.”
d. “I may experience a sun-burnt like effect after the procedure.”
8. You are watching the ICP monitor, noting the ICP waveforms. Which of the following correctly
state what P3 is?
a. Corresponds to the repolarization of the ventricles.
b. Reflect the dicrotic wave corresponding to the aortic valve closure
c. Denotes the degree of intracranial compliance
d. Denotes the arterial pulsations
9. The client with metastatic cerebral lesion originating from invasive gastrinoma was about to be
given with tranexamic acid 1 gram IV every 8 hours. The nurse understands that hemostatics are
given to patients with intracerebral lesions because which of the following:
a. Finding of cerebrovascular accident concurrent with the tumor
b. Coagulopathy due to paraneoplastic syndromes
c. Bleeding of the stomach due to gastrinoma
d. Intra-tumoral hemorrhage
10. A client has undergone transphenoidal hypophysectomy 3 days ago to remove a primary tumor
in the pituitary gland. Which of the following assessment parameters should the nurse worry
about?
a. A blood pressure of 107/75mmHg
b. A WBC count of 7.5
c. A serum sodium of 146 mEq/L
d. A urine specific gravity of 1.027
 CRITICAL THINKING
Make a care plan to address the following nursing diagnoses related to brain cancer
 Altered sensory perception
 Self-care deficit
 Altered family processes
 Anticipatory grieving
Nursing Possible Signs and Scientific explanation (with Interventions Rationale
Diagnosis Etiology Symptoms algorithm)
Altered Related to Some of the It is "a change in the amount  Provide a  Routine
sensory impaired defining or patterning of incoming consistent eliminates the
perception sensory characteristics stimuli accompanies by a physical element of
processing of impaired and diminished, exaggerated, environment surprise,
and the disturbed distorted, or impaired and a daily overstimulation,
absence of sensory and response to such stimuli" as routine. and further
the perceptual those associated with the  Provide confusion.
processing alterations client's visual, auditory, access to  Familiarity
of stimuli include the tactile, gustatory, olfactory familiar helps reduce
secondary client’s changes and kinesthetic responses to objects, confusion.
to disorders in terms of these stimuli. when  Reduce anxiety
such as behavior, possible. and emotional.
blindness, problem  Develop
deafness, a solving, sensory client-nurse
loss of taste sharpness and relationships
or smell, acuity, and are  Promotes
and an decision therapeutic. communication
inability to making which  Use a calm that enhances
feel things, can lead to the and the person’s
some of client's unhurried sense of dignity.
which can restlessness, a approach
occurs as lack of when
the result of orientation, interacting  Noise increases
genetics, confusion, with the neuronal
aging, altered patient. disorders.
trauma, communication,  Maintain a  It leads to the
biochemical poor pleasant and introduction of
causes, concentration, quiet reality and the
electrolyte hallucinations, environment. clients.
imbalances and a lack of  Call the  Improve
and both focus and client with
excesses of attention. understanding.
their name. Speaking high
stimulation
and hard causes
and deficits  Use a rather stress which
in terms of low voice
sensory sparked angry
and speak confrontation
stimulation. slowly when and response.
talking to the
client.
 Nursing Possible Signs and Scientific explanation (with Interventions Rationale
Diagnosis Etiology Symptoms algorithm)
Self-care Related  inability to  Guide the  Patient may
deficit to complete basic patient in require help
ineffectiv activities of daily accepting the in
e daily living needed determining
functions  inability to amount of the safe
of health complete dependence. limits of
and well- instrumental trying to be
being activities of daily independen
living t.
 muscle weakness  Establish  Helping the
 pain limits short-term patient to
activity A self-care deficit is an inability goals with the reduce
 inability to feed to perform certain daily functions patient. frustration.
self related to health and well-being,
 shortness of such as dressing or bathing. Self-
breath care deficits can arise from
physical or mental impairments,  Present  To promote
such as surgery recovery, positive ongoing
depression, or or the result of reinforcement efforts. And
gradual deterioration that erodes for all patients
the individual’s ability or activities often have
willingness to perform the attempted; difficulty
activities required to care for note partial seeing
himself or herself. Also, patients achievements. progress.
who are suffering  Render  The
from depression may not have supervision patient’s
the interest to engage in self-care for each ability to
activities. activity until perform
the patient is self-care
secured in measures
independent may change
care; re- often over
evaluate time and
regularly to be will need to
certain that be assessed
the patient is regularly.
keeping the
skill level and
remains safe
in the
environment.
 Implement  To prevent
measures to injury from
promote activities
independence, without
but intervene causing
when the frustration.
Nurses can
 patient cannot be key in
function. helping
patients
accept both
temporary
and
permanent
dependence
.
 An
 Apply regular established
routines, and routine
allow requires
adequate time less effort.
for the patient This helps
to complete the patient
task. organize
and carry
out self-
care skills.

Nursing Possible Signs and Scientific explanation Interventions Rationale

Diagnosis Etiology Symptoms (with algorithm)
Altered Related  Inability to Altered family processes  Identify  Provides
family to the function in larger can be related to the patterns of information
processes impact society. impact that an ill family communication about
of  Rigidity in roles, member can have on the in family and effectiveness
member behaviors and family system. An patterns of of
of the beliefs. illness, hospitalization, interaction communication
family/  Failure to surgery, previous between family and identifies
patient’s accomplish diagnoses, coping styles, members. problems that
illness. current or past culture can all place may interfere
development tremendous stress on a with family’s
task. Inability to family and greatly ability to assist
meet the physical interfere with keeping a patient and
and spiritual family strong and united. adjust
needs of family A family member may be positively to
members. diagnosed with an diagnosis and
 Inability to accept illness treatment of
or received cancer.
needed help.  Assess family  Understanding
Lack of support from the members’ another’s
family members perception of perception can
the problem. lead to
clarification
Inability to make and problem-
decision making solving.
regarding the health of  Evaluate  This facilitates
the patient strengths, the previously
 coping skills used
and current techniques.
Altered family process support
systems.
 Assess  Middle-aged
developmental adults may be
level of the having
family difficulty
members. handling of the
demands of
adolescent
children and
elderly
patients.
 Consider  In some
cultural factors. cultures, the
male head of
the family must
make all major
decisions about
health care.
This can create
serious conflict
when the
female is often
more
participative in
healthcare and
desires a
different
decision that
her husband.
 Encourage  This increase
members to understanding
empathize with of others
other family feelings and
members. fosters mutual
respect and
support.
 Encourage  Feelings of
appropriate anger are to be
expressions of expected when
anger without individuals are
reacting dealing with
negatively to the difficult
them. and potentially
fatal illness of
cancer.
Appropriate
expression
 enables
progress
toward
resolution of
the stages of
the grieving
process.
 Assist family in  Assist with
breaking down problem-
problems into solving, with
manageable delineated
parts. responsibilities
and follow-
through.

Nursing Possible Signs and Scientific explanation Interventions Rationale

Diagnosi Etiology Symptoms (with algorithm)
s
Anticipat Related  Irritability and Anticipatory grieving is a  Anticipate  The effective
ory to the anger state in which an increase or behavior may
grieving patient’s  Fear/Anxiety individual grieves before exaggerated increase or
diagnosis  Physical an actual loss. But grief affective exaggerated.
(BRAIN problems doesn’t occur in behavior. Regression may
CANCE  Sadness and isolation. Often the transpire.
R) tearfulness experience of grief can  Encourage  Patient may feel
 Changes in bring to light memories verbalization of supported in
communication of other episodes of grief thoughts or expression of
patterns in the past. Anticipatory concerns and feelings by the
grief can be similar to accept understanding
grief after death but is expressions of that deep and
also unique in many sadness, anger, often conflicting
ways. Grief before death rejection. emotions are
often involves more Acknowledge normal and
anger, more loss of normality of experienced by
emotional control, and these feelings. others in this
atypical grief responses. difficult
situation.
 Support patient  These times of
and significant stress can be
others share used as an
mutual fears, opportunity for
concerns, plans, growth and
and hopes for family
each other. development.
 Review and  Very helpful and
point out provides
strengths and perspective in
progress to date.
 Strengthen the the whole
patient’s efforts process.
to go on with his  Allow the patient
or her life and and family to feel
normal routine. that they are
enabled to do this
 Consider the by supporting
patient’s or them.
family’s denial  The nurse needs
about the loss for to recognize and
it is part of the understand these
grieving process. events which an
individual or
family
member incorpo
rates his or her
strength to go on
to the next stage
 Refer to visiting of grief.
nurse, home  Provides support
health agency as in meeting
needed, or physical and
hospice emotional needs
program, if of patient and
appropriate. SO, and can
supplement the
care family and
friends are able
to give.
GRIEVING: