Nursing 211

N211: Health Differences Across the Lifespan I Include identifying baseline neurological functioning, monitor IV fluids and output carefully, monitor for signs of increasing ICP (increasing systolic BP, bradycardia and irregular respirations). With infratentorial incision, head position is flat with neck slightly extended. With supratentorial incision, head is elevated, often at 30 degrees; keep head and neck midline to promote arterial and venous blood flow. Monitor pain and provide relief; avoid medications that will sedate the client, which can interfere with evaluation of level of consciousness. Monitor surgical site for hemorrhage and infection. Encourage client and family to talk about diagnosis and feelings. Administer medications desmospressin (DDAVP) to control symptoms of diabetes insipidus if it occurs secondary to brain tumor. 3.23 Neuroblastoma Neuroblastoma is a solid tumor outside the cranium, arising from the sympathetic nervous system. It is the most common form of extra-cranial solid tumor of childhood and primarily affects infants and children under the age of four. Prognosis is bases on client age and staging of the tumor; children under 1 year of age have a better prognosis. Cause is unknown, although environmental factors, such as prenatal drug exposure may be implicated. This tumor is often silent, leading to late diagnosis and poor prognosis. Nursing Assessment Includes a peritoneal tumor may be evidenced as an abdominal mass or by bowel and bladder dysfunction; weight loss, abdominal fullness, irritability, fatigue and fever. Mediastinal tumors cause dyspnea and lead to neck and facial edema if tumor is large. Bone metastasis may lead to a limp and malaise, ptosis and ecchymosis of the eyes. Diagnostics Include CT scan of skull, neck, chest, abdomen and bone. Bone marrow aspiration helps to locate the mass and determine metastasis. Urine testing detects breakdown products of adrenal catecholamines (epinephrine and norepinephrine), which some tumors secrete; these breakdown products are vanillylmandelic acid (VMA) and homovanillic acid (HVA). Nursing Diagnosis • Anxiety and knowledge deficit of parents and child related to diagnosis of cancer and treatments • Risk for infection, related to myelosuppression from chemotherapy and radiation therapy • Pain related to muscle manipulation, tissue trauma, and possible progression of disease • Potential constipation or bowel and bladder incontinence related to pressure of tumor • Body image disturbance related to surgery and effects of chemotherapy/radiation therapy. • Activity intolerance related to fatigue secondary to effects of radiation therapy’s surgery, or chemotherapy


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