CASE STUDY - BRAIN TUMOR With Answers 10/31/11 B.T. is a 49-year-old woman admitted with the diagnosis of Rule out Brain Tumor. During the admission history and assessment the nurse notes the following: Complaints of a severe headache which is worse upon awakening and diminishes during the day Complaints of weakness and numbness on the right side Complaints of alterations in taste sensation Left hand grips > right hand grips Able to follow commands but has difficulty verbalizing responses to questions Pupils equal, round and reactive to light but somewhat sluggish in their response Temperature 99.6 0 F., Pulse 68 bpm, BP 152/74 mm Hg, Respirations 18 bpm 1. Based upon the above information, what area(s) of the brain do you think are involved? Frontal region or possibly the left parietal region (patient has contralateral weakness and numbness) or the brain stem . Both of the latter two areas are responsible for taste. Apraxia comes with problems with parietal region also. Sluggish pupillary response would indicate a problem with cranial nerve III. Cranial nerves arise from the brainstem. 2. What additional findings would be consistent with a tumor involving this (these) area(s)? Respirations would not be within normal limits, hallucinations, focal seizures, agnosias (failure to recognize familiar objects), dyslexia, visual field cuts, apraxia (speech disorder in which persons cannot say consistently what they want to say—patient has this, diminished appreciation for the side of the body opposite the tumor (they tend to ignore it), tactile inattention, problems with taste (patient has), problem-solving and reasoning difficulties 3. Formulate a list nursing diagnosis for this client based upon your knowledge of the pathophysiology of this condition and the assessment data given. a. Decreased intracranial adaptive capacity r/t increase in intracranial pressure AEB sluggish pupils, weakness on right side, and double vision b. Disturbed sensory perception r/t intracranial pressure and cerebral tissue changes AEB difficulty verbalizing response, sluggish pupils, and weakness c. Impaired verbal communication r/t decreased circulation to brain AEB difficulty verbalizing response, disorientation, and difficulty forming words
These notes cover the first Med/Surg course in nursing school. Not every topic covered is here, but it’s a good start! Enjoy 🙂
Before you dive into these….check out our PREMIUM notes…which covers topics not represented here including Respiratory and GI!
Cardiovascular: CVCV 2
Neuro: NeurologyNeuro Assessment
Renal and IV therapy
Stress & Fatigue
For GI, Respiratory and Diabetes, click here!
For each of our exams, we had case studies to evaluate. I eventually came up with a snazzy way to methodically think through each one, inspired by my caffeine addiction. I used the acronym “LATTE” to guide my thinking. L = what does the patient LOOK like (what is their presentation?); A = What ASSESSMENTS will you make?; T = What TESTS will be ordered?; T = What TREATMENTS will be provided?; E = How will you EDUCATE the patient? Basically, by using “LATTE” you cover what you need to know for any particular condition. Here’s an example of this method in action: LATTE Case Studies