chapter 6 Neurologic Disorders Case Study 69
Case Study 69 Brain Tumor
Difficulty: Intermediate
Setting: Hospital
Index Words: brain tumor, diagnostic tests, medications, laboratory values, assessment
Scenario
F.N. is a 57-year-old housewife, happily married with grown children and 2 new grandchildren. F.N.
made an appointment with her optometrist to explore a progressive OS (left eye) visual loss over a
9-month period. Her eye exam was essentially normal, and the optometrist referred her to a neurologist. After work-up, a 2.5-cm brain mass was found, and surgery was scheduled. Her only past medical
history (PMH) is hypertension (HTN), for which she takes long-acting metoprolol (Toprol XL) 100 mg/
day. Her past surgical history (PSH) includes tonsillectomy and adenoidectomy (T&A) as a child, cholecystectomy, and a total abdominal hysterectomy (TAH) at age 42. She also takes a conjugated estrogen
(Premarin) 0.625 mg/day.
1. Name one test that can be done to evaluate for brain tumor.
✽ Note: There is no standardized, universally accepted system of classifying brain tumors. They can
be classified on a histologic basis, intraaxial versus extraaxial, or malignant versus benign.
2. Using the term benign when discussing brain tumors is somewhat misleading. Why?
3. Onset of neurologic symptoms is usually insidious, and patients exhibit symptoms in
relation to the area of the brain where the tumor is located. List six general symptoms
associated with many brain tumors.
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PART ONE Medical-Surgical Cases
4. Corticosteroids, such as dexamethasone (Decadron), prednisone (Deltasone), or
methylprednisolone (Solu-Medrol), are commonly prescribed when a tumor is diagnosed
and the presence of increase intracranial pressure (ICP) is demonstrated. The drugs are
administered preoperatively and postoperatively and in conjunction with radiation and
chemotherapy. Why is dexamethasone prescribed, and why should it not be abruptly
stopped?
5. Other common supportive medications include anticonvulsants, diuretics (including osmotic
diuretics), H2 blockers, analgesics, antiemetics, and antidepressants. Indicate why each is
used.
6. Once the diagnosis is made, the patient and family must be involved in the plan for
treatment. Treatment depends on the type, grade, and location of the tumor and can
include surgery, radiation, chemotherapy, or any combination of these. The patient also has
the right to refuse treatment. Identify four other factors the medical team, patient, and
family would consider in devising a treatment plan.
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chapter 6 Neurologic Disorders Case Study 69
7. Describe common responses to a diagnosis of a brain tumor.
8. F.N. draws up a living will and health care power of attorney after she hears the diagnosis.
She also sits down with her family and makes her wishes known. Why is this important for
F.N. in particular and for everyone in general?
9. You enter F.N.’s room to take vital signs (VS), and she says, “What if I come out of
surgery and I’m different? Or what if I die? My grandbabies will never know me.” You
hear the concern in her voice and want to provide realistic reassurance about expected
outcomes. Suggest several ways that F.N. can communicate with her loved ones in the
event that her surgery is unsuccessful.
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10. F.N. has the surgery and is admitted to ICU postoperatively. She does very well and
remains neurologically intact (neurologic checks every hour). Her blood pressure (BP) is
slightly elevated (147/68 mm Hg); the rest of her VS are normal; she has two peripheral
IVs, TED (thromboembolic deterrent) hose, oxygen (O2) at 4 L by nasal cannula (NC),
and a Foley. Postoperatively, F.N.’s potassium (K) level drops to 2.7 mmol/L, and glucose
is 202 mg/dl. Describe possible reasons why these 2 laboratory values are abnormal, and
identify what treatment will be ordered to correct each.
CASE STUDY PROGRESS
F.N. did suffer mild neurologic damage as a result of the surgery. She was discharged to a rehabilitation facility and eventually recovered most of her lost function. She continues to enjoy an active life
and has become involved in helping others face similar experiences.
For additional information contact:
American Brain Tumor Association: http://hope.abta.org; (800) 886-2282
American Cancer Society: http://www.cancer.org; (800) ACS-2345
Cancer Information Service: http://cis.nci.nih.gov; (800) 4-CANCER
National Brain Tumor Foundation: http://www.braintumor.org; (800) 934-CURE
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