طلبتك يانيرس محمد

[(روح المحبه)]

كيف حالك

عساك بخير

ابغي مساعده منك ضروري عندي

case study

ومحتاجه بعض الاشياء ضروري

الموضوع عن spinal cord tumor

بغيت الـ etiology

و بعد nursing care plane

شاكره لك تعاونك معانا

[nurse_mohammad]

:)
سوري اختي على التاخر
انا الحمد لله بخير

Pathophysiology andEtiology :
1. Astrocytomas, characterized by asymmetrical expansion in the spinal cord, are more common in children than adults. Ependymomas, usually with a cyst, are the most common intramedullary tumor in the adult, but are rare in children. These tumors are central in the spinal cord.
2. Vascular tumors can affect the spinal cord in various ways. Hemangioblastomas often cause edema and syrinx formation. Cavernomas are located on the dorsal surface of the spinal cord.
3. Approximately 85% of all patients with cancer develop bony stasis, with the spinal column as the primary site. Spinal cord compression due to cancer typically presents with incomplete paraplegia involving the thoracic spine.
4. Cause for abnormal cell growth is unknown.
5. Extradural tumors spread to the vertebral bodies.
6. Spinal cord and/or nerve compression results.

NCP:
Nursing assessment:
1. Perform motor and sensory components of the neurologic examination.
2. Assess pain using scale of 0 to 10 as indicated.
3. Assess autonomic nervous system relative to level of lesion—pupillary responses, vital signs, bowel, and bladder function.
4. Assess for spinal or nerve compression—progressive increase in pain, paralysis or paresis, sensory loss, loss of rectal sphincter tone, and sexual dysfunction.

Nursing Diagnoses
1. Anxiety related to surgery and outcome
2. Pain related to nerve compression
3. Disturbed Sensory Perception (tactile, kinesthetic) related to nerve compression
4. Impaired Urinary Elimination related to spinal cord compression
5. Risk for Injury related to surgery

Nursing Interventions:
Relieving Anxiety
1. Provide a safe environment for patient to verbalize anxieties.
2. Provide explanations regarding all procedures. Answer questions or refer patient to someone who can answer questions.
3. Refer to cancer and SCI support groups as needed.
4. Provide the patient/family with written information regarding disease process and medical interventions.
5. Reduce environmental stimulation.
6. Promote periods of rest to enhance coping skills.
7. Involve the family in distraction techniques.
8. Provide options in care when possible.

Relieving Pain
1. Administer analgesics as indicated and evaluate for pain control.
2. Instruct the patient in the use of patient control analgesia, if available.
3. Instruct the patient in relaxation techniques, such as deep breathing, distraction, imagery.
4. Position patient off surgical site postoperatively.

Compensating for Sensory Alterations
1. Reassure patient that degree of sensory/motor impairment may decrease during the postoperative recovery period as the amount of surgical edema decreases.
2. Instruct the patient with sensory loss to visually scan the extremity during use to avoid injury related to lack of tactile input.
3. Instruct the patient with painful paresthesias in appropriate use of ice, exercise, and rest.
4. Assess the patient with sensory and motor alterations, and refer to physical therapy for assistance with ADLs, ambulation.

Achieving Urinary Continence
1. Assess the urinary elimination pattern of the patient.
2. Instruct the patient in the therapeutic intake of fluid volume and relationship to elimination.
3. Instruct the patient in an appropriate means of urinary elimination and bowel management

Providing Additional Postoperative Care
1. Provide routine postoperative care to prevent complications.
2. Monitor surgical site for bleeding, CSF drainage, signs of infection.
3. Keep surgical dressing clean and dry.
4. Clean surgical site as ordered.
5. Pad the bed rails and chair if the patient experiences numbness or paresthesias, to prevent injury.
6. Support the weak/paralytic extremity in a functional position.

Patient Education and Health Maintenance
1. Encourage the patient with motor impairment to use adaptive devices.
2. Demonstrate proper positioning and transfer techniques.
3. Instruct the patient with sensory losses about dangers of extreme temperatures and the need for adequate foot protection at all times.
4. If the patient has suspected or confirmed neurofibromatosis, suggest referral to genetic counselor. Also, encourage follow-up for MRI every 12 months to monitor disease progression.
5. Refer to cancer and SCI support groups as needed.


Evaluation: Expected Outcomes
1. Asks questions and discusses care options
2. Reports that pain is relieved
3. Reports decreased paresthesias; ambulatory postoperatively
4. Voids at intervals without residual urine
5. Incision healing, skin intact

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