brain tumor

Question 1

patient with a brain tumor

Answer 1

General Information:
a. Broad term encompassing tumors found
within the brain inside the skull
compressing the brain.
b. Some are malignant, some benign and
all are life-threatening requiring
aggressive treatment.
c. Primary tumors originate in intracranial
tissue or the meninges.
d. Secondary tumors metastasize from malignant
sites to the brain.

Question 2

statistics for brain tumors

Answer 2

8 out of every 100,000 adults and children are effected in the US.
People of any age can have a brain tumor but it is most common in children under 15 and in older adults.
Primary tumors are more common in males ( 1.5 to 1 ratio with females)

Question 3

causes of brain tumors

Answer 3

Primary brain tumors form when genetic structure of normal brain cells ( neurons & glial cells) change.
Trigger can be genetic predisposition, environmental trigger or both. Exposure to radiation especially to head to treat other cancers or exposure to cancer-causing chemicals (vinyl chloride) can trigger them.

Question 4

signs and symptoms of brain tumors

Answer 4

Headache is early symptom seen in 50% of patients. Usually intermittent, moderate to severe, worse in morning and associated with nausea and/or vomiting. Patient may have diplopia, weakness and paresthesia with it.
New onset seizure may be initial sign of brain tumor.
Cognitive changes in memory, speech, communication and concentration. May notice changes in behavior, intellectual function, personality, planning and decision making ability
Fatigue is common. May see metabolic abnormalities and poor functional state.
Mass Effect: ICP, cranial nerve deficits, visual changes, deep coma
Focal Deficits: motor, sensory, visual-spatial disorders, speech deficits, trouble with balance-coordination, projectile vomiting,

Question 5

frontal lobe brain tumor

Answer 5

Personality disturbances, inappropriate affect, motor dysfunction, seizures, aphasia (expressive).

Question 6

occipital lobe brain tumor

Answer 6

Visual disturbances, headache, seizures.

Question 7

parietal lobe brain tumor

Answer 7

Inability to replicate pictures, loss of right and left discrimination, seizures, paresthesias, sensory-perceptual deficits.

Question 8

temporal lobe brain tumor

Answer 8

Olfactory, visual,, or gustatory hallucinations, complex partial seizures or automatic behavior, aphasia (receptive)

Question 9

diagnosis of brain tumors

Answer 9

Careful history and neurological exam
EEG if seizures
MRI with contrast or CT to reveal tumor
PET scan to measure cellular metabolism
Lumbar puncture: See increased protein. Do cytology.
Biopsy if possible. Sometimes angiogram.

Question 10

glioma

Answer 10

Make up 50% primary tumors. Is a broad term. 77% are malignant-some benign)
peak incidence is 75 to 84 yrs old.
Classification is based on glial cell type:
a. Astrocytoma- are glial cells that support
and nourish neurons. Can be low,
intermediate and high grade tumors.
Low highest survival rate. Seen in
children & young adults. Intermediate &
high grade seen in adults. High grade
glioblastoma is a very aggressive type.
Most common malignant brain tumor. Survival
less than a year.

Question 11

. Oliogodentroglioma

Answer 11

in glial cells that
produce myelin to surround & insulate
axons of the brain & spinal tumors.
Usually can’t be removed by surgery
totally.

Question 12

Ependymomas

Answer 12

glioma close
ependyma (membrane lining ventricles)
Common in kids. Benign in 85% of cases

Question 13

meningioma

Answer 13

25% of brain tumors. Most common in adults especially older adults. Affects women 2Xs more than men. Usually benign but expand and press on brain and spinal cord.

Question 14

other brain tumors

Answer 14

a. Ganglioma- rare. Usually benign. High
cure rate.
b. Medulloblastoma- fast growing malignant
tumors common in kids. May be cured
with radiation.
c. Schwannoma-in bone in posterior skull. Form in
cranial nerve 8 so hearing & balance affected.
d. Lymphoma- usually seen in people with HIV/AIDS. Less
common now with advances in AIDS’ treatment

Question 15

treatment goals for tumors

Answer 15

Identify tumor type and location
Remove or decrease size of tumor
Prevent and manage ICP

Question 16

treatment approaches for brain tumors

Answer 16

Surgery- can be diagnostic and therapeutic. Some deep seated tumors can’t be removed but are accessible for biopsy. Most malignant tumors need additional treatment.
Radiation- commonly given post-op for treatment of malignant tumors. May be used instead of surgery if tumor is inoperable or very responsive to radiation.
Chemotherapy- can be used as additional therapy to treat a brain tumor or to treat recurrence, but blood-brain barrier is a problem. May be given mannitol to help drug to cross barrier.

Question 17

chemotherapy options for brain tumors

Answer 17

Combination chemotherapy- used to control multiple tumor types. More effective & better tolerated than monotherapy.
Lower toxicity drugs- new generation of drugs being explored for brain tumors
High-dose chemotherapy- massive doses of a drug followed by giving an antidote.
Growth factor inhibitor therapy- can help shrink tumor.
Intracavity/interstitial therapy- giving chemo via implantable wafer directly into tumor.
Microspheres- implanted in the brain to dissolve slowly and release drug contents over a particular time period. Can place several drugs in one capsule.
Receptor-mediated permeabilizers (RMPs) are synthetic substances that help chemo to cross blood-brain barrier like mannitol.
Reservoirs are surgically implanted under scalp with a tube leading into brain ventricle by which chemo can be delivered into CSF. Medication is injected into reservoir via syringe.

Question 18

nursing assessment for brain tumors

Answer 18

History data/ Objective data: Headaches, vomiting, papilledema, seizures, changes in mental status, focal neurological deficits, bowel& bladder function, balance & proprioception, coping abilities of patient & family, ability to perform ADLs, conversation ability.
Diagnostic tests

Question 19

nursing diagnosis for brain tumors

Answer 19

Altered cerebral tissue perfusion r/t cerebral edema
Pain (headache) r/t cerebral edema and increased intracranial pressure.
Self-care deficit r/t altered neuromuscular function 2nd to tumor growth and cerebral edema.
Anxiety r/t diagnosis and treatment regime.

Question 20

nursing interventions for brain tumors

Answer 20

Check vital signs, neuro. signs. Observe for ICP
Give medications as ordered: Decadron, anticonvulsants, analgesics etc.
Supportive CVA type care for focal neurological deficits.
Prepare patient for surgery and other therapies.
Provide care for effects of radiation and chemotherapy.
Provide psychological support to patient & family.
Provide patient teaching and discharge planning.

Question 21

nursing care pre-op for brain tumors

Answer 21

Routine pre-op care
Emotional support. Explain what will happen post-op
Evaluate and record baseline assessments
Avoid measures that will increase ICP
Give pre-op steroids as ordered. Patient will need IV and foley

Question 22

nursing care post-op for brain tumors

Answer 22

Care od unconscious patient
Maintain patent airway and adequate ventilation.
Monitor closely vital signs, neuro. Signs, changes in LOC, increased ICP, possible seizures, hyperthermia.
Supratentorial Incision: above tentorium
a. Keep HOB elevated 15 to 45% as
ordered to promote venous outflow.
b. Critical- must not lower head in acute
for any procedure without written doctor’s
order.
c. Turn & position q 2hrs.
Infratentorial incision- below the tentorium
a. Keep HOB flat or elevated only to 20-30
degrees as ordered to prevent pressure
on brain stem.
b. Critical-must not elevate Hob in acute
phase. Do not flex head on chest.
c. Turn side to side q 2hrs using turning
sheet. Keep in alignment.
d. Check respirations closely and report any
changes. Avoid measures that will increase ICP.
e. May be NPO longer- possible impaired gag reflex
Monitor fluid and electrolytes. Accurate I&O. May have to restrict fluids to decrease ICP. Observe for signs of Diabetes Insipidus and Inappropriate ADH secretion.
Assess dressings frequently and report any abnormalities.
Administer medications as ordered.
Ice sometimes applied to decrease swelling of eyelids. Lubricate lids & areas around eyes
Refer patient for rehabilitation