Brain Tumors Classification
- Brain tumors
— Arise anywhere in the brain
— Benign or malignant
— Most Common among 50 -70 Chart 70-1Classification of Brain Tumors
— Primary vs. Secondary
— Supratentorial vs Infratentorial
Types of Brain Tumors
- Intracerebral Tumors
— Gliomas - Tumors arising from supporting structures
— Meningiomas – most common
— Neuromas (Acoustic, Schwannoma)
— Pituitary adenomas - Developmental Tumors
— Angiomas
— Dermoid, epidermoid, teratoma, craniopharyngioma - Metastatic Lesions
Common Brain Tumor Sites
Gerontologic Considerations
- Brain Tumors increase with age
- Can be overlooked as signs and symptoms can be mistaken for changes that come with aging
- Brain Metastases occur in patients with a hx of prior cancer
- Nursing provides supportive care
Manifestations
- Headache (most common)
- Vomiting
- Visual disturbances
- Seizures
- Hemiparesis or hemiplegia
- Hypokinesia
- Hyperesthesia, paresthesia, decreased tactile discrimination
- Aphasia
- Changes in Personality or behavior
Complications
- Expands and invades, infiltrates, compresses and displaces brain tissue.
- Symptoms depend on the location and size of the lesion and the compression of associated structures
- Complications
— Cerebral edema/brain tissue inflammation
— Localized or generalized neurologic symptoms (deficits)
— Symptoms of increased ICP
— Pituitary dysfunction
— Hydrocephalus
Nursing Process:
Care of Patient With Cerebral Metastases or
Inoperable Brain Tumors
Diagnosis
- Self-care deficit
- Imbalanced nutrition
- Anxiety
- Interrupted family processes
Manifestation
Brainstem Tumors
- Loss of hearing, tinnitus, and vertigo with acoustic neuroma
- Facial Pain
- Dysphagia decreased gag
- Nystagmus – repetitive uncontrolled movements
- Hoarseness
- Ataxia and dysarthria (cerebellar tumors)
— Loss of full control of body movements and unclear articulation of speech
- Hormonal effects with pituitary adenoma
Assessment
- Baseline neurologic exam with focus:
— Patient function, moving, and walking; adapting to weakness and paralysis and to loss of vision and speech; dealing with seizures - Pain, respiratory symptoms, bowel and bladder function, sleep, skin integrity, fluid balance, and temperature regulation
- Nutritional status and dietary history
- Family coping and family process
Diagnostic Evaluation
- CT scan
- MRI
- PET scan
- EEG
- Cytologic study of cerebrospinal fluid
- Biopsy
Medical Management
- Specific treatment depends on type, location, accessibility of the tumor
- Surgery
— Goal is removal of tumor w/o increasing neuro symptoms or relieve symptoms by decompression
— Craniotomy, transsphenoidal surgery, stereotactic procedures - Radiation therapy
— Cornerstone of treatment for many brain tumors - Chemotherapy
- Pharmacologic therapy
— Analgesics for pain
— Dexamethasone for edema
— Phenytoin for seizures
— Proton pump inhibitors
Craniotomy
- Incision into cranium
- Goal is:
— Remove the tumor
— Improve symptoms
— Decrease the tumor size (debulk)
— Challenge to remove tumor without damaging normal tissue
— Complete removal is possible with some benign tumors,
— Postop patient may be admitted to critical care unit or neurosurgical unit for frequent observation
Craniotomy Pre OP
- Consent, Teaching, Reduce Anxiety
- No alcohol, tobacco, NSAIDS, Anticoagulants x 5 days
- Intra OP- local or general anesthesia
- Post OP – Monitor to detect changes
- Assess neuro status and V/S every 15 to 30 minutes for first 4 to 6 hours then every hour.
- If stable for 24 hours, frequency of checks may be decreased to every 2 to 4 hours, depending on the agency’s policy or the patient’s condition.
- Report immediately and document new neurologic deficits,
— Decreased level of consciousness (LOC),
— Motor weakness or paralysis,
— Aphasia (speech and/or language problems),
— Decreased sensation
— Reduced pupil reaction to light
— Personality changes such as agitation, aggression, or passivity
Post op complications
- ICP
- Hematomas
- Subdural hematoma/Epidural hematoma
— Subarachnoid hemorrhage
— Hypovolemic shock
— Hydrocephalus
— Respiratory complications Atelectasis
— Hypoxia
— Pneumonia
— Neurogenic pulmonary edema
— Wound infection
— Fluid and electrolyte imbalances
— Dehydration
— Hyponatremia
— Hypernatremia
— Seizures
— Cerebrospinal fluid (CSF) leak
— Cerebral edema
A client returns from the post anesthesia care unit (PACU) after a craniotomy for removal of a left parietal lobe tumor. How will the nurse position the client after surgery?
- A Flex the client’s knees to decrease intra-abdominal pressure and cerebral hypertension.
- B Keep the client on the left side to prevent surgical site bleeding or cerebrospinal fluid leakage.
- C Elevate the client’s head to at least 30 degrees to promote cerebral venous drainage.
- D Hyperextend the client’s neck to maintain the airway and prevent aspiration regardless of supine or side-lying positioning.
C
Nursing Process:
Care of Patient With Cerebral Metastases or
Inoperable Brain Tumors
Planning
Major goals may include:
- Compensating for self-care deficits
- Improving nutrition
- Reducing anxiety
- Enhanced family coping skills
- Absence of complications
Nursing Process:
Interventions
- Encourage independence for as long as possible
- Measures to improve cognitive function
- Allow patient to participate in decision making
- Allow patient to express fears and concerns
- Presence of family, friends, spiritual advisor, and health care personnel may be supportive
- Referral to counselor, social worker, home health care, support groups
- Referral for hospice care
Improving Nutrition
- Oral hygiene before meals
- Plan meals for times when patient is comfortable and well rested
- Measures to make mealtimes as pleasant as possible
- Offer preferred foods
- Dietary supplements
- Daily weight
- Record dietary intake
Relieving Anxiety
- Give patient opportunity to exercise control over situation
- Encourage family and friends to visit
- Spiritual advisor
- Supportive health professionals
- Brain tumor support groups.
