Brain Tumors
Adults and Children II
I. Types of Brain Tumors
Primary brain tumors originate from the various cells and structures normally found within the brain.
Metastatic brain tumors
Types of Brain Tumors
Malignant
Benign
Intracerebral tumors
Gliomas
Astrocytoma 10%
Glioblastoma 20%
Oligodendrocytoma 5%
Ependynoma 6%
Medulloblastoma 4%
Tumors arising from supporting structures
Meningiomas 15%
Neuromas 7%
(Acoustic Neuroma)
Pituitary adenomas 7%
Developmental
(congenital tumors)
Dermoid and epidermoid 4%
Craniopharyngioma 4%
Angiomas 6%
Unclassified
Sarcomas 4%
Pinealoma 3%
Glioma/optic nerve 5%
II. Clinical presentation
History usually reflects an evolving progression of S & S with rate of progression depending on size, location, rate of growth and type of tumor.
A. Headache
Generalized or localized in frontal or sub occipital region.
Usually described as intermittent and not severe.
Usually worse in morning.
B. Vomiting
Related to increased ICP & brainstem compression.
Usually occurs without nausea, unrelated to meals, more common in morning.
May be projectile.
C. Papilledema
(swelling of the optic disc)
Seen with 70-75% brain tumor pts.
Associated with visual changes (decreased acuity, diplopia and deficits in visual fields)
Papilledema
Remember, visual pathways extend through lobes of cerebral hemispheres (supratentorial)
D. Personality Changes
Frontal Lobe: Loss of emotional restraint.
Impairment of various intellectual abilities.
Various neurotic traits: noticed by patient/family
E. Focal Disturbances
Focal symptomatology for intracrainal tumors.
F. Pituitary dysfunction
Hypopituitarism
Giantism
Acromegally
Cushing's syndrome
III.
Medical
Management
A. Drug Therapy
Decadron
Dilantin
Tylenol
Codeine
Colace/Ducosate
Three (3) Approaches:
Surgery
Radiation
Chemotherapy
Alone or in combination
B. Surgery
Craniotomy
Partial
Decompression
Shunting
C. Radiation Therapy
Used alone or combined with surgery.
Not all patients respond well to radiation therapy.
Radiation may exacerbate increased ICP due to radiation edema.
D. Chemotherapy
Found useful in treating malignant brain tumors, especially medulloblastomas and glioblastomas.
Glio is most malignant tumor
Protocol will be multiple drug approach.
IV. Nursing Care of the patient with a: Brain Tumor
A positive, supportive approach:
Catastrophic illness: COPING
Increased ICP, cerebral edema.
Radiation and Chemotherapy
Nursing care of the patient undergoing....
A CRANIOTOMY
Location
Surgical Incision
A. Supratentorial
Area above the tentorium that includes cerebrum.
Can reach the frontal, parietal, occipital and temporal lobes.
B. Infratentorial
Area below the tentorium that includes brainstem, (medulla, midbrain, and pons), and cerebellum.
C.
Post-op complications
1. Shock
Hemorrhagic or Hypovolemic-
Use of osmotic diuretics.
Check dressing, tachycardia, hypotensive, pallor, cold, clammy skin.
Restless, decreased output.
2. Increased ICP:
Vital Signs
(Cushing's Triad)
LOC
Respiratory Pattern
3. Cerebral Edema:
Most common cause of Increased ICP.
Keep HOB elevated. (30 degrees)
Fluid Restriction.
Corticosteroids. (must taper)
4. Respiratory Complications:
Avoid airway obstruction (tongue, muscous)
Pneumonia, atelectasis, pulmonary embolus.
TCDB, suction, O2 and vent.
5. Convulsions:
Seizure Precautions.
Medications
6. Meningitis:
Check drsg for halo sign:
inner circle of drainage is blood,
serosanginuous, light serous: and surrounded by yellow outer circle = CSF.
Dextrostix = + glucose
Drainage from nose and ears.
Meningitis Cont.
Nucal rigidity
Photophobia
Restlessness
Irritability
Increased temp
7. Wound Infection:
Cultures
Aseptic technique with dressing change (check drsg for too tight)
Administer antibiotics:
Vancomycin
8. Thrombophlebitis:
Bed rest complications
D.
Basic Nursing Care
Following Cranial Surgery
Basic Nursing care:
Hygiene
Ted Hose and SCD
Turn q 2 hours, positioning.
ROM
Catheter care
HOB up
Cold/warm compresses to eyes
Basic nursing care cont.
Lubricate eyes
Safety: side rails up and restrain
Analgesia for pain
Spread out nursing activities
VS and Neuro checks
Monitor lab values.