Transcript Brain Tumor (powerpoint to print for class)

Lisa Randall, RN, MSN, ACNS-BC
RNSG 2432
• Classify brain tumors according to type and
location
• Discuss unique characteristics of primary and
metastatic brain tumors
• Recognize common signs and symptoms
• Discuss nursing care re: management of S/S and
treatment interventions
• Incidence of primary brain tumors
(benign or malignant) 12.8/100,000
• 10%–15% of cancer patients develop
brain metastases
• Primary – unknown
• Genetic – hereditary
• Metastatic
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35% - lung
20% - breast
10% - kidney
5% - gastrointestinal tract
• Often unknown
• Under investigation:
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Genetic changes
Heredity
Errors in fetal development
Ionizing radiation
Electromagnetic fields (including cellular phones)
Environmental hazards (including diet)
Viruses
Injury or immunosuppression
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Tissue of origin
Location
Primary or secondary (metastatic)
Grading
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Microscopic appearance
Growth rate
Different for other types of CA
For CNS, per WHO:
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GX Grade cannot be assessed (Undetermined)
G1 Well-differentiated (Low grade)
G2 Moderately differentiated (Intermediate grade)
G3 Poorly differentiated (High grade)
G4 Undifferentiated (High grade)
• Depends on location, size, and type of tumor
• Neurological deficit 68%
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45% motor weakness
Mental status changes
• HA 54%
• Seizures 26%
• General
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Cerebral edema
Increased intracranial pressure
Focal neurologic deficits
Obstruction of flow of CSF
Pituitary dysfunction
Papilledema (if swelling around optic disk)
• Cerebral Tumors
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Headache
Vomiting unrelated to food intake
Changes in visual fields and acuity
Hemiparesis or hemiplegia
Hypokinesia
Decreased tactile discrimination
Seizures
Changes in personality or behavior
• Brainstem tumors
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Hearing loss (acoustic neuroma)
Facial pain and weakness
Dysphagia, decreased gag reflex
Nystagmus
Hoarseness
Ataxia (loss of muscle coordination) and dysarthria (speech
muscle disorder) (cerebellar tumors)
• Cerebellar tumors
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Disturbances in coordination and equilibrium
• Pituitary tumors
Endocrine
dysfunction
o Visual deficits
o Headache
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• Frontal Lobe
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Inappropriate behavior
Personality changes
Inability to concentrate
Impaired judgment
Memory loss
Headache
Expressive aphasia
Motor dysfunctions
• Parietal lobe
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Sensory deficits
 Paresthesia
 Loss of 2 pt discrimination
 Visual field deficits
• Temporal lobe
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Psychomotor seizures – temporal lobe-judgment,
behavior, hallucinations, visceral symptoms, no
convulsions, but loss of consciousness
• Occipital lobe
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Visual disturbances
• Gliomas
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Astrocytoma (Grades I & II)
Anaplastic Astrocytoma
Glioblastoma Multiforme
Oligodendroglioma
Ependymomas
Medulloblastoma
CNS Lymphoma
• Grade I
• Non-infiltrating
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Grade II
Infiltrating
Slow growing
• Grade III
• Infiltrating
• Aggressive
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Grade IV
Highly infiltrative
Rapidly growing
Areas of necrosis
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Grades II-IV
Mixed astro/glio
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Slow growing
Benign
HCP/ICP
Surgery, RT, Chemo
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Small cell embryonal
neoplasms
• Malignant
• HCP/ICP
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Primary CNS lymphoma
B lymphocytes
Increased ICP
Brain destruction
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Meningioma
Metastatic
Acoustic neuromas (Schwannoma)
Pituitary adenoma
Neurofibroma
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Usually benign
Slow growing
Well circumscribed
Easily excisable
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Peritumoral edema
Necrotic center
• Benign
• Schwannoma cells
• CN VIII
• Benign
• Anterior pituitary
• Endocrine dysfxn
• Cystic tumor
• Hypothalamic-pituitary axis dysfunction
• Radiological Imaging
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Computed Tomography scan (CT scan) with/without
contrast
Magnetic Resonance Imaging (MRI) with/without
contrast
Plain films
Myelography
Positron Emission Tomography scan (PET scan)
• LP/CSF analysis
• Pathology
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Resection
Craniotomy
Stereotaxis Surgery
Biopsy
Transsphenoidal
http://youtu.be/d95K3unaNCs
• Drug therapy – Palliative
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Done for symptom treatment and to prevent
complications
 NSAIDs
 Analgesics – Vicodin, Lortab, MS Contin
 Steroids (Decadron, medrols, prednisone)
 Anti-seizure medications (phenytoin) Dilantin &
Cerebyx
 Histamine blockers
 Anti-emetics
 Muscle relaxers (for spasms)
 Mannitol for ICP –New Hypertonic saline
• Pre-op care
• Post-op care
• Patient teaching
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Activity
Wound care
Diet
Meds
F/U
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Neuro assessment
Vital signs
H&P
Teaching
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Diagnostic test info
Pre & Post-op care
ICU
Dressings, edema, bruising, hair removal
Sensations if done partially awake
Emotional support
Avoid false hope
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Anxiety
Risk for infection
Risk for injury: seizures
Pain (Acute)
Impaired cognitive ability
Impaired physical mobility
Altered nutrition: less than body requirements
Urinary retention
Risk for constipation
Disturbed self-esteem
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Increased ICP
Hematoma
Hypovolemic shock
Hydrocephalus
Atelectasis
Pulmonary edema
Meningitis
Fluid and electrolyte
imbalances (ADH)
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Wound infection
Seizures
CSF leak
Edema
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Follow-up appointments and procedures
Medications
Exercise
Diet
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Patient may need referral to dietician to help with diet
planning while undergoing chemotherapy
• Seizures
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Are a risk for 1 or more years following surgery
• If expecting long term changes, coordinate
discharge planning with appropriate members of
health care team
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Damages DNA of rapidly dividing cells
4000–6000 Gy total dose
Duration of 4–8 weeks
Brachytherapy
Stereotactic radiosurgery
• Side Effects
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Skin burns, hair loss, fatigue, local swelling
• Patient teaching
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Do not erase markings
Steroids
S/S of cerebral edema
• Radiation necrosis
• Slows cell growth
• Cytotoxic drugs
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CCNU, BCNU, PCV, Cisplatin, Etoposide,
Vincristine, Temozolomide (Temodar)
• Gliadel wafers
• Ommaya Reservoir
• Side effects
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Oral mucositis, bone marrow suppression, fatigue,
hair loss, nausea/vomiting, anxiety, peripheral
neuropathy
• Patient teaching
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Meds/MV
Nutrition/hydration/activity
Avoid pregnancy
Resources
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Ineffective Tissue Perfusion
Ineffective Airway Clearance
Impaired Communication
Decreased Intracranial Adaptive Capacity
Activity Intolerance
Disturbed Sensory disturbance
Acute Confusion
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Subjective data?
Interventions?
Goals?
Evaluation?
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A patient is being directly admitted to the
medical-surgical unit for evaluation of a brain
mass seen in the frontal lobe on a diagnostic CT
scan. Which of the following signs and
symptoms would the patient most likely
present with?
Personality changes
b. Visual field cuts
c. Difficulty hearing
d. Difficulty swallowing
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The nurse is evaluating the status of a client
who had a craniotomy 3 days ago. The nurse
would suspect the client is developing
meningitis as a complication of surgery if the
client exhibits
a. A positive Brudzinski’s sign
b. A negative Kernig’s sign
c. Absence of nuchal rigidity
d. A Glascow Coma Scale score of 15
• AANN Core Curriculum for Neuroscience Louis,
MO. Nursing, 4th Ed. 2004. Saunders. St.
• Greenberg, Mark. (2006). Handbook of
Neurosurgery. Greenberg Graphics,
Tampa, Florida.