BRAIN TUMORS M. DuBois Fennal, PhD, RN, CNS

Definition  Intrarcranial tumor created by abnormal and uncontrolled cell division. A localize of diffuse lesion or mass occurs in the brain. May be benign or malignant  Primary tumors result from cells or structures within the brain  Secondary Tumors develop from structures outside the brain

Etiology  Primary: Unknown

 Secondary: Metastatic lesions

Incidence  18,000 new cases  Occur more frequently in men than in women  More often in during and after the fifth decade  Incidence higher in blacks than in whites  2.4% of all cancer deaths in US

Pathophysiology  Abnormal cell growth that eventually interfere with normal functioning. Classified according to the cell that the tumor arise from

Gliomas  From the glial cells  Most common type of brain tumor in adults  Responsible for 42% of all brain tumors  Divided into: Astrocytoma Astrocytoma Oligodendroglioma Oligodendroglioma Ependymoma Ependymoma

 Meningiomas affect the meninges  Schwannomas affect the sheaths that cover the nerve fibers  Medulloblastoma common brain tumor found in children after age ten.

 With any growth in the cranium the problem becomes one of “no space”  The cranium holds about 1400cc of matter  It does not expand  Therefore additional growth will produce pathology and/or death.

 Pressure increases in the cranium will produce various pathologies.

Signs and Symptoms  Headache  Cognitive and behavioral impairment  Personality changes  Motor changes  Visual impairment  Paralysis

Diagnosis  History  Neuro exam  CT  MRI  PET (Positron emission tomography)  EEG  Definitive diagnosis can only be confirmed by tissue examination

Medical Management  Chemotherapy  Radiation  Brachytherapy (implantation or radiation sources)  Surgery

Nursing Management  Prevent complications  Assess five critical areas: Level of consciousness * Level of consciousness * Pupillary reaction Pupillary reaction Motor function Motor function Sensory Function Sensory Function Vital signs Vital signs

Level of Consciousness  Verbal response Alertness-Attention Alertness-Attention Lethargic Lethargic Drowsy-sleep (always check for sedation) Drowsy-sleep (always check for sedation) Restless Restless Orientation Orientation PersonPerson PlacePlace TimeTime

Process of disorentation  Sense of time  Sense of place  Sense of the familiar  Sense of self

Check the obvious  Reason for confusion Language Language medication medication

Assessing Motor Responses  Give simple verbal or written commands  Painful stimuli: Start with calling name, procede to touching, nail bed stimulation, sternal rub. Loclizing to pain Loclizing to pain Decorticate posturing Decorticate posturing Decebrate posturing Decebrate posturing Flaccidity Flaccidity

Assessing Pupils  Shape  Size  Equality  Reaction to light

Assessing Motor Function  Posture  Strength  Tone  Coordination  Reflexes  Abnormal movement  Absence of movement  Quality of movement (consider conditions that may affect motion or movement)

Assessing Reflexes  Babinski  Blink  Gag-swallow  Dolls eyes

Sensory Assessment  Visual fields  Hearing  Understand verbal commands  Superficial sensation  Deep sensation

Vital Signs  Respirations (describe the pattern)  Temperature (pattern of elevation or drop)  Blood pressure (look for a widening pulse pressure)  Pulse (watch for slowing)

Nursing Diagnosis  Alteration/Risk for level of consciousness  Impaired cognitive functioning  Alteration in perfusion (brain)  Potential for alteration in breathing pattern  At risk for injury (death).