Neurosensory: Stroke/Brain tumors Part # 2 Brain Tumors

A. Pathophysiology/etiology Primary brain tumors Arise from support cells, neurogilia cells; the meninges; or blood vessels Do not metastasize outside cranium Cause unknown

Pathophysiology/etiology Primary brain tumors Grade I and II gilomas (astrocytoma) made up of astrocytes; are benign, slow-growing tumors Grade II and IV gliomas (glioblastoma Multiforme are invasive and fast-growing Meningiomas arise from the meninges; slow-growing; benign, encapsulated and compress the brain Brain tumors may be lethal due to their location

Pathophysiology/etiology Metastatic (secondary) brain tumors Originate from outside the brain- lung and breast most common sites Single or multiple tumors within the brain tissue Becoming more common as individuals with cancer in other parts of the body are living longer

B. Common manifestations/complications Brain tumor symptoms occur due to their ability to compress or destroy brain tissue From edema that forms around the tumor From hemorrhage From obstruction of CSF flow General increased intracranial (IICP) symptoms (refer to module # ), headache usually worse in AM

Common manifestations/complications Local (anatomical) as interfere with function Frontal lobe: personality changes; inappropriate behavior; inability to concentrate; impaired judgment; headache; expressive aphasia if dominant hemisphere; motor weakness or paralysis from motor strip Parietal lobe: sensory deficits- paresthesia, visual field deficits; contralateral sensory disturbances from sensory strip; loss of interpretation and discrimination for sensing input; perceptual problems

Common manifestations/complications Local (anatomical) Occipital lobe: visual disturbances; visual agnosia Temporal lobe: complex partial (psychomotor) seizures; auditory hallucinations; memory problems; Wernicke aphasia if dominant hemisphere Cerebellum: gait distrubances; balance and coordination problems Brain stem: cranial nerve dysfunction; vital signs

C. Therapeutic interventions for brain tumors Diagnostic tests: CT/MRI; EEG Medications Chemotherapy: IV; intraventricular (ommaya Reservoir) or by wafer implanted Corticosteroids to treat brain edema Anticonvulsants to prevent seizures

Therapeutic interventions for brain tumors- Surgery To remove tumor or for symptom relief Supratentorial- cranial surgery above the tentortium (double fold dura between cerebrum & cerebellum) Infratentorial- surgery below the tentortium Stereotaxic surgery to localize tumor/remove

Therapeutic interventions for brain tumors Radiation therapy Used alone or with other therapies Gamma Knife- shielded helmet containing cobalt directed to tumor to shrink the tumor Rehabilitation Outpatient or in-house Coping adapting with neuro deficits

D. Nursing assessment specific brain tumors Health history: progression of symptoms; other cancers, disease Physical exam Neuro vital signs Specific signs of the local functions of different parts of the brain Similar neuro deficits as the individual with a stroke Signs of increased intracranial pressure/herniation

E. Pertinent nursing problems & interventions 1. Anxiety: brain is the essence of an individual; individual/family support and education 2. Risk for infection- post crani: assess for CSF leak; meningitis; other infections 3. Ineffective protection post surgery: assess for IICP from cerebral edema or bleeding 4. Acute pain: assess for pain; R/O meningitis as cause for pain; medication; HOB 30 degrees

Pertinent nursing problems & interventions 5. Disturbed self-esteem: individual support 6 Home care: rehabilitation; home evaluation for neuro deficits; support groups

Nursing Care Plan: A Client with a Brain Tumor LeMone p. 1397 http://wps.prenhall.com/wps/media/objects/737/755395/brain_tumor.pdf http://wps.prenhall.com/chet_lemone_medicalsurg_3/0,7859,757263-,00.html

Added critical thinking questions: Nursing Care Plan: A Client with a Brain Tumor LeMone p. 1394 1. Where is the frontal lobe and what is its functions? 2. What is the pathophysiology of Clair Langes’ symptoms? 3. Why would the nursing diagnosis of altered cerebral perfusion pressure be important? 4. What type of seizure did Clair have? 5. What are the different types of gliomas? 6. Why does lying in a flat position and coughing increase Clair’s headache?