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

2. 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

3. Etiology  Primary: Unknown

4.  Secondary: Metastatic lesions

5. 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

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

7. 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

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

9.  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.

10.  Pressure increases in the cranium will produce various pathologies.

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

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

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

14. 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

15. 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

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

17. Check the obvious  Reason for confusion Language Language medication medication

18. 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

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

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

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

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

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

24. 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).