Brain Tumors

Clients with Brain Tumors

Clinical Manifestations

  • Increased Intracranial Pressure:
    • Symptoms include:
    • Headache
    • Vomiting
    • Visual disturbances
    • Seizures
    • Pupillary changes (note: a very late sign)

Diagnostics

  • Neurologic Exam: Crucial to assess the trending of the data to determine if the client is improving or deteriorating.
  • Imaging Techniques:
    • CT (Computed Tomography): Provides structural imaging of the brain.
    • MRI (Magnetic Resonance Imaging): Offers detailed views of the brain's structure.
    • Computer-Assisted Stereotactic Biopsy:
    • Allows for precise targeting to biopsy the tumor directly.
    • PET (Positron Emission Tomography) Scan:
    • Enables tagging of cancer-related cells for better localization of cancer.

Medical and Surgical Treatment

  • Surgical Management:
    • Craniectomy: Surgical removal of a portion of the skull to access the brain tumor for removal.
  • Other Treatments:
    • Radiation Therapy: Targeted radiation to shrink or destroy tumor cells.
    • Chemotherapy: Use of drugs to treat cancer, may include various regimens.
    • Pharmacologic Therapy: General medications may be used to manage symptoms or other conditions.
    • Intrathecal Chemotherapy: Administered via an Ommaya reservoir placed inside the head.

Nursing Diagnoses and Interventions

  • Common Diagnoses:

    • Acute confusion
    • Fear
    • Decreased intracranial adaptive capacity (risk of herniation)
    • Acute pain
    • Vision loss
    • Risk for injury

  • Nursing Interventions:

    • Assess the client's neurological status regularly.
    • Reorient clients to time, place, and person as necessary to alleviate confusion.
    • Address and alleviate fear associated with diagnosis and treatment.
    • Assess for visual acuity, particularly due to the potential effect of tumors growing around the optic chiasm, which can lead to blindness.
    • Create a safe, low-stimulation environment to minimize agitation and allow for recovery.
    • Manage pain carefully; be cautious with the use of pain medications as they can mask neurological events, making it more challenging to assess the true neurological status of the client.

Additional Information on Brain Tumors

  • Types of Brain Tumors:
    • Primary Brain Tumors: Originate in the brain itself.
    • Secondary Brain Tumors: Result from metastasis from other areas, commonly lung cancer, which metastasizes directly to the brain.
  • Effects of Tumors:
    • Occupy space in the skull leading to increased intracranial pressure, potential seizures, and hydrocephalus (excess cerebrospinal fluid).
    • Can present as spherical masses, diffusely infiltrating tissue, or lesions throughout brain.