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
o
o
o
o

35% - lung
20% - breast
10% - kidney
5% - gastrointestinal tract

 Often unknown
Under investigation:
o
o
o
o
o
o
o
o

Genetic changes
Heredity
Errors in fetal development
Ionizing radiation
Electromagnetic fields (including cellular phones)
Environmental hazards (including diet)
Viruses
Injury or immunosuppression

Tissue of origin
Location
Primary or secondary (metastatic)
Grading

Microscopic appearance
Growth rate
Different for other types of CA
For CNS, per WHO:
o
o
o
o
o

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%
o
o

45% motor weakness

Mental status changes

HA 54%
Seizures 26%

 General
o
o
o
o
o
o

Cerebral edema
Increased intracranial pressure
Focal neurologic deficits
Obstruction of flow of CSF
Pituitary dysfunction
Papilledema (if swelling around optic disk)

 Cerebral Tumors
o
o
o
o
o
o
o
o

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
o
o
o
o
o
o

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
o

Disturbances in coordination and equilibrium

Pituitary tumors
Endocrine
dysfunction
o Visual deficits
o Headache
o

 Frontal Lobe
o
o
o
o
o
o
o
o

Inappropriate behavior
Personality changes
Inability to concentrate
Impaired judgment
Memory loss
Headache
Expressive aphasia
Motor dysfunctions

 Parietal lobe
o

Sensory deficits
Paresthesia
Loss of 2 pt discrimination
Visual field deficits

Temporal lobe
o

Psychomotor seizures temporal lobe-judgment,

behavior, hallucinations, visceral symptoms, no
convulsions, but loss of consciousness

Occipital lobe
o

Visual disturbances

 Gliomas
o
o
o

Astrocytoma (Grades I & II)

Anaplastic Astrocytoma
Glioblastoma Multiforme

Oligodendroglioma
Ependymomas
Medulloblastoma
CNS Lymphoma

 Grade I
Non-infiltrating

Grade II
Infiltrating
Slow growing

 Grade III
Infiltrating
Aggressive

Grade IV
Highly infiltrative
Rapidly growing
Areas of necrosis

Grades II-IV
Mixed astro/glio

Slow growing
Benign
HCP/ICP
Surgery, RT, Chemo

Small cell embryonal

neoplasms
Malignant
HCP/ICP

Primary CNS lymphoma

B lymphocytes
Increased ICP
Brain destruction

Meningioma
Metastatic
Acoustic neuromas (Schwannoma)
Pituitary adenoma
Neurofibroma

Usually benign
Slow growing
Well circumscribed
Easily excisable

Peritumoral edema
Necrotic center

 Benign
Schwannoma cells
CN VIII

 Benign
Anterior pituitary
Endocrine dysfxn

 Cystic tumor
Hypothalamic-pituitary axis dysfunction

 Radiological Imaging
o
o
o
o
o

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

Resection
Craniotomy
Stereotaxis Surgery
Biopsy
Transsphenoidal

http://youtu.be/d95K3unaNCs

 Drug therapy Palliative

o

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
o
o
o
o
o

Activity
Wound care
Diet
Meds
F/U

Neuro assessment
Vital signs
H&P
Teaching
o
o
o
o
o
o
o

Diagnostic test info

Pre & Post-op care
ICU
Dressings, edema, bruising, hair removal
Sensations if done partially awake
Emotional support
Avoid false hope

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

Increased ICP
Hematoma
Hypovolemic shock
Hydrocephalus
Atelectasis
Pulmonary edema
Meningitis
Fluid and electrolyte
imbalances (ADH)

Wound infection
Seizures
CSF leak
Edema

Follow-up appointments and procedures

Medications
Exercise
Diet
o

Patient may need referral to dietician to help with diet

planning while undergoing chemotherapy

Seizures
o

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

Damages DNA of rapidly dividing cells

40006000 Gy total dose
Duration of 48 weeks
Brachytherapy
Stereotactic radiosurgery

 Side Effects
o

Skin burns, hair loss, fatigue, local swelling

Patient teaching
o
o
o

Do not erase markings

Steroids
S/S of cerebral edema

Radiation necrosis

 Slows cell growth

Cytotoxic drugs
o

CCNU, BCNU, PCV, Cisplatin, Etoposide,

Vincristine, Temozolomide (Temodar)

Gliadel wafers
Ommaya Reservoir

 Side effects
o

Oral mucositis, bone marrow suppression,

fatigue, hair loss, nausea/vomiting, anxiety,
peripheral neuropathy

Patient teaching
o
o
o
o

Meds/MV
Nutrition/hydration/activity
Avoid pregnancy
Resources

Ineffective Tissue Perfusion

Ineffective Airway Clearance
Impaired Communication
Decreased Intracranial Adaptive Capacity
Activity Intolerance
Disturbed Sensory disturbance
Acute Confusion

Subjective data?
Interventions?
Goals?
Evaluation?

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
a.

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 Brudzinskis sign
b. A negative Kernigs 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.