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Lisa Randall, RN, MSN, ACNS-BC RNSG 2432. Classify brain tumors according to type and location Discuss unique characteristics of primary and metastatic.

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Presentation on theme: "Lisa Randall, RN, MSN, ACNS-BC RNSG 2432. Classify brain tumors according to type and location Discuss unique characteristics of primary and metastatic."— Presentation transcript:

1 Lisa Randall, RN, MSN, ACNS-BC RNSG 2432

2 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

3 Incidence of primary brain tumors (benign or malignant) 12.8/100,000 10%–15% of cancer patients develop brain metastases

4 Primary – unknown Genetic – hereditary Metastatic o 35% - lung o 20% - breast o 10% - kidney o 5% - gastrointestinal tract

5 Often unknown Under investigation: o Genetic changes o Heredity o Errors in fetal development o Ionizing radiation o Electromagnetic fields (including cellular phones) o Environmental hazards (including diet) o Viruses o Injury or immunosuppression

6 Tissue of origin Location Primary or secondary (metastatic) Grading

7 Microscopic appearance Growth rate Different for other types of CA For CNS, per WHO: o GX Grade cannot be assessed (Undetermined) o G1 Well-differentiated (Low grade) o G2 Moderately differentiated (Intermediate grade) o G3 Poorly differentiated (High grade) o G4 Undifferentiated (High grade)

8 Depends on location, size, and type of tumor Neurological deficit 68% o 45% motor weakness o Mental status changes HA 54% Seizures 26%

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

10 Cerebral Tumors o Headache o Vomiting unrelated to food intake o Changes in visual fields and acuity o Hemiparesis or hemiplegia o Hypokinesia o Decreased tactile discrimination o Seizures o Changes in personality or behavior

11 Brainstem tumors o Hearing loss (acoustic neuroma) o Facial pain and weakness o Dysphagia, decreased gag reflex o Nystagmus o Hoarseness o Ataxia ( loss of muscle coordination ) and dysarthria ( speech muscle disorder ) (cerebellar tumors)


13 Cerebellar tumors o Disturbances in coordination and equilibrium Pituitary tumors o Endocrine dysfunction o Visual deficits o Headache

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

15 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


17 Gliomas o Astrocytoma (Grades I & II) o Anaplastic Astrocytoma o Glioblastoma Multiforme Oligodendroglioma Ependymomas Medulloblastoma CNS Lymphoma

18 Grade I Non-infiltrating

19 Grade II Infiltrating Slow growing

20 Grade III Infiltrating Aggressive

21 Grade IV Highly infiltrative Rapidly growing Areas of necrosis

22 Grades II-IV Mixed astro/glio

23 Slow growing Benign HCP/ICP Surgery, RT, Chemo

24 Small cell embryonal neoplasms Malignant HCP/ICP

25 Primary CNS lymphoma B lymphocytes Increased ICP Brain destruction

26 Meningioma Metastatic Acoustic neuromas (Schwannoma) Pituitary adenoma Neurofibroma

27 Usually benign Slow growing Well circumscribed Easily excisable

28 Peritumoral edema Necrotic center

29 Benign Schwannoma cells CN VIII

30 Benign Anterior pituitary Endocrine dysfxn

31 Cystic tumor Hypothalamic-pituitary axis dysfunction


33 Radiological Imaging o Computed Tomography scan (CT scan) with/without contrast o Magnetic Resonance Imaging (MRI) with/without contrast o Plain films o Myelography o Positron Emission Tomography scan (PET scan) LP/CSF analysis Pathology

34 Resection Craniotomy Stereotaxis Surgery Biopsy Transsphenoidal http://

35 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

36 Pre-op care Post-op care Patient teaching o Activity o Wound care o Diet o Meds o F/U

37 Neuro assessment Vital signs H & P Teaching o Diagnostic test info o Pre & Post-op care o ICU o Dressings, edema, bruising, hair removal o Sensations if done partially awake o Emotional support o Avoid false hope

38 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

39 Increased ICP Hematoma Hypovolemic shock Hydrocephalus Atelectasis Pulmonary edema Meningitis Fluid and electrolyte imbalances (ADH) Wound infection Seizures CSF leak Edema

40 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

41 Damages DNA of rapidly dividing cells 4000–6000 Gy total dose Duration of 4–8 weeks Brachytherapy Stereotactic radiosurgery

42 Side Effects o Skin burns, hair loss, fatigue, local swelling Patient teaching o Do not erase markings o Steroids o S/S of cerebral edema Radiation necrosis

43 Slows cell growth Cytotoxic drugs o CCNU, BCNU, PCV, Cisplatin, Etoposide, Vincristine, Temozolomide (Temodar) Gliadel wafers Ommaya Reservoir

44 Side effects o Oral mucositis, bone marrow suppression, fatigue, hair loss, nausea/vomiting, anxiety, peripheral neuropathy Patient teaching o Meds/MV o Nutrition/hydration/activity o Avoid pregnancy o Resources

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

46  Subjective data?  Interventions?  Goals?  Evaluation?

47  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? a. Personality changes b. Visual field cuts c. Difficulty hearing d. Difficulty swallowing

48  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 Brudzinski’s sign b. A negative Kernig’s sign c. Absence of nuchal rigidity d. A Glascow Coma Scale score of 15


50 AANN Core Curriculum for Neuroscience Louis, MO. Nursing, 4 th Ed. 2004. Saunders. St. Greenberg, Mark. (2006). Handbook of Neurosurgery. Greenberg Graphics, Tampa, Florida.

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