1. Neurosensory: Stroke/Brain tumors
Part # 2 Brain Tumors

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

3. 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

4. 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

5. 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

6. 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

7. 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

12. 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

13. 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

14. 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

15. 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

16. 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

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

18. Nursing Care Plan: A Client with a Brain Tumor LeMone p. 1397

19. 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?