Ns.Ratna Dewi Silalahi,S.Kep,M.

Biomed
• 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 35% - lung
o 20% - breast
o 10% - kidney
o 5% - gastrointestinal tract
• 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
• Tissue of origin
• Location
• Primary or secondary (metastatic)
• Grading
• 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)
• Depends on location, size, and type of tumor
• Neurological deficit 68%
o 45% motor weakness
o Mental status changes
• HA 54%
• Seizures 26%
• 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)
• 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
• 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)
• Cerebellar tumors
o Disturbances in coordination and equilibrium

• Pituitary tumors
o Endocrine
dysfunction
o Visual deficits
o Headache
• 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
• 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 Astrocytoma (Grades I & II)
o Anaplastic Astrocytoma
o 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 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
• 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 Activity
o Wound care
o Diet
o Meds
o F/U
• 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
• 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 • Wound infection
• Hematoma • Seizures
• Hypovolemic shock • CSF leak
• Hydrocephalus • Edema
• Atelectasis
• Pulmonary edema
• Meningitis
• Fluid and electrolyte
imbalances (ADH)
• 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
• 4000–6000 Gy total dose
• Duration of 4–8 weeks
• Brachytherapy
• Stereotactic radiosurgery
• 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
• 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 Meds/MV
o Nutrition/hydration/activity
o Avoid pregnancy
o 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?
a. Personality changes
b. Visual field cuts
c. Difficulty hearing
d. Difficulty swallowing
 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
• AANN Core Curriculum for Neuroscience Louis,
MO. Nursing, 4th Ed. 2004. Saunders. St.
• Greenberg, Mark. (2006). Handbook of
Neurosurgery. Greenberg Graphics,
Tampa, Florida.