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 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
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 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 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, 4
th
Ed. 2004. Saunders. St.
Greenberg, Mark. (2006). Handbook of
Neurosurgery. Greenberg Graphics,
Tampa, Florida.