Brain Tumors Flashcards
Space-occupying lesions
- IICP
- Dec blood flow
- Cerebral edema
- Neurologic deficits
- Hydrocephalus
- Pituitary dysfunction
> SIADH
> DI
Etiology & Genetic Risk
- Age
- Exposure to (ionizing) radiation
- Fhx brain tumors
Primary tumors
- Originate within the CNS & rarely metastasize (spread) outside this area
Secondary tumors
- Result from metastasis from other areas of the body, like the lung, breast, pancreas, kidney, & GI tract, & travel via blood & lymph
Classifications
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Cancerous, usually fast growing & aggressive, & can invade nearby tissue
Also likely to recur after treatment
Malignant
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Non-cancerous
Slow growing, & do not spread to surrounding tissue; h/e, can grow & cause damage to surrounding tissue and/or function
Benign
Cellular or anatomical origins
- Supratentorial (meaning cerebral hemispheres) & infratentorial (meaning area of the brainstem structures & cerebellum)
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Are the most common type of benign tumor
Arise from the covering of the brain
As they grow, they compress brain tissue & cause problems; can be removed but tend to recur
Are NOT cancer
meningioma
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Is the most common & deadliest of malignant primary brain tumors in adults & is 1 of a group of tumors
glioblastoma
> a grade IV (most serious) astrocytoma; develops from the lineage of star-shaped glial cells, astrocytes, that support nerve cells
Benign
- Acoustic neuroma (schwannoma)
- Choroid plexus papilloma
- Meningioma
- Astrocytoma (grade I may undergo changes & become malignant)
- Chondroma
- Craniopharyngioma
- Hemangioblastoma
Metastatic
- Astrocytoma (glioblastoma multiforme is a grade IV astrocytoma)
- Oligodendroglioma
- Ependymoma
- Meduloblastoma
- Chondrosarcoma
- Glioma
- Lymphoma
Nonspecific Manifestations: Brain Tumors
- HA’s that’re usually more severe on awakening in the am
- N/V
- Visual sx’s
- Seizures or convulsions
- Facial numbness or tingling
- Loss of balance or dizziness
- Weakness or paralysis in 1 part or 1 side of the body
- Difficulty thinking, speaking, or articulating
- Changes in mentation or personality
- Papilledema
Specific Manifestations: Cerebral tumors
⋆ HA (most common feature)
⋆ Vomiting unrelated to food intake
⋆ Changes in visual acuity & visual fields; diplopia (visual changes c/b papilledema)
⋆ Hemiparesis or hemiplegia
⋆ Hypokinesia (dec motor ability)
⋆ Hyperesthesia, paresthesia, dec tactile discrimination
⋆ Seizures
⋆ Aphasia
⋆ Changes in personality or behavior
Brainstem tumors
- Hearing loss (acoustic neuroma)
- Facial pain & weakness
- Dysphagia, dec gag reflex
- Nystagmus
- Hoarseness
- Ataxia & dysarthria (cerebellar tumors)
Diagnostics: Brain Tumor
- CT
- MRI
- EEG
- Radionuclide scans
- Angiogram
- LP
- Stereotactic biopsy
- PET
Management of Brain Tumors
✦ Radiation therapy
✦ Chemotherapy
✦ Antacids, antihistamines, PPI to control stress ulcers
✦ Anticonvulsants such as phenytoin or levetiracetam to reduce or prevent seizures
✦ Corticosteroids such as dexamethasone to reduce brain swelling
✦ Osmotic diuretics like mannitol to reduce brain swelling
✦ Pain medicines (codeine, acetaminophen for HA)
✦ Stereotactic radiosurgery
Surgical Intervention: Advantages of radiosurgery (noninvasive)
- Stereotactic radiosurgery/craniotomy/gamma knife treatment
✓ Lower risk when compared w/traditional craniotomy
✓ Surgical precision
✓ Dec cost
✓ Dec morbidity
✓ Dec length of hosp stay
✓ Rapid recovery time
Disadvantages
x Device requires an uncomfortable rigid head frame
x Also can be used for pts who don’t qualify for traditional brain surgery r/t age/health cond, or who refuse open brain surgery
Nursing Management of Surgical Client w/Brain Tumor
Preoperative
- Teaching
- Preoperative assessment & interventions
- Surgeon will spare vital brain parts while removing or dec tumor size
- Consider hair loss/body image
- May need short or long-term rehab
- No alcohol/tobacco/anticoags/NSAIDs for @ least 5 days <surgery (some say a week or longer)
- NPO for @ least 8 hrs
Postoperative
- Monitor for general postop
- Ecchymosis & periorbital edema (not unusual & treat w/cold compresses)
! IICP
- Neuro checks q15-30min for the 1st 4 hrs, then qhr for 24hrs; report deficits
- Cardiac monitoring
- Accurate I&O for 1st 24 hrs
- Freq turns but NOT onto opposite
- Deep breathing q2h & DVT prophylaxis like pneumatic boots
- Positioning 30° for supratentorial surgery
Postoperative cont’d
- Flat & side-lying q2h for infratentorial (brainstem) to prevent pressure on the neck area incision site; also prevents pressure on opposite from upper portions of brain
- Dressing check q1-2h for drainage; may have JP drain or Hemovac for 24 hrs >surgery
! A typical amt of drainage to expect over 8h might be 30-50mL
Notify surgeon for drainage >50 mL/8hr
> Labs
- CBC, serum electrolytes, osmolarity, coags
> Assess for electrolyte imbalances/fluid shifts
- Other CN’s may also be affected, such as the optic (II), trochlear (IV), & abducens (VI) nerves
→ blurred vision, diplopia, & changes in EOM
- Central herniation may initially manifest as sluggish but unequal pupil response
- Uncal herniation may cause a dilated unilateral pupil
↓ in motor function
- Hemiparesis/hemiplegia
- Decerebrate posturing (extensor)
! indicates more serious damage - Decorticate posturing (flexor)
