• Classify brain tumors according to type and location
• Discuss unique characteristics of primary and metastatic brain tumors
• Recognize common signs and symptoms• List 3 types of spinal cord tumors• Discuss 3 spinal cord tumors according to
histology, location, and clinical manifestations• 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 developbrain metastases
• Primary – unknown• Genetic – hereditary• Metastatic
o 35% - lungo 20% - breasto 10% - kidneyo 5% - gastrointestinal tract
• Often unknown• Under investigation:
o Genetic changeso Heredityo Errors in fetal developmento Ionizing radiationo Electromagnetic fields (including cellular phones)o Environmental hazards (including diet)o Viruseso 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 weaknesso Mental status changes
• HA 54%• Seizures 26%
• Generalo Cerebral edemao Increased intracranial pressureo Focal neurologic deficitso Obstruction of flow of CSFo Pituitary dysfunctiono Papilledema (if swelling around optic disk)
• Cerebral Tumorso Headacheo Vomiting unrelated to food intakeo Changes in visual fields and acuityo Hemiparesis or hemiplegiao Hypokinesiao Decreased tactile discriminationo Seizures o Changes in personality or behavior
• Brainstem tumorso Hearing loss (acoustic neuroma)o Facial pain and weaknesso Dysphagia, decreased gag reflexo Nystagmuso Hoarsenesso Ataxia (loss of muscle coordination) and dysarthria (speech
muscle disorder) (cerebellar tumors)
• Cerebellar tumorso Disturbances in coordination and equilibrium
• Pituitary tumorso Endocrine dysfunctiono Visual deficitso Headache
• Frontal Lobeo Inappropriate behavioro Personality changeso Inability to concentrateo Impaired judgmento Memory losso Headacheo Expressive aphasiao Motor dysfunctions
• Parietal lobeo Sensory deficits
Paresthesia Loss of 2 pt discrimination Visual field deficits
• Temporal lobeo Psychomotor seizures – temporal lobe-judgment,
behavior, hallucinations, visceral symptoms, no convulsions, but loss of consciousness
• Occipital lobeo Visual disturbances
• Gliomaso Astrocytoma (Grades I & II)o Anaplastic Astrocytomao 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 Imagingo Computed Tomography scan (CT scan) with/without
contrasto Magnetic Resonance Imaging (MRI) with/without
contrasto Plain filmso Myelographyo 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 Activityo Wound careo Dieto Medso F/U
• Neuro assessment • Vital signs• H & P• Teaching
o Diagnostic test infoo Pre & Post-op careo ICUo Dressings, edema, bruising, hair removalo Sensations if done partially awakeo Emotional supporto 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• 4000–6000 Gy total dose• Duration of 4–8 weeks• Brachytherapy• Stereotactic radiosurgery
• Side Effectso Skin burns, hair loss, fatigue, local swelling
• Patient teaching o Do not erase markingso Steroidso 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 effectso Oral mucositis, bone marrow suppression,
fatigue, hair loss, nausea/vomiting, anxiety, peripheral neuropathy
• Patient teachingo Meds/MVo Nutrition/hydration/activityo Avoid pregnancyo 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.