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Lesson 44. Brain Tumor

2-44. BRAIN TUMOR

a.      Definition. A brain tumor is a localized intracranial lesion which occupies space with the skull and tends to cause a rise in intracranial pressure.

b.     Signs and Symptoms.

(1) A brain tumor is usually characterized by a progressive course of symptoms over a period of time.
(2) Symptoms depend primarily on the location of the mass within the
(3) Symptoms related to increased intracranial pressure will occur.
(a) Decrease in level of consciousness. Confusion.
(b) Headache. Lethargy. Vomiting.
(c) Papilledema--edema of optic nerve.
(d) Alterations in mentation. Aphasia.
(e) Hemiparesis.
(f) Visual field defects.
(g) Sensory defects (smell, hearing). Seizures.

 c. Preoperative Medical and Nursing Management.

(1) Instruct patient and family about the necessity and importance of diagnostic tests to determine the exact location of the tumor.
(2) Monitor and record vital signs and neurological status accurately q2-4h, or as ordered. Report changes to professional nurse immediately.
(3) Institute measures to prevent inadvertent increases in intracranial pressure.
(a) Elevate head of bed 30º.
(b) Stool softeners to prevent straining at stool (which increases intracranial pressure).
(4) Institute seizure precautions at patient's bedside. (Tongue blade airway.)
(5) Supportive nursing care is given depending upon the patient's symptoms and ability to perform activities of daily living.
(6) Administer all doses of steroids and antiepileptic agents on time.
(a) Withholding steroids can result in adrenal crisis.
(b) Withholding of antiepileptic agents frequently precipitates seizure.

(7) Surgery (craniotomy) is performed to remove neoplasm and alleviate symptoms.

d. Post Operative Nursing Care Considerations.

(1) Meticulous nursing management and care aimed at prevention of postoperative complications are imperative for the patient's survival.
(2) Accurately monitor and record all vital signs and neurological signs.
(a) Postoperative cerebral edema peaks between 48 and 60 hours following surgery.
(b) Patient may be lucid during first 24 hours, then experience a decrease in level of consciousness during this time.
(3) Administer artificial tears (eye drops) as ordered, to prevent corneal ulceration in the comatose patient.
(4) Maintain skin integrity.
(5) Bone flap may not have been replaced over surgical site; turning patient to the affected side, if the flap has been removed, can cause irreversible damage in the first 72 hours.
(6) Maintain head of bed at 30ºelevation.
(7)  Perform passive range of motion exercises to all extremities every 2-4 hours.
(8) Maintain body temperature.
(a)  Increases of body temperature in the neurosurgical patient may be due to cerebral edema around the hypothalamus.
(b) Monitor rectal temperature frequently.
(c) Place patient on hypothermia blanket, as ordered.
(9) Institute seizure precautions at patient's bedside. (Tongue blade, airway.)
(10) Maintain accurate record of intake and output.
(11) Prevent pulmonary complications associated with bedrest.
(a) Cough and deep breath every 2 hours.
(b) Perform gentle chest percussion, with the patient in the lateral decubitus position, if tolerated.

(12) Continuously talk to the patient while providing care, reorienting him to person, place, and time.

David L. Heiserman, Editor

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Revised: June 06, 2015