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.