3 Brain Tumor Nursing Care Plans

Brain Tumor is the most common solid tumor form that may be benign, malignant or a metastatic growth from a tumor in another area of the body. Most central nervous system tumors occur at the midline in the brain stem or cerebellum and can result in increased intracranial pressure and other associated symptoms. Other tumors occur in the cerebrum.

A malignant brain tumor is the second most common type of cancer in children and has a poor prognosis as the tumor usually grows and becomes advanced before signs and symptoms appear or are detected as they are easily missed. Signs and symptoms are site and size dependent. Brain tumors are most prevalent in children 3 to 7 years of age.

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Treatment options include surgery, although total removal is not usually possible, chemotherapy, and radiation, which may be administered to reduce the size of the tumor prior surgery. One or a combination of these methods may be given with each resulting in possible continuing deficits in the neurologic status.

Brain tumors are categorized as primary or secondary. A primary brain tumor originates in your brain. Many primary brain tumors are benign. A secondary brain tumor, also known as a metastatic brain tumor, occurs when cancer cells spread to your brain from another organ, such as your lung or breast.

Types of brain tumors

Primary brain tumors

Primary brain tumors originate in your brain. They can develop from your:

Brain cells

The membranes that surround your brain, which are called meninges

Nerve cells

Glands

Primary tumors can be benign or cancerous. In adults, the most common types of brain tumors are gliomas and meningiomas.

Gliomas

Gliomas are tumors that develop from glial cells. These cells normally:

support the structure of your central nervous system

provide nutrition to your central nervous system

clean cellular waste

break down dead neurons

Gliomas can develop from different types of glial cells.

The types of tumors that begin in glial cells are:

astrocytic tumors such as astrocytomas, which originate in the cerebrum

oligodendroglial tumors, which are often found in the frontal temporal lobes

glioblastomas, which originate in the supportive brain tissue and are the most aggressive type

Other primary brain tumors include:

  • Pituitary tumors, which are usually benign
  • Pineal gland tumors, which can be benign or malignant
  • ependymomas, which are usually benign
  • craniopharyngiomas, which occur mostly in children and are benign but can have clinical symptoms like changes in vision and premature puberty
  • Primary central nervous system (CNS) lymphomas, which are malignant
  • Primary germ cell tumors of the brain, which can be benign or malignant
  • Meningioma, which originate in the meninges
  • schwannomas, which originate in cells that produce the protective cover of your nerves (myelin sheath) called Schwann cells

Most meningiomas and schwannomas occur in people between the ages of 40 and 70. Meningiomas are more common in women than men. Schwannomas occur equally in both men and women. These tumors are usually benign, but they can cause complications because of their size and location. Cancerous meningiomas and schwannomas are rare but can be very aggressive.

Secondary brain tumors

Secondary brain tumors make up the majority of brain cancers. They start in one part of the body and spread, or metastasize, to the brain. The following can metastasize to the brain

  • Lung cancer
  • Breast cancer
  • Kidney cancer
  • Skin cancer

Secondary brain tumors are always malignant. Benign tumors don’t spread from one part of your body to another.

What are the risk factors for a brain tumor?

Risk factors for brain tumors include:

Family history

Only about 5 to 10 percent of all cancers are genetically inherited, or hereditary. It’s rare for a brain tumor to be genetically inherited. Talk to your doctor if several people in your family have been diagnosed with a brain tumor. Your doctor can recommend a genetic counselor for you.

Age

Risk for most types of brain tumors increases with age.

Race

Brain tumors in general are more common among Caucasians. However, African-American people are more likely to get meningioma.

Chemical exposure

Being exposed to certain chemicals, such as those you might find in a work environment, can increase your risk for brain cancer. The National Institute for Occupational Safety and Health Trusted Source keeps a list of potential cancer-causing chemicals found in work places.

Exposure to radiation

People who have been exposed to ionizing radiation have an increased risk of brain tumors. You can be exposed to ionizing radiation through high-radiation cancer therapies. You can also be exposed to radiation from nuclear fallout. The nuclear power plant incidents in Fukushima and Chernobyl are examples of how people can be exposed to ionizing radiation.

No history of chicken pox

According to the American Brain Tumor Association, people with a history of childhood chicken pox have a decreased risk of getting brain tumors.

What are the symptoms of a brain tumor?

Symptoms of brain tumors depend on the location and size of the tumor. Some tumors cause direct damage by invading brain tissue and some tumors cause pressure on the surrounding brain. You’ll have noticeable symptoms when a growing tumor is putting pressure on your brain tissue.

Headaches are a common symptom of a brain tumor. You may experience headaches that:

  • Are worse in the morning when waking up
  • Occur while you’re sleeping
  • Are made worse by coughing, sneezing, or exercise

You may also experience:

  • Vomiting
  • Blurred vision or double vision
  • Confusion
  • Seizures (especially in adults)
  • Weakness of a limb or part of the face
  • A change in mental functioning

Other common symptoms include:

  • Clumsiness
  • Memory loss
  • Confusion
  • Difficulty writing or reading
  • Changes in the ability to hear, taste, or smell
  • Decreased alertness, which may include drowsiness and loss of consciousness
  • Difficulty swallowing
  • Dizziness or vertigo
  • Eye problems, such as drooping eyelids and unequal pupils
  • Uncontrollable movements
  • Hand tremors
  • Loss of balance
  • Loss of bladder or bowel control
  • Numbness or tingling on one side of the body
  • Trouble speaking or understanding what others are saying
  • Changes in mood, personality, emotions, and behavior
  • Difficulty walking
  • Muscle weakness in the face, arm, or leg

Symptoms of pituitary tumors

The following symptoms can occur with pituitary tumors:

  • Nipple discharge or galactorrhea
  • Lack of menstruation in women
  • Development of breast tissue in men, or gynecomastia
  • Enlargement of the hands and feet
  • Sensitivity to heat or cold
  • Increased amounts of body hair, or hirsutism
  • Low blood pressure
  • Obesity
  • Changes in vision, such as blurry vision or tunnel vision

How is brain tumors diagnosed?

Diagnosis of a brain tumor begins with a physical exam and a look at your medical history.

The physical exam includes a very detailed neurological examination. Your doctor will conduct a test to see if your cranial nerves are intact. These are the nerves that originate in your brain.

Your doctor will look inside your eyes with an ophthalmoscope, which is an instrument that shines a light through your pupils and onto your retinas. This allows your doctor to check how your pupils react to light. It also allows your doctor to look directly into your eyes to see if there’s any swelling of the optic nerve. When pressure increases inside the skull, changes in the optic nerve can occur.

The doctor may also evaluate your:

  • Muscle strength
  • Coordination
  • Memory
  • Ability to do mathematical calculations

Your doctor may order more tests after they finish the physical exam. These could include:

CT scan of the head

CT scans are ways for your doctor get a more detailed scan of your body than they could with an X-ray machine. This can be done with or without contrast.

Contrast is achieved in a CT scan of the head by using a special dye that helps doctors see some structures, like blood vessels, more clearly.

MRI of the head

If you have an MRI of your head, a special dye can be used to help your doctor detect tumors. An MRI is different from a CT scan because it doesn’t use radiation, and it generally provides much more detailed pictures of the structures of the brain itself.

Angiography

This study uses a dye that’s injected into your artery, usually in the groin area. The dye travels to the arteries in your brain. It allows your doctor to see what the blood supply of the tumors looks like. This information is useful at the time of surgery.

Skull X-rays

Brain tumors can cause breaks or fractures in the bones of the skull, and specific X-rays can show if this has occurred. These X-rays can also pick up calcium deposits, which are sometimes contained within a tumor. Calcium deposits may be in your bloodstream if your cancer has moved to your bones.

Biopsy

A small piece of the tumor is obtained during a biopsy. A specialist called a neuropathology will examine it. The biopsy will identify if the tumor cells are benign or malignant. It will also determine whether the cancer originated in your brain or another part of your body.

Treatment of brain tumors

The treatment of a brain tumor depends on:

  • The type of tumor
  • The size of the tumor
  • The location of the tumor
  • Your general health

The most common treatment for malignant brain tumors is surgery. The goal is to remove as much of the cancer as possible without causing damage to the healthy parts of the brain. While the location of some tumors allows for easy and safe removal, other tumors may be located in an area that limits how much of the tumor can be removed. Even partial removal of brain cancer can be beneficial.

Risks of brain surgery include infection and bleeding. Clinically dangerous benign tumors are also surgically removed. Metastatic brain tumors are treated according to guidelines for the type of original cancer.

Surgery can be combined with other treatments, such as radiation therapy and chemotherapy.

Physical therapy, occupational therapy, and speech therapy can help you to recover after neurosurgery.

Outlook

The outlook for a brain tumor will depend on:

  • The type of tumor
  • The size of the tumor
  • The location of the tumor
  • Your general health

Early treatment can prevent complications that can occur as a tumor grows and puts pressure on the skull and brain tissue. See your doctor if you’re worried about any symptoms you’re experiencing.

Nursing Care Plans

Nursing care planning goals for a child with brain tumor centers on relieving pain, reducing anxiety, and promoting an understanding of the signs and symptoms of increased ICP and expected changes in body appearance related to the planned cranial surgery.

Here are three (3) nursing care plans and nursing diagnosis for brain tumor:

Acute Pain

Nursing Diagnosis

May be related to

  • Biologic injuring agents

Possibly evidenced by

  • Verbal complains of pain
  • Headache in the frontal or occipital area that is worse during the morning and becomes worse with straining or if the head is dropped
  • Changes in vital signs
  • Hostile, tense behavior
  • Restlessness

Desired Outcomes

  • Child will rate pain as less than (specify pain rating and scale used).
Nursing Interventions Rationale
Assess the severity and duration of a headache; observe precipitating factors, recurrence, and progressive characteristics. Provides data about the presence of a tumor as a headache is a most usual symptom in the child.
Ascertain the child’s perception of the word “pain” and ask the family what word the child normally uses. Use a pain assessment tool appropriate for age and developmental level to determine the pain intensity. Promotes better communication between child/family and nurse during the assessment.
Administer analgesic as prescribed. Used for the treatment of pain due to central nervous system tumors.
Instruct the child to refrain from sneezing, coughing, or straining during defecation. Avoids straining that trigger or aggravates a headache.
Apply a cool compress on the head for low to moderate pain. Promotes comfort and ease from a headache, reduces facial edema if present.
Provide toys, games for quiet play. Provides diversionary activity to detract from pain.
After surgical intervention, opioids such as morphine sulfate may be initially given. Monitor for side effects such as sedation and respiratory depression; use Naloxone to block the effects of opioids. Rarely side effects occur, opioids can be administered safely with appropriate monitoring.
Form a preventive strategy for pain management around the clock; note for physiologic and behavioral signs of pain. Allows immediate identification of pain which improves measures for pain relief.
Educate parents and child about analgesics, to administer in anticipation of a headache and type to give (sustained release) and that it will help to control a headache. Manages pain before it becomes severe.
Assist parents to formulate activities that will not trigger or heighten headache pain. Promotes stimulation for a child’s development needs.

Anxiety

Nursing Diagnosis

  • Anxiety

May be related to

  • Change in health status and a threat to self-concept

Possibly evidenced by

  • Increased apprehension as the diagnosis is confirmed and the condition worsens
  • Expressed concern and worry about postoperative residual tumor and effects, hair removal before surgery
  • Social isolation
  • Insomnia

Desired Outcomes

  • Parent will verbalize reduced anxiety.
  • Child will appear relaxed, with an absence of crying or irritability.
Nursing Interventions Rationale
Assess anxiety level and need for
information that will relieve it post surgery.
Provides information about the degree of anxiety and need for measures and support; allow for identification of fear and uncertainty about surgery and treatments and recovery, guilt about illness, possible loss of the child, parental role and
responsibility.
Allow expression of concerns and ask about the status of a sick child and possible complications and prognosis. Provides a chance to release feelings, secure information needed to reduce anxiety.
Encourage parents to remain with infant/
child; allow participation in the care of infant/child.
Promotes care and support of the child by parents.
Prepare family and/or child for diagnostic tests and surgery. Clarify to the child any misconceptions about the condition by illustrating a picture of a brain; allow the use of medical play (dolls, puppets, equipment) after procedures. Promotes understanding which minimizes anxiety; may clarify misconceptions and raise feelings of control.
If surgery planned, orient to the surgery unit, equipment, and staff. Lessens anxiety caused by fear of the unknown.
Educate parents and child about hair
clipping and reassure that hair will grow back in a brief period of time, to cover head with hats, turbans or scarf  temporarily; that there is swelling of the face and eyes post surgery; that an application of dressing will completely cover the head; use of a doll with head wrapped in a bandage may be helpful in describing the post-surgical dressing.
Promotes understanding of postoperative appearance to assert self-image; support self-concept.
Educate parents and child that post surgery, a headache, and somnolence may be experienced for a few days or even lethargy and coma may be present. Renders an explanation of what to expect after surgery.
Clarify any information in simple language and utilize age-related aids that are helpful to the child. Prevents unnecessary anxiety following from misinterpretation or inconsistencies in information.

Risk for Injury

Nursing Diagnosis

May be related to

  • Sensory, integrative, and effector dysfunction

Possibly evidenced by

  • Behavioral changes
  • Increased ICP
  • Neuromuscular changes
  • Neurosensory changes
  • Seizure activity
  • Vital signs changes

Desired Outcomes

  • Child will not exhibit signs of increased intracranial pressure. and will participate in teaching about treatment options.
Nursing Interventions Rationale
Assess vital signs including increased BP, decreased pulse pressure, pulse, and respirations; take one full minute when
monitoring pulse and respiration.
Any changes in the vital signs may reveal the presence of brain tumor depending on type and location of the tumor.
Assess for irritability, lethargy, fatigue, sleepiness, loss of consciousness or coma. Behavioral changes indicating the presence of brain tumor.
Assess changes in vision (visual acuity, strabismus, diplopia, nystagmus), head tilt, papilledema. Changes in neurosensory status revealing the presence of brain tumor.
Assess changes in gross and fine motor control, spasticity, ataxia, weakness, paralysis or change in balance, coordination. Symptoms of neuromuscular changes indicating the presence of brain tumor.
Assess for increased ICP including
high-pitched cry (infant) or vomiting, poor feeding, irritability, head enlargement,  lethargy, diplopia, behavioral changes, change in VS, seizure activity.
Provides data about changes in intracranial pressure as a result of brain distortion or shifting caused by a tumor.
Assess the child’s head circumference; Fluid obstruction caused by tumor will increase head size. Provides information indicating an increase in ICP as the tumor grows with a poorer prognosis because tumor size becomes large before a diagnosis is made.
Maintain a position of comfort with head elevated. Provides comfort and minimizes increased ICP by promoting venous drainage.
Modify environment by padding bed or crib, decrease light and stimulation. Prevents injury if seizure activity possible.
Educate parents and child about diagnostic procedures done to assess the presence of a tumor; base information on child’s age and past experiences. Promotes understanding of procedures.
Notify parents that surgery may be
performed to remove the tumor as a
reinforcement of physician information and that radiation and chemotherapy may be offered after surgery.
Prepared for surgery and possible  postoperative treatment with information limited to sensitive, hopeful explanation; information about postoperative therapy should be postponed until this
a decision is secured post surgery.

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