Nursing Care Plan for Brain Tumors

Pathophysiology

A brain tumor is an overgrowth of cells that creates a mass of tissue within the brain. As it grows, this compresses the brain tissue, causing symptoms ranging in severity from minor headaches to brain death. Symptoms will vary based on the size and location of the tumor.

Etiology

May be benign (non-cancerous) or malignant (cancerous). Malignant tumors may be primary, meaning they originate in the brain itself (glioblastoma, meningioma, etc.), or they could be secondary. Secondary tumors originate elsewhere in the body and metastasize to the brain. There are quite a few things that put patients at risk for brain tumors, including head injuries, radiation exposure, environmental exposure, and genetics.

Desired Outcome

Prevent severe complications (seizures, strokes), minimize and manage symptoms, successful treatment and removal without residual effects.

Brain Tumors Nursing Care Plan

Subjective Data:

  • Headaches
  • Memory Loss
  • Mood/Personality Changes
  • Sensory Losses
  • Loss of balance
  • Nausea

Objective Data:

  • Seizures
  • Altered LOC
  • Dysphasia/Aphasia
  • Vision loss
  • Elevated temp
  • Respiratory distress
  • Cushing’s Triad
  • Diabetes Insipidus if Pituitary Damage present

Nursing Interventions and Rationales

  1. Administer antiepileptic drugs

  2. Brain tumors can put pressure on neurons within the brain and cause the electrical activity to overreact. Patients are at high risk for seizures. Antiepileptic drugs increase the seizure threshold.

  3. Administer other medication therapy as ordered

    • Chemotherapy
    • Corticosteroids
    • Antiemetics
  4. Chemotherapy and/or radiation may be given to shrink the tumor. Corticosteroids are given to decrease inflammation around the tumor. Antiemetics are given to decrease nausea and prevent vomiting if possible.

  5. Place patient in seizure precautions

  6. Side rails should be padded to prevent injury, suction should be available in case of aspiration during a seizure.

  7. Frequent neuro checks (q1-2h)

  8. Neurological changes related to increasing ICP may be subtle or may occur rapidly. Frequent detailed neuro checks allow changes to be recognized quickly so that interventions can be initiated.

  9. Perform interventions to minimize ICP:

    • Maintain HOB 30-45°
    • Decrease stimuli
    • Avoid valsalva maneuvers
    • Maintain HOB 30-45°
      • HOB < 30 = increased blood flow to brain → Increased ICP
      • HOB > 45 = increased intrathoracic pressure → decreased venous outflow from brain → increased ICP
    • Decrease stimuli
      • Agitation or stress can cause increased ICP
    • Avoid valsalva maneuvers
      • Coughing or bearing down can cause increased ICP

  10. Monitor respiratory status & protect airway as needed

  11. If there is brainstem involvement, patients may experience difficulty regulating their breathing or protecting their airway. The airway may also be compromised if the patient has a seizure.

  12. Prepare patient for possible craniotomy

  13. A craniotomy may be performed to remove the tumor or to biopsy it. It may also be performed to place an ICP monitoring device.

  14. Educate patient on importance of medication compliance.

  15. Antiepileptic drugs have a narrow therapeutic window. Missing even one dose can cause a seizure.


References

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