Brain Tumor Nursing Care Plans Diagnosis and Interventions
Brain Tumor NCLEX Review and Nursing Care Plans
A brain tumor is characterized by any accumulation of aberrant cells growing at abnormal rates in the brain. Brain tumors can be grouped either benign or malignant in characteristic. Primary brain tumors are tumors that start in the brain. Secondary brain tumors are tumors whose origin started somewhere else in the body and have spread to the brain.
The development of tumors in the brain can be debilitating, considering that the brain is the primary control network for the normal processes of the rest of the body. Early recognition and treatment of brain tumors is paramount and should be prioritized to prevent such complications.
Types of Brain Tumor
Primary brain tumors are tumors that originate from the central nervous system. There are different types of brain tumors, with more than 100 kinds accounted for. It can affect people from all ages but will differ in the type that is common for each age group. The most common in adults are:
- Gliomas. These are the most common types of tumors, originating in glial cells that nourish and support the nervous system. There are different subtypes of glioma; each would depend on the target cell. The most common type for adults is astrocytoma. Glioblastoma is the most aggressive type of cancer under this category. Gliomas, once detected, are oftentimes malignant.
- Meningiomas. These tumors originate in the meninges, the protective tissue covering the nervous system. Oftentimes, they are not malignant but can cause incapacitating effects.
- Schwannomas. These tumors damage the defensive coating of nerve cells. Most of the time, they are not cancerous but may cause auditory issues.
- Pituitary adenomas. These tumors start in the pituitary gland, the master gland of the endocrine system. Tumors from this region grow slowly and are not necessarily cancerous.
Common brain tumors in children are the following:
- Medulloblastomas. These tumors originate in the cerebellum and medulla, the portion of the nervous system that connects the brain to the spinal cord. They are the most common type in children, accounting for 15% of pediatric tumors. It is also the most prevalent malignant brain tumor in children.
- Gliomas. Gliomas are also common in children. The following types are prevalent in this age group:
- Astrocytoma. This tumor develops in the astrocytes, star-shaped cells in the nervous system. They contribute to half of the diagnosed pediatric brain tumors.
- Brain stem glioma. This tumor develops in the brain stem and may cause seizures and endocrine issues.
- Ependymoma. This tumor develops in the ventricles of the brain and often causes blockages in the flow of cerebrospinal fluid (CSF).
- Optic nerve gliomas. This tumor originates in the nerves of the eyes, thereby causing vision issues.
Signs and Symptoms of Brain Tumors
- Headaches that occur more frequently and severely
- Speech, vision, and hearing changes
- Balance problems
- Mobility problems
- Numbness or tingling in the extremities
- Memory issues
- Personality changes
- Difficulty concentrating and making decisions
- Weakness, could either be generalized or to one part of the body
- Morning vomiting in the absence of nausea
- Confusion in everyday matters
- Inability to follow simple commands
Causes and Risk Factors of Brain Tumors
There are a few causes and risk factors for the development of brain tumors. Most of the time, healthcare providers cannot exactly pinpoint the reason for its occurrence. However, there are still some risk factors that have been associated with its development.
- Exposure to radiation. Children who have previously received radiation to their brain have been known to have a higher risk of brain tumors as they grow into adulthood. Family history. Brain tumors have been linked to genetic factors.
- Age. Old adults aged 65 to 79 years old, and children aged 5 to 8 years old are susceptible to developing brain tumors.
- No history of chickenpox infection. One study postulated that people who have had previous chicken pox infections have lower risks of developing gliomas.
- Sex. There is an increased risk for brain tumors in men than in women. Certain types, such as meningioma, are more common in women.
- Home and work exposures. Exposure to chemicals such as solvents, pesticides, rubber, vinyl, oil products, and others increases the predisposition to developing brain tumors. Despite this, more studies are needed to establish this link.
- Electromagnetic fields. Although most adult studies cannot show direct links between electromagnetic fields and brain tumors, the data in pediatric risks is conflicting.
- Race and ethnicity. White Americans are more likely to develop gliomas when compared to Black Americans.
- N-nitroso compounds. Some studies suggest the link and role of nitrates and nitrites found in cured meat, cigarettes, and cosmetics in the development of brain tumors. However, more studies are needed to establish a definitive link to this.
Complications of Brain Tumors
- Uncontrolled seizures. Brain tumors left untreated can lead to brain structure deviations that can lead to uncontrolled seizures.
- Spinal cord compression. This complication can happen if the brain tumor has spread enough to other nearby structures, thereby causing paralysis to the rest of the body.
- Brain stem herniation. Due to the brain being enclosed in the skull that has no space for further expansion, having brain tumors would result in increased intracranial pressure that could consequently shift the internal structures. This shifting of structures can cause a decline in consciousness and depressed vital signs that can lead to coma and death.
Diagnosis of Brain Tumors
- Medical and family history. A thorough evaluation is done to establish links to brain tumor formation.
- Comprehensive physical examination. A physical examination is used to identify any deviations from the norm in order to aid in the correct and accurate diagnosis of a brain tumor. This will include assessment of the neurological system (i.e., cranial nerves) and its correlated cognitive functions or dysfunctions.
- Diagnostic tests. These include imaging or laboratory tests in order to confirm the diagnosis of brain tumor.
- Magnetic resonance imaging (MRI). An imaging technique that uses magnets to produce an in-depth layout of the brain and surrounding structures.
- Tissue sampling or biopsy. The definitive technique for establishing the brain tumor type. It involves the removal of a part or the whole tumor, which will be tested by a pathologist under a microscope for evaluation.
- CT scan. This technique utilizes x-rays taken from different angles to visualize the brain.
- Lumbar puncture. This technique is done to sample the patient’s cerebrospinal fluid (CSF) to look for tumor cells.
- Myelogram. This involves the injection of dye into the CSF so that structures can be viewed using an x-ray.
- Biomarker testing. This technique involves testing the patient’s blood to detect certain substances that are correlated with brain tumor incidence. (e.g., isocitrate dehydrogenase, IDH, for gliomas).
- Supplemental tests
- Electroencephalogram (EEG). This involves placement of electrodes in the patient’s head to assess electrical activity in the brain.
- Evoked potentials. This utilizes electrodes to measure nerve activity. They can often detect acoustic schwannoma.
Treatment of Brain Tumors
Treatment for a brain tumor would include a combination of techniques, each with varying degrees of success. Several factors are to be considered when treating brain tumors, and they are:
- The size, type, and grade
- The tumor’s impact on the brain
- The extent of the spread
- Possible side effects
- Preferences and the general health of the patient
The different techniques are as follows:
- Surgery. The surgical management for brain tumors is through a craniotomy. This is the first-line treatment for brain tumors. This involves the skill of a neurosurgeon in order to successfully remove the tumor.
- Radiation therapy. This treatment uses x-rays and radiation to destroy tumor cells.Examples of these are:
- Conventional radiation therapy. This therapy uses the application of radiation guided by anatomic landmarks placed through an x-ray.
- 3-dimensional conformal radiation therapy (3D-CRT). This therapy uses radiation to kill tumor cells guided by anatomic landmarks placed through a CT scan or an MRI.
- Intensity modulated radiation therapy (IMRT). This is a type of 3D-CRT that can treat tumors more precisely while causing less damage to healthy structures.
- Proton therapy. This therapy uses protons instead of x-rays to kill tumor cells. This is indicated for tumors that have grown to nearby bone, the base of the skull or near the optic nerves.
- Stereotactic radiosurgery. This therapy uses one high dose of radiation directly on the tumor with no healthy tissues involved. It can also be utilized for metastatic brain tumors. There are various types of equipment used in this technique, and they are:
- Modified linear accelerator. A machine that uses electricity to generate high-energy radiation.
- Gamma knife. A technique that uses gamma radiation beams on the tumor.
- Cyberknife. A robot-assisted method of guiding radiation to tumors in the head and neck.
- Fractionated stereotactic radiation therapy. This technique uses stereotactic precision but is given in fractions instead of a single, powerful dose. This is indicated for sensitive locations such as tumors in the optic nerves.
- Medical Management
- Supportive medical management. This includes prescriptions for:
- Corticosteroids. Steroids are given to reduce swelling in the brain tissues, either due to the tumor or to other treatment regimens given.
- Anti-seizure medications. Due to the location of the tumor, anti-seizure medications are prescribed to prevent possible episodes that may occur.
- Chemotherapy. This option uses powerful medications aimed at destroying aberrant cells.
- Targeted Therapy. This option uses medication that targets specific genes or proteins that are secreted or associated with tumors. This treatment attaches to receptors in the tumors wherein their damaging effects take place to eliminate the aberrant tissues. Examples of these are:
- Anti-angiogenesis therapy. This targeted therapy stops the formation of new blood vessels in order to “starve” tumor cells.
- Neurotrophic tyrosine receptor kinase (NTRK) fusion. This type targets tumors undergoing these metabolic changes, brain tumors included, that are otherwise difficult to remove or are metastatic in origin.
Brain Tumor Nursing Diagnosis
Nursing Care Plan for Brain Tumor 1
Nursing Diagnosis: Acute Pain related to the effects of surgery secondary to a brain tumor as evidenced by the patient’s verbal complaint of pain, headache in the frontal or occipital area, changes in vital signs, and restlessness.
- The patient will verbalize a decrease in pain scale from 10 to 0.
- The patient will be able to perform activities of daily living without feeling pain and discomfort.
|Nursing Interventions for Brain Tumor||Rationale|
|1. Ask the patient about the present level of pain affecting the head, including the duration, intensity, and quality every 4 to 6 hours.||A patient’s verbalization of the level of pain is an appropriate indicator of pain This will help in determining the appropriate interventions for the patient.|
|2. Check the patient’s general condition including the vital signs.||Changes in the patient’s vital signs should be monitored because possible changes in vital signs may happen during pain episodes.|
|3. Provide a cool compress on the head for low to moderate levels of pain.||Providing a cool compress to the patient’s head will promote comfort and ease the headache. A cool compress may also decrease facial edema if present.|
|4. Place the patient in a position that is comfortable for him or her.||A comfortable position will help in controlling and alleviating pain.|
|5. Administer or give analgesics for headaches as needed and as prescribed by the physician.||Analgesics can be given to the patient to relieve pain and it may also reduce inflammation or may change the way the brain perceives pain.|
Nursing Care Plan for Brain Tumor 2
Nursing Diagnosis: Anxiety related to changes in health status and threat to self-concept secondary to a brain tumor as evidenced by the patient’s expression of concern and worry about the condition, social isolation, and difficulty sleeping.
- The patient will be able to express reduced anxiety levels after the interventions.
- The patient will appear relaxed and will not experience difficulty sleeping.
|Nursing Interventions for Brain Tumor||Rationale|
|1. Evaluate the patient’s level of anxiety and assess the need for information about the condition.||This will provide information about the degree of anxiety and the patient’s need for measures and support.|
|2. Allow the patient to express his or her concern and encourage the patient to ask questions about the condition. Give time and listen to the patient’s concerns about the condition.||This intervention will provide a chance to release feelings and secure information about the condition that might reduce anxiety.|
|3. Encourage the patient’s family and significant other to stay with the patient and participate in caring for the patient.||Caring and support from the family and significant others will help in decreasing the patient’s anxiety.|
|4. Explain and clarify the condition of the patient in simple language using words that the patient and the family will clearly understand.||Using simple language while explaining the condition will prevent unnecessary anxiety from misinterpretation or inconsistencies in information.|
|5. Encourage and teach the patient relaxation techniques and exercises such as deep breathing exercises that will help in reducing and avoiding anxiety.||Relaxation techniques and exercises such as deep breathing exercises are effective ways to help reduce anxiety.|
Nursing Care Plan for Brain Tumor 3
Nursing Diagnosis: Risk for Injury related to sensory, integrative, and effector dysfunction secondary to a brain tumor.
- The patient will be free from injury and will be able to demonstrate behaviors that will help avoid injury.
- The patient will be able to participate in the interventions that will decrease the risk of injury because of the condition.
|Nursing Interventions for Brain Tumor||Rationale|
|1. Check the patient’s vital signs including blood pressure, decreased pulse pressure, pulse, and respirations accurately.||It is important to monitor the patient’s vital signs accurately because changes in the vital signs may happen to patients with brain tumors. Changes in the vital signs may increase the risk of patients with a brain tumor injury.|
|2. Check for the signs of lethargy, irritability, fatigue, sleepiness, loss of consciousness, or coma.||The risk for injury for patients with a brain tumor may increase when lethargy, irritability, fatigue, sleepiness, loss of consciousness, or coma happens.|
|3. Evaluate and check for any changes in the patient’s vision, visual acuity, strabismus, diplopia, nystagmus, head tilt, and papilledema.||If the patient experiences changes in neurosensory status due to a brain tumor the risk for injury may increase.|
|4. Position the patient in a comfortable position and place the bed of the patient in the lowest position and provide safety at all times.||Placing the patient in a comfortable and safe position is important to patients with brain tumors because the patient may experience impaired mobility, visual acuity, and neurological dysfunction that will increase the risk of injury. Lowering the bed to its lowest position and using side rails will help in reducing the risk of injury.|
|5. Advise and instruct the patient’s family to stay with the patient at all times if possible.||The patient’s family must be instructed to stay with the patient to provide safety and support to the patient.|
Nursing Care Plan for Brain Tumor 4
Nursing Diagnosis: Risk for Infection related to the chronic disease process and invasive procedure secondary to a brain tumor.
- The patient will remain free from fever and will remain free from infection.
- The patient will be able to identify and participate in the interventions that will help reduce the risk for infection.
|Nursing Interventions for Brain Tumor||Rationale|
|1. Teach the patient and the visitors the proper way of doing handwashing. Limit the visitors who may have present infections and place them in reverse isolation as indicated.||This intervention will help in protecting the patient from other sources of infections that he or she may acquire.|
|2. Emphasize and encourage the patient about proper personal hygiene.||Proper personal hygiene will limit potential sources of infection and secondary overgrowth.|
|3. Check and monitor for any symptoms of infection including increased body temperature.||A patient with a brain tumor should be monitored because the elevated temperature is an early indication of infection that needs appropriate therapy to be started promptly.|
|4. Position the patient comfortably and frequently reposition the patient. Always keep the patient’s bed linen dry and wrinkle-free.||Placing the patient in a comfortable position and keeping the bed linen dry and wrinkle-free may reduce pressure and irritation to the tissues and skin breakdown that may be a potential site for bacterial growth.|
|5. Check and monitor the patient’s CBC, including the differential WBC, granulocyte count, and platelet count as indicated.||Checking and monitoring the blood levels will help in preventing further complications and will evaluate the need for drug therapy.|
|6. Administer antibiotics as indicated and as advised by the physician.||Antibiotics can be used to treat identified infections and some medications may be given prophylactically to immunocompromised patients.|
Nursing Care Plan for Brain Tumor 5
Nursing Diagnosis: Anticipatory Grieving related to the anticipated changes in lifestyle and perceived death related to a brain tumor as evidenced by changes in eating habits, alterations in sleep patterns, and decreased communication patterns.
- The patient will be able to identify and express feelings appropriately.
- The patient will be able to continue normal life activities and continue planning for the future.
|Nursing Interventions for Brain Tumor||Rationale|
|1. Evaluate the patient and the significant others for the stage of grief that is currently being experienced. Explain the process of the procedure as appropriate.||The knowledge of the patient and the significant others about the grieving process reinforces the normality of feelings and reactions of the patient and the significant others.|
|2. Provide an open non-judgmental environment and use therapeutic communication skills.||An open non-judgmental environment and using therapeutic communication will promote and encourage realistic dialogue about feelings and concerns.|
|3. Encourage the patient to verbalize thoughts and concerns about the condition and accept the patient’s expression of anger, sadness, and rejection.||The patient should feel supported in expressing his or her feelings. The nurse should emphasize that deep and often conflicting emotions are normal and experienced by other patients in this difficult situation.|
|4. Visit the patient frequently and provide him or her physical contact as appropriate. Encourage a care provider and support person to stay with the patient as needed.||Support for the patient helps in reducing isolation and abandonment.|
|5. Assess for the presence of conflict including expression of anger, statements of despair, guilt, and hopelessness.||Angry behaviors may be a way for the patient to express feelings of despair or distress and could indicate suicidal ideation.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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