Brain Tumor and 3 Nursing Care Plans and Nursing Diagnosis for Brain Tumors

Brain Tumor and 3 Nursing Care Plans and Nursing Diagnosis for Brain Tumors

This study guide is about brain tumor and 3 nursing care plans and nursing diagnosis for brain tumors. It can be used to create nursing care plans and interventions for brain tumor.

Brain Tumor

What is a brain tumor?

Brain Tumor and 3 Nursing Care Plans and Nursing Diagnosis for Brain Tumors
Brain Tumor

A 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.

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.

What are the types of brain tumors?

  1. Acoustic neuroma
  2. Astrocytoma
  3. Brain metastases
  4. Choroid plexus carcinoma
  5. Craniopharyngioma
  6. Embryonal tumors
  7. Ependymoma
  8. Glioblastoma
  9. Glioma
  10. Medulloblastoma
  11. Meningioma
  12. Oligodendroglioma
  13. Pediatric brain tumors
  14. Pineoblastoma
  15. Pituitary tumors

What are the symptoms of brain tumors?

The signs and symptoms of a brain tumor vary greatly and depend on the brain tumor’s size, location and rate of growth.

General signs and symptoms caused by brain tumors may include:

  • New onset or change in pattern of headaches
  • Headaches that gradually become more frequent and more severe
  • Unexplained nausea or vomiting
  • Vision problems, such as blurred vision, double vision or loss of peripheral vision
  • Gradual loss of sensation or movement in an arm or a leg
  • Difficulty with balance
  • Speech difficulties
  • Feeling very tired
  • Confusion in everyday matters
  • Difficulty making decisions
  • Inability to follow simple commands
  • Personality or behavior changes
  • Seizures, especially in someone who doesn’t have a history of seizures
  • Hearing problems

What are the causes of brain tumors?

Brain tumors that begin in the brain

Brain Tumor and 3 Nursing Care Plans and Nursing Diagnosis for Brain Tumors

 

Brain Tumor and 3 Nursing Care Plans and Nursing Diagnosis for Brain Tumors

 

Primary brain tumors originate in the brain itself or in tissues close to it, such as in the brain-covering membranes (meninges), cranial nerves, pituitary gland or pineal gland.

Primary brain tumors begin when normal cells develop changes (mutations) in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. The mutations tell the cells to grow and divide rapidly and to continue living when healthy cells would die. The result is a mass of abnormal cells, which forms a tumor.

In adults, primary brain tumors are much less common than are secondary brain tumors, in which cancer begins elsewhere and spreads to the brain.

Many different types of primary brain tumors exist. Each gets its name from the type of cells involved. Examples include:

  • Gliomas. These tumors begin in the brain or spinal cord and include astrocytomas, ependymomas, glioblastomas, oligoastrocytomas and oligodendrogliomas.
  • Meningiomas. A meningioma is a tumor that arises from the membranes that surround your brain and spinal cord (meninges). Most meningiomas are noncancerous.
  • Acoustic neuromas (schwannomas). These are benign tumors that develop on the nerves that control balance and hearing leading from your inner ear to your brain.
  • Pituitary adenomas. These are tumors that develop in the pituitary gland at the base of the brain. These tumors can affect the pituitary hormones with effects throughout the body.
  • Medulloblastomas. These cancerous brain tumors are most common in children, though they can occur at any age. A medulloblastoma starts in the lower back part of the brain and tends to spread through the spinal fluid.
  • Germ cell tumors. Germ cell tumors may develop during childhood where the testicles or ovaries will form. But sometimes germ cell tumors affect other parts of the body, such as the brain.
  • Craniopharyngiomas. These rare tumors start near the brain’s pituitary gland, which secretes hormones that control many body functions. As the craniopharyngioma slowly grows, it can affect the pituitary gland and other structures near the brain.

Cancer that begins elsewhere and spreads to the brain

Secondary (metastatic) brain tumors are tumors that result from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain.

Secondary brain tumors most often occur in people who have a history of cancer. Rarely, a metastatic brain tumor may be the first sign of cancer that began elsewhere in your body.

In adults, secondary brain tumors are far more common than are primary brain tumors.

Any cancer can spread to the brain, but common types include:

  • Breast cancer
  • Colon cancer
  • Kidney cancer
  • Lung cancer
  • Melanoma

What are the risk factors of brain tumors?

In most people with primary brain tumors, the cause of the tumor isn’t clear. But doctors have identified some factors that may increase your risk of a brain tumor.

Risk factors include:

  • Exposure to radiation. People who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumor. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs.
  • Family history of brain tumors. A small portion of brain tumors occurs in people with a family history of brain tumors or a family history of genetic syndromes that increase the risk of brain tumors.

3 Nursing Care Plans and Nursing Diagnosis for Brain Tumors

What are some of the available nursing care plans and diagnosis for brain tumors?

 3 Nursing Care Plans and Nursing Diagnosis for Brain Tumors

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.

1. Acute Pain

Nursing Diagnosis

  • Acute Pain

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.

2. 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.

3. Risk for Injury

Nursing Diagnosis

  • Risk for Injury

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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