Nursing Care of the Patients with Brain Tumors

Definition. A brain tumor is a localized intracranial lesion which occupies space with the skull and tends to cause a rise in intracranial pressure.
(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.

Nursing Management
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 neuro status accurately q2-4h, or as ordered.

(3) Multiple measures to prevent increases in ICP.
(a) Elevate head of bed 30?.
(b) Stool softeners to prevent straining at stool (increases ICP)
(4) Institute seizure precautions at patient s bedside.

(5) Surgery (craniotomy) is performed to remove neoplasm and alleviate symptoms
Post Operative Nursing Care Considerations
(1) 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 30?elevation.
(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.