BRAIN TUMOR (I)

BRAIN TUMOR (I):

BRAIN TUMOR (I) PRESENTED BY KIRAN RANDHAWA ARMY COLLEGE OF NURSING

COMMON BRAIN TUMOR SITES:

COMMON BRAIN TUMOR SITES

DEFINITION:

DEFINITION Primary tumor are those which are arising from the brain or its supporting structures are called primary brain tumors . Secondary tumors are those which are metastasizing from other areas in the body are secondary tumors.

EPIDEMIOLOGIC DATA:

EPIDEMIOLOGIC DATA The highest incidence of brain tumors in adults occurs in the fifth, sixth and seventh decades . Higher incidence in men then women .

ETIOLOGY:

ETIOLOGY The type of cell that give rise to the tumor can often be identified, the mechanism causing the cells to act abnormally remains unknown. Most primary brain tumors do not metasize out of the brain to other areas. Neuroscience researchers consider that immunodepression and environmental factors be will be the cause of causing tumors .

PATHOPHYSIOLOGY:

PATHOPHYSIOLOGY SPACE OCCUPYING LESIONS Brain tumor Tumor displace normal tissue & occupy their space. Due to compress ,blood flow alter and ischemia.

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Contd …. Necrosis Destroying major function

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Contd… INCREASED INTRACRANIAL PRESSURE Tumor produce considerable cerebral edema Brain tumor increase ICP

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Contd …. Displacement of brain structure with herniation.

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Contd …. INTRACRANIAL TUMOR These arise from neuron or support cell or neuroglial cell. These tumor can be encapsulated ,non-encapsulated or invasive

W.H.O CLASSIFICATION OF TUMOR:

W.H.O CLASSIFICATION OF TUMOR DETERMINE ACCORDING TO THE MATURITY OF TUMOR CELL

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Contd …. GLIAL TUMOR Gliomas are tumors of the neuroglia Astrocytomas are the most common type of glial cell tumor and can be found throughout the brain or spinal cord. .

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Contd…. These tumor occur in adults and children. Depending on the exact location, clinical manifestations may result in increased ICP or focal compression

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Contd.. OLIGODENDROGLIOMAS These cells are found in the CNS and produce myelin. These are the tumor of white matter of the brain. They tend to develop in the cortex of the frontal and parietal lobes.

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Contd..… This tumor is fairly slow-growing and calcifies, which makes it recognizable on X-ray studies. The calcification may contribute to the development of seizures as a presenting clinical manifestation. Oligodendrogliomas peak in client between the ages of 30 years.

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Contd… Clinical manifestations of oligodendrogliomas Seizures Headache personality changes Papilledema

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Contd…. EPENDYMOMAS The ependymal cells line the ventricles and form the inner lining of the spinal cord . Ependymas may be found anywhere within the CNS; This tumor affects all age groups.

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Contd… MANIFESTATION OF EPENDYMOMAS ARE CAUSED BY Ventricular obstruction and include Headache Vomiting Diplopia, dizziness Ataxia Vision changes Motor and sensory abnormalities

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Contd… PITUTARY TUMORS Pituitary tumor are usually slow growing tumor that involve only the anterior lobe of the pituitary gland or extend into the floor of the third ventricle. Most of them are benign, small and encapsulated

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Contd… Manifestation of the pituitary tumor can be related to hypo functioning of the gland and include Visual field defect Irregular or absent menstrual cycles Infertility

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Contd…. Decreased libido Impotence Decreased body hair Decreased production of pituitary stimulating hormones and this results in decreased thyroid and adrenal function.

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Contd…. Manifestation of the pituitary tumor are often overlooked for month because they are so diverse. Clients are usually diagnosed by testing blood for the presence of pituitary-stimulating hormones.

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Contd… TUMORS OF SUPPORTING STRUCTURES INCLUDE ARE: Meningiomas Acoustic neuromas .

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Contd… MENINGIOMAS These are common benign tumors that may involve all meningeal layer; however these tumor are believed to originate in the arachnoids cells. Most of the meningiomas are benign, but some tumors may become malignant .

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Contd … Meningiomas may be found in the brain or spinal cord . They are slow growing and occur at any age ,most commonly at mid-life and in women.

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Contd… MANIFESTATION OF THE MENINGIONMAS depends upon locations of the tumor and can be diverse. Outcomes are related to the site of the tumor.

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Contd… ACOUSTIC NEUROMAS These are the tumor of the schwann cells of the eight cranial nerve,the acoustic nerve.

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Contd…. MANIFESTATION OF ACOUSTIC NEUROMAS ARE: Tinnitus Dizziness and unilateral hearing loss

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Contd… If the tumor is allowed to grow, it can displace the other cranial nerves Especially cranial nerves IV to X And the brain stem

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Contd… An excellent outcome can be expected with surgical resection and preservation of the remaining cranial nerves. Most clients experiencing at least temporary tinnitus balance problems and facial weakness after surgery.

CLINICAL MANIFESTATION:

CLINICAL MANIFESTATION Mental status changes Headache Nausea vomiting Papilledema seizures

LOCALIZED MANIFESTATION:

LOCALIZED MANIFESTATION Focal weakness Sensory disturbances Language disturbances Coordination disturbances Visual disturbances

DIAGNOSTIC FINDINGS:

DIAGNOSTIC FINDINGS CT scan MRI

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Contd… X Ray examination EEG Radio nuclide scans Angiogram Lumbar puncture Brain mapping

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Contd… A sterotactic biopsy may confirm the diagnosis of a brain tumor and help in planning : Chemotherapy Radiation therapy PET scan

MEDICAL AND SURGICAL MANAGEMENT:

MEDICAL AND SURGICAL MANAGEMENT OBJECTIVE: 1.To remove or destroy tumor 2.Without increasing neurological deficit. Trans sphenoidal surgical removal RADIATION

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Contd… Conventional surgical approach require surgical incision into the skull(craniotomy) Meningiomas Acoustic neuromas Cystic astrocytomas

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Contd… “Brain mapping” technology Laser and radiation can be delivered with sterotactic approaches. Brachy therapy Intravenous autologus bone marrow transplantation is used in some patients who will receive chemotherapy or radiation therapy after treatment is completed. Corticosteriods may be used before treatment and after the treatment.

NURSING MANAGEMENT:

NURSING MANAGEMENT The patient with a brain tumor may have problems with aspiration related to cranial nerve dysfunction. Per –operatively, the gag reflex and ability to swallow are evaluated. If there is a diminished gag response, care includes : Teaching the patient to direct food and fluids towards the unaffected side. The patient sit upright to eat . Offering semi soft diet. Having suction readily available.

FUNCTION SHOULD BE REASSESSED POSTOPERATIVELY:

FUNCTION SHOULD BE REASSESSED POSTOPERATIVELY Perform neurologic checks Monitors vital signs Maintains a neurologic flow chart Spaces nursing intervention to prevent rapid increase in ICP. .

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Contd… . Reorientation and the use of orienting devices . Supervision of and assistance with self care. Intervention for preventing of injury , patients with seizures are carefully monitored. Patient’s speech is evaluated

BIBLIOGRAPHY :

BIBLIOGRAPHY Brunner and suddarth’s ,“Medical surgical Nursing ” ,10 Edition ,Lippincott Williams and Wilkins-publishers, pg no. 778-784. Black. J and Hawks. J , “Medical and Surgical Nursing”, 7 th Edition, volume: 2,Elsevier-publishers, pg no.2083-2093. Willam LS ,Hooper pd “medical surgical nsg ,” fa davis publishers.

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