212 LECTURE / MIDTERMS

Care of Clients w/ Problems in Oxy, F/E, Infectious, Inflammatory &

Immunologic Response, CA (Acute & Chronic)
○ contraindicated for cases of:
CANCER ○ ‘porphyria’ - a genetic enzyme disorder
affecting the skin or nervous system
○ esophageal bleeding
OUTLINE ○ fistula - an abnormal passageway in the
throat or esophagus
I. OTHER THERAPEUTIC MODALITIES ○ tumor that affects a large blood vessel.
A. IMMUNOTHERAPY
B. PHOTODYNAMIC THERAPY
Additional Notes:
C. BONE MARROW TRANSPLANT
D. HORMONE THERAPY
● both men and women should use effective
II. PAIN IN CANCER birth control to prevent pregnancy because
A. CAUSES it can harm the unborn baby.
B. ASSESSMENT
C. MEDICATION MANAGEMENT C. BONE MARROW TRANSPLANT
D. SURGICAL MANAGEMENT ● accepted treatment to stimulate a non-function
III. CELLULAR ABERRATION IN DIFFERENT SITES marrow or to replace marrow
A. BREAST CANCER ● a procedure that uses healthy blood forming stem
B. PROSTATE CANCER cells to replace the damaged bone marrow, it is also
C. UTERINE CANCER known as “stem cell transplant”
D. LIVER CANCER ● may use cells from our own body, relatives or from
E. BRAIN TUMOR a donor
● primary goal is to cure many diseases and any
LESSON 3: OTHER THERAPEUTIC MODALITIES types of cancer

OTHER THERAPEUTIC MODALITIES

A. IMMUNOTHERAPY
● Using biologic response therapy or also known as
“Biological response modifier therapy or biotherapy”
○ It is used to modify the biologic processes
that result in malignant cells, primarily
through enhancing the person’s own
immune responses.
○ Intended for the treatment of various
cancers like bladder cancer, brain cancer
or tumor, breast cancer, cervical ovarian
cancer, colorectal cancer or colon cancer,
kidney liver lung cancer and even
leukemia
○ Depending on the agents biological
response can be given in routes: Oral and
IV

Additional Notes:
● Immunotherapy can be given alone or in
combination with other types of cancer
treatment like immunotherapy with
chemotherapy or immunotherapy with
radiation therapy.

B. PHOTODYNAMIC THERAPY
● Phototherapy/photoradiation/photochemotherapy
○ This is a new method of treating certain
kinds of superficial tumors.
○ Two stage treatment that combines a life
energy with a drug called ‘photosensitizer’
designed to destroy cancerous and
precancerous cells after a live activation.
Photosensitizer is activated by a specific
wavelength of light energy usually from a
laser
● Photofin
○ an intravenous dose of photosensitizing
compound, which is selectively retained in
D. HORMONE THERAPY
higher concentrations of malignant tissue
● Because steroid hormones are powerful drivers of
and
gene expression in certain cancer cells, changing
○ a laser light therapy to reduce the size of
the levels of activity of certain hormones can cause
tumors in the lungs or esophagus

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 certain cancers to cease growing, or even undergo CELLULAR ABERRATION IN DIFFERENT SITES
cell death.
○ used as an adjunct to other types of CA BREAST CANCER
therapy
○ it can slow tumor growth or prevent
re-occurence
○ a treatment that is used together with a
primary treatment: chemo with hormone
therapy, to assist or support the primary
treatment
○ a medication that contains female
hormones, replaces estrogen that the body
stops making during menopause

PAIN IN CANCER

CAUSES
1. Bone marrow destruction
2. Obstruction of an organ
3. Compression of peripheral nerves
4. Infiltration or distention of tissue
5. Inflammation, infection and necrosis TYPES OF BREAST CANCER
A. Carcinoma in Situ
Psychological Causes ● Characterized by the proliferation of
● Depends on the client’s perceived threat malignant cells within the ducts and
1. Fear of anxiety generated from the effects lobules, without invasion into the
2. Loss or threat of loss surrounding tissue
3. frustration
Two Types:
ASSESSMENT 1. Ductal Carcinoma in Situ (DCIS)
1. Severity and duration 2. Lobular Carcinoma in Situ (LCIS)
2. What, when and where pain occurs
3. Understand as client views it B. Invasive Carcinoma
4. Nature of the disease ● Arises from the intermediate ducts of the
5. Probable life expectancy breast and may involve surrounding breast
6. Temperament and psychological state tissue, lymph, and blood vessels
7. Occupational, economic, educational background
8. Vital signs Seven Types:
a. Low to moderate pain and superficial in 1. Infiltrating Ductal Carcinoma
origin (sympathetic) ● most common type 75-80%
● Increase BP, PR, RR, and muscle ● arise from duct and invade
tension ● often form a solid mass in breast;
b. Severe pain or visceral in origin usually hard in palpation;
(parasympathetic) prognosis is poor
● Decrease BP, PR, N/V, weakness
9. Behavior as indicator of pain 2. Infiltrating Lobular Carcinoma
a. Posture ● arise from the lobules; 5-10 %
b. Gesture ● occur as an area of ill-defined
c. Daily activities thickening in the breast, spread in
bone, lungs, liver and brain
MEDICATION MANAGEMENT
1. Acetaminophen, ASA, NSAID (mild pain) 3. Medullary Carcinoma
2. Opioids - CODEINE ● accounts 15%; other books 6%
a. Added regimen as pain increases cases
1. Intraspinal Morphine Administration ● tumor grow in capsule; mistaken
a. An implantable infusion pump delivers a as fibroadenoma because the
continual supply of opiate to the epidural or mass is large; tumor is soft (flesh
subarachnoid space mass)
● prognosis: favorable (doesn’t
SURGICAL MANAGEMENT grow quickly and spread)
1. Nerve block
a. Involves interruption of nerve pathways 4. Mucinous Cancer
some place along the path of transmission ● mucin produce cancer; produces
from periphery to brain. mucus
2. Non invasive Modalities ● slow growing mass
● Transcutaneous Nerve Stimulation (TENS) ● Prognosis: favorable (rarely
○ Electrical stimulation of the skin spreads to the lymph nodes)
surface over a painful area
5. Tubular Ductal Carcinoma

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 ● 2% of cases
● Prognosis: excellent (axillary
metastasis is uncommon)
● mass is small: 1 cm or less
6. Inflammatory Carcinoma
● rare type of breast CA
● 1-2 % (aggressive form of B Ca)
● Characterize of diffuse edema
and brawny erythema (skin of the
breast become briskly/ red)-due
to malignant cells that will block
the lymph channels in the skin
● referred as “peau d’ orange” -
orange like skin
● mass is tender and painful when
palpated
● can cause nipple retraction
● Change in size and shape of breat
● Dimpling, pulling, or retractions
● Peau d’ orange skin
● Persistent skin rash near nipple
● Faking or eruption near the nipple; dry, scaling,
ddark coloring, redness.
DIAGNOSTIC EXAMS
● Breast self-exam
● Clinical breast self-exam
● Baseline mammogram between age 40 & 49;
annual mammogram after age 50
Imaging Studies
● Ultrasonography
● CT scan
● MRI
● PET scan

7. Paget’s Disease of the Nipple Specimen Examinations

● rare (1%) ● Cytologic exam
● scaly lesions; burning and itching ● Tissue biopsy
around nipple area complex
TREATMENT BY STAGE AT DIAGNOSIS
ETIOLOGY
● The cause is unknown.
● Although genetics hormonal or biochemical factors STAGE TUMOR SURGER CHEM TX RADIATI
are likely to be involved, 70% of women with breat Y ON
CA had no known risk factors
0 Cis TM (Total Tamoxifen For
Predisposing Factors: Mastecto lumpecto
● Gender - most common in female and rare in male. my) or my
● Race - white are slightly more likely to develop than lumpecto
black, hispanic and asian women. my
● Age - diagnosed after the age of 50
● Family history - women with close relative with I Tumors BCT Considere For BCT
breast cancer has a higher level of developing BC. are < 2 (Breast d for all
● Medical history - the older you get the more likely cm in conserva invasive
you get breat cancer. diameter tion) or tumors
● Menstrual history - women started menstruation & MRM
younger have a higher risk of breast cancer: same confined
to women menopause older that 65. to breast

Precipitating Factors: II Tumors BCT or Regimen For BCT

● Reproductive history - early menarche (prone): are < 5 MRM depends
pregnancy associated with breast cancer cm, or on tumor
● Radiation exposure - exposure to ionizing smaller size &
radiation with nodal
● Lifestyle - lifestyle changes are important in mobile status
prevention: diet, physical activity, smoking etc. axillary
lymph
Men-Risk Factors: node
● A 1st degree male or female relative with breat involvem
cancer - parenst, siblings, children ent
● Variations in BRCA2 gene - change in 1 and 2 can
affect hereditary breast; about 3% result from IIIa Tumors MRM Post-op & To chest
inhereited in BRCA1 and BRCA1 genes. are > 5 possible wall &
● Klinefelter’s syndrome - a genetic condition that cm, pre-op possibly
results from a boy born with extra copy of X accompa axillae
chromosomes. nied by after
● Exposure to ionizing radiation - 3 or momre enlarged MRM
radiographic examination, xrays etc. axillary
lymph
SIGNS AND SYMPTOMS nodes
● small , hard painless lump in breast fixed to
● Non-tender and fixated lesions one
● Lesions are hard with irregular borders rather than another
encapsulated and smooth or to
● Nipple discharge adjacent

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 ● Quadrantectomy
tissue
2. Axillary lymph node dissection
IIIb More MRM Post-op & To chest ● A surgery to remove the lymph
advanced possibly wall and nodes from the armpit or
lesions pre-op possibly underarm or axilla
with axillae
satellite after 3. Total Mastectomy
nodules, MRM ● Removes the entire breast
fixation to
the skin 4. Modified Radical Mastectomy
or chest
wall, 5. Radical mastectomy
ulceration ● A surgical procedure involving the
, edema removal of the breast underlying
chest muscle (pectoralis
IV All tumors Possibly To control To control major/minor)
with lumpecto progressi progressi
distant my or on and/or on and/or 6. Breast Reconstruction
mets mRM palliation palliation

SCARFF BLOOM RICHARDSON GRADING SYSTEM

(NOTTINGHAM SYSTEM)
Three(3) features:
1. The frequency of cell mitosis
2. Tubule formation
3. Nuclear pleomorphism

Scoring:
3,4, or 5 = Grade 1 tumor
6 or 7 = Grade 2 tumor (moderately differentiated)
8 or 9 = Grade 3 tumor (poorly differentiated)

1 - closest to normal
3 - abnormal
● Tissue Expanders
● These 3 scores are added together making the ○ An empty breast implant
Nottingham System placed during
mastectomy
Maximum score - 9 ○ Done at outpatient
department
1= closest to normal ○ Once tissue expander is
3= normal in place, the surgeon will
put on liquid in 6-12
TREATMENT weeks
A. Medical Management ○ Stretch tissue around it
1. Chemotherapy : combination therapy to make stitch around
● Doxorubicin (Adriamycin) breast implant
● Methotrexate ● Transverse Rectus Abdominis
● 5-fluorouracil Muscle Flap
○ Kukuha sa ibang parte
2. Hormonal therapy: ○ Forms a natural looking
● Androgens: fluorymesterone breast
(Halotestin) ○ Does not need a breast
● Estrogens: diethylstilbestrol implant
(DES) ○ Skin grafting
● Antohormonal agents: Tamoxife ● Latissimus Dorsi Muscle Free flap
○ An oval flap of the skin
3. Radiation therapy (fat muscle, blood
● Typically begins about 6 weeks vessel,l from the upper
after the surgery to allow the back is used to
incision to heal reconstruct the breast)
● Nipple-Areola Reconstruction
B. Surgical Management ○ Done outpatient
1. Breast-conserving procedures procedure that uses the
● Lumpectomy skin from the area of the
● Wide excision breast where the nipple
● Partial mastectomy are located
● Segmental mastectomy

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 ○ Uses skin from the area
of the breast where
nipple is located to form
a new nipple
NURSING MANAGEMENT
Diagnostic Phase:
1. Minimize uncertainty
2. Prevent disease advancement
3. Protect emotional well-being
● Difficult phase where the family is having a
difficulty of accepting the disease
4. Establish trusting communication
Adjuvant Therapy Phase
1. Develop a supportive network
2. Minimize adverse physical outcomes
3. Manage stress
● Cancer is one of the most stressful
moments in life with added stress from
family, work and financial problems.
● Understand family members’ responses
Ongoing Recovery Phase
1. Maintain association with professionals
● Collaborative care
○ Ex. Dietary - talk to dieticians,
NGT
○ Ex. PT - consult
2. Maintain positive outlook
● Act with positive thinking
● Positive thinking = lowers stress, improves
overall wellbeing
3. Redefine self and partner
● It is normal for CA patients to feel anxious,
nervous, angry, or depressed
● CA drugs can cause trouble concentrating
and remembering
4. Cultivate ongoing support
● Cancer support groups have many
benefits
Preoperative Nursing Intervention
1. Explain breast CA, correct misconceptions, and
treatment options
● Misconceptions - CA is contagious
● Tx options - expectations (Nausea and
vomiting 6h after chemo)
2. Reduce fear
● Talk and explain according to the patient’s
level of understanding
3. Reduce anxiety
● Normal to be anxious
● Explain procedure to patient
4. Improving coping ability
● Include family support
5. Promote decision making ability
● Give time to think if for surgery or for
chemo
Postoperative Nursing Intervention
1. Relieve pain and discomfort
● Administration of pain relievers as
medicated
● Score patient’s pain
2. Maintain skin integrity
● Check and change post-operative dressing
as needed
● Change pt’s position (turning to sides q2h)
3. Prevent infection and injury
● Encourage compliance of antibiotics
● Make sure the pt and family understands
● Observe proper aseptic technique
● Make sure all materials are sterile
● Monitor VS (high temp, high HR) and LOC
(level of consciousness)
● Prevent falls since pt is drowsy from
anesthesia
4. Promote positive adjustment and coping
● Teach coping strategies and lifestyle
changes
● 5. Monitor drainage, monitor bleeding
● Monitor for oozing in post-op dressing
PROSTATE CANCER
● form of cancer that begins in the gland cells of the
prostate
● 2nd leading cause of death in males
● Most men with early prostate cancer do not notice
any signs and symptoms - 80% of cases identified
after age 80
● Can take upto 30 years to be identified
● Fertility is not a factor
RISK FACTORS
1. Increasing age (after 50 years old)
2. African-americans (twice more likely than
Caucasians)
3. High fat diet (lowest incidence in Japanese)
● 2 per 100,000 in Japan
● 14 per 100,000 in US
4. Genetics - 8x more risk if 1st and 2nd degree
relative
● Also having family history of breast and
ovarian CA (BRCA gene mutations)
5. Relatives are affected
SIGNS AND SYMPTOMS
● Asymptomatic in early stages
● Urinary symptoms: frequency, dribbling
(mahirapan mag ihi), retention, obstruction,
hematuria, cystitis (related to UTI)
● Bone metastases results in hip pain, back ached,
weight loss, perineal (perineal pain) and rectal
discomfort
DIAGNOSIS
● DRE (digital rectal examination)
- rectal exam using index finger
● Biopsy
- Core needle biopsy – the main method
used to diagnose prostate cancer; usually
done by a urologist; guided with ultrasound
● T-R USD (Trans-Rectal Ultrasound)
● PSA (prostate specific antigen) – may be (+) in BPH
and prostatitis
- (swelling/inflammation of prostate gland) –
routine screening; important to detect
prostate cancer at an early stage
● ACID PHOSPHATASE – increased in 2/3 of patient;
more predictive of metastasis
- Aka prostatic acid phosphatase –
produced in the prostate; first major zero
marker for prostate cancer
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● ALKALINE PHOSPHATASE + Bone Scan =
metastasis
- Metastasis in the bone which causes a rise
in acid phosphatase level; with the level
increasing in correspondence to the extent
of the disease
- When it spreads beyond the prostate, it
usually moves to the bones; kaya common
spread ng prostate cancer kay sa pelvis
and spine (common area of prostate RISK FACTORS
cancer metastasis) 1. Early menarche
2. Late menopause
MANAGEMENT 3. Overweight
● Pomegranate juice 4. Never had kids
● Radiation: Brachytherapy 5. Missed periods
● Orchiectomy/cryoablation 6. Bladder infections
● Surgery: Radical Prostatectomy 7. Spotting or abnormal vaginal bleeding (twice a
● Teletherapy month, etc.)
● Analgesics 8. Cumulative exposure to estrogen
● The use of chemotherapy 9. Familial tendency
● E-hormal therapy YAN 10. DM, HPN, gallbladder disease
11. Ovarian neoplasm decrease sex hormone
12. Tamoxifen

SIGNS AND SYMPTOMS

- Uterine Enlargement
- Abdominopelvic pain
- Pre and Post menopausal bleeding

DIAGNOSTIC TEST
- Annual PE / Gyne Exam
- Biopsy
- Papsmear - 50% of patients with abnormal results
- Schiller's test (Lugol's Test) - Cervical tisuue
staining; CA cells resist the stain.
- MRI or CT scan - Evaluates myometrial invasion
HORMONE THERAPY and LN involvement
● Luteinizing hormone-releasing hormone agonists - CA 125
(LHRH agonists.)
● Anti-androgens MANAGEMENT
UTERUS
NURSING PROBLEMS U-se of chemotherapy
● Altered urinary elimination T-ake hormonal agents
● Pain E-mphasize follow-up care
● Sexual dysfunction / Body Image disturbance R-adiation: External/Intracavity
● Urinary retention U-tmost psychosocial support
● Altered role performance S-urgery: TAH/TAHBSO

UTERINE CANCER INTERVENTIONS FOR CHEMO TREATMENT

● CANCER OF THE ENDOMETRIUM ● Check serum crea (for status of kidneys), BUN
● The most common gynecologic CA (Blood Urea Nitrogen), Mg, Ca, K levels before start
● Usually AdenoCA of therapy
Additional notes:
Chemo therapy can cause electrolyte levels to become too
low or too high.
Changes to the amount of water in the body beacuse of side
effects like vomiting &diarrhea.

● Use gloves
● Hydrate and monitor I & O (good nutrition helps
flush toxins in the body and reduce treatment for the
side effects)
● Do not use ordinary rubber catheter during
Chemotherapy- Use TEFLON

LIVER CANCER
● A rare form of cancer with a high mortality rate

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 ● 90% arise from the liver parenchymal cells
(hepatoma)
● Some originate from the intrahepatic bile duct
(cholangioma)
Additional notes:
- Hepato cellular carcinoma and cholangioma or
cholangio carcinoma- most common type of liver
cancer
- Hepato cellular carcinoma -begins in main type of
deliver cell (hepatocyte)
- Intra hepatic cholangio carcinoma
● Oncogenic foods - diet low in fruits and vegetables
(mahilig sa meat sucha as beef &pork, processed
foods
● L-iver toxins( vinyl chloride,
arsenic)
Additional notes:
- exposure can contribute to increase risk of liver
cancer.
- Vinyl chloride - commonly used chemical in
commercial industry
- ingredient in making a certain plastic
- Arsenic- also in industrial company

TYPES OF PRIMARY TUMOR

● Hepatocellular CA
● Cholagiocellular CA

SIGNS AND SYMPTOMS

- abnormal mass, RUQ pain, jaundice, anemia
- CA signs: weight loss, fatigue, anorexia
- Portal hypertension, ascites, esophageal varices
which may rupture and cause hemorrhage

RISK FACTORS (ALCOHOL)

● A-Icoholic beverages - excessive alcohol
consumption can lead to irreversible liver damage
ad increase the risk of liver cancer
● Liver cirrhosis - Progressive and irreversible
condition causes scar tissue to form in the liver &
Increases the chance of developing liver cancer.
● Cigarette smoking - smoking can affect the liver
through inflammatory pathways and it will aggravate
the pathogenic effects of alcohol in the liver.
Additional Notes:
- CRP (c reactive protein) - Marker for inflammation
- isa sa mga gina pa test sa pt. pag may problem sa
liver

● Overexposure to aflatoxin - Poisons that produce by

molds that grow in crafts (grains, nuts) common DIAGNOSIS
contaminated with aflatoxins. ● Serum Bilirubin 0.3 to 1.9 mg/dL
● Hepatitis B,C,D & Schistosomiasis ● Alkaline Phosphatase
Additional Notes: ● SGOT/AST
- Chronic infection with hep b&c virus increases the
risk of liver cancer ● SGPT/ALT
- If you have hepatitis you are a candidate of ● LDH
developing liver cirrhosis in the future. ● increase WBC, low RBC
- There’s a study that Schistosomiasis can promote ● Hypoglycemia
hepato cellular carcino genesis. (Complication of ● hypercholesterolemia
schistosomiasis)

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 ● hepatojugular reflux sign Additional notes:
● Serum albumin (3.4-5.4 g/dl) - The brain metastases occurs when the cancer cell
● AFP (alpha-feto protein) spread from their original site
● Liver scan, USD, CT, MRI, PET scan - Any cancer can spread to the brain but the common
● needle biopsy type is caused by brain metastases
● increased serum ammonia - Brain metastases may form one tumor or many
● serum crea, BUN tumors in the brain

MANAGEMENT TYPES OF TUMOR

SURGERY ● Malignant – cancerous = infiltrating
● Benign – non-infiltrating (encapsulated)
→ Treatment of choice when confined to one lobe; not for
● Gliomas (60%)
patient with cirrhosis
Glioblastoma – worst
(SUBTOTAL HEPATECTOMY)
- most common type of malignant brain
tumor among adults
TYPES OF SURGERY: Astrocytoma (70%)
a. Lobectomy- entire lobe of the liver is being removed - occur in the brain or spinal cord
e.g liver cancer, infection, benign tumor ● Meningioma
b. Cryosurgery- also known as cryotherapy or ● Metastatic carcinoma (35%)
cryoablation, to prolong survival rate - skin, lung, breast, prostate
c. Liver Transplant- to replace a diseased liver with a
healthy liver

CHEMOTHERAPY
→ adjuvant prior to surgery

RADIATION THERAPY
→ for unresectable tumors, palliative so NO significant
change in survival rate.
Additional Notes:
- the objective is to preoperatively reduce tumor size

TRANSCATHETER CHEMOEMBOLIZATION
→ the chemotherapeutic agent is injected to the hepatic
artery
→ effective in shrinking tumors

BRAIN TUMOR
● Localized intracranial lesion that occupies space
within the skull
● Primary- originates from cells and structures within
the brain
● Secondary- tumors that develop from the outside of
the brain

GROUPS OF TUMOR
➔ Arising from the coverings of the brain
(meningioma)
➔ Arising from the cranial nerves ( acoustic neuroma/
vestibular schwannoma)
➔ Originating from brain tissue (gliomas)
➔ Metastatic

INCIDENCE
- The cause is unknown
- Metastatic CA is the most CA in the brain
- 25% of people with CA develop brain metz
(metastases)

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 d. Weakness / numbness / paralysis in one
side of the body
e. Loss of balance
f. Dizziness
g. Unsteadiness
h. Loss of hearing
i. Vision changes

SIGNS AND SYMPTOMS

● Result from enlarging mass which compresses
brain structures (pain, increased in ICP,
convulsions)
● Depend on type of tumor location, and degree of
invasion
● May be localized or systemic

INCREASED ICP
1. Classic Signs: DIAGNOSIS
● Headache - aggravated by straining (carrying heavy ✔ CT scan
stuff, having constipation) Additional notes:
● Vomiting - irritation of vagal centers in medulla o Proper preparation is needed
● Papilledema - present in 70% of patients (serious o Check jewelries
medical condition, the optic nerve becomes swollen, ✔ MRI
can cause vision problems) Additional notes:
o Proper preparation is needed
Additional notes:
- It occurs when there is swelling and the brain is o Check jewelries
pushing against the skull ✔ Cerebral angiography
Additional notes:
CUSHING’S TRIAD o This test will use a catheter, x-ray imaging
Additional notes: guidance, and injection of a contrast
- Recognize that the body’s initial response to rising material to examine the blood vessels in
ICP arise in systolic blood pressure the brain for abnormalities
- The rising of the systolic pressure results in o This can also be used in heart
widening pulse pressure (bradycardia) and irregular ✔ EEG
breathing Additional notes:
1. Increased BP – hypertension o Electroencephalography
2. Slow pulse – bradycardia // below normal o This should be prepared a day before the
3. Altered breathing – apnea test
o It detects the abnormalities in the brain
waves or in the electoral activity of the
brain
o There are electrodes consisting of small
metal disk with thin wires placed on the
scalp of the patient
o This is to detect tiny electrical charges that
result from the activity of the brain cells
✔ CSF studies (cytology)
Additional notes:
o Cerebrospinal fluid studies
o CSF will be taken from the spinal column
and sent to lab
Personality changes - behavioral changes of the patient o Doctor will be the one to extract not the
Focal deficits in motor, sensory, and cranial nerve function nurse
a. seizure or convulsion - 1st symptom: 8 out
of 10
b. Headache
c. Difficulty of thinking

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 MANAGEMENT
1. Craniotomy - remove tumor whenever possible
2. Radiation & Chemotherapy - may follow surgery;
also for inaccessible & metastatic tumors
3. Watch for wound breakdown & ICP
4. Drug treatment - hyperosmotic agents, steroids, &
diuretics to manage increased ICP

NURSING MANAGEMENT
● VS/NVS monitoring -
● Watch for increased ICP
● Administer meds as ordered
● Supportive care for neuro deficits
● Pre-op care/Chemo care
● Psychologic support
● Document seizure activity
● Watch for pupillary dilation & loss of light reflex

REFERENCES

I. PROF’S PPT AND LECTURE

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