nursing management brain tumor.docx

Nursing Management The characteristics of headache, when present, should be assessed. Upright positioning and pain medications may be useful in managing pain; nurses should evaluate the effectiveness of pain management interventions (Ijzerman- Korevaar, Snijers, Saskia, et al., 2018). Even if seizur...

Nursing Management The characteristics of headache, when present, should be assessed. Upright positioning and pain medications may be useful in managing pain; nurses should evaluate the effectiveness of pain management interventions (Ijzerman- Korevaar, Snijers, Saskia, et al., 2018). Even if seizure history is absent, the patient and family should be educated about the possibility of seizure and the need to adhere to prophylactic anticonvulsant medications, if prescribed. The patient with a brain tumor may be at increased risk for aspiration as a result of cranial nerve dysfunction. Medications to alleviate nausea and to prevent vomiting should be considered (Ijzerman-Korevaar et al., 2018). Preoperatively, the gag reflex and ability to swallow are evaluated. In patients with diminished gag response, care includes educating the patient to direct food and fluids toward the unaffected side, having the patient sit upright to eat, offering a semisoft diet, and having suction readily available. The effects of increased ICP caused by the tumor mass are reviewed in Chapter 61. The nurse performs neurologic checks; monitors vital signs; maintains a neurologic observation record (see Chapter 61, Fig. 61-6); spaces nursing interventions to prevent rapid increase in ICP; and reorients the patient when necessary to person, time, and place. The use of corticosteroids to control headache and neurologic symptoms requires astute nursing assessment and intervention because many adverse effects can occur, including hyperglycemia, electrolyte abnormalities, and muscle weakness (see Chapter 45, Table 45-3). Patients with changes in cognition caused by their lesion require frequent reorientation and the use of orienting devices (e.g., personal possessions, photographs, lists, a clock), supervision of and assistance with self-care, and ongoing monitoring and intervention for prevention of injury. Patients with seizures are carefully monitored and protected from injury. Motor function is checked at intervals because specific motor deficits may occur, depending on the tumor’s location. When muscle weakness is present, an interprofessional approach, including the nurse and physical and occupational therapists, can be used to preserve muscle strength, promote range of motion, and facilitate independence in self-care. Sensory disturbances are assessed and any area of numbness should be protected from injury. Speech is evaluated, and patients with speech deficits can be educated to use alternative forms of communication. Eye movement and pupillary size and reaction may be affected by cranial nerve involvement. Fatigue is common during therapy; efforts should be made to conserve energy and promote rest.