3 Brain Tumor Nursing Care Plans

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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.

Nursing Care Plans

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.

Here are three (3) nursing care plans (NCP) and nursing diagnosis for brain tumor:

1. Acute Pain

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Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

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

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Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.

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

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Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

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.

References and Sources : nurse labes