CHAPTER 65: Management of Patients with

Oncologic or Degenerative Neurologic Disorders

Lecturer: Sir Christian Caluza, RN

Brain Tumors they are or how they affect surrounding tissues of the CNS
 Benign (less complicated or harmful) or malignant
(progresses to a cancer or leads to metastasis) Manifestations of Brain Tumors
 Classification is based on location and histologic  Symptoms depend on the location and size of the
characteristic lesion and the compression of associated structures
 type, location, sites where its originated  Manifestations
 histologic characteristics is the way a tumor  Localized or generalized neurologic symptoms
could infiltrate the brain tissue or tissue  increased ICP (lethargy)
 Types of primary tumors  how tumor could caused increased ICP
 Gliomas
> Monre-Kellie Hypothesis
 affects glial cells
 Headache
 malignant types or common
> common in morning
 glial cells- supporting cells of the CNS,
>there is compression of nerves within the brain
where they give physical support to the CNS because of growing tumor. once cerebral nerves
> GLUE is the one that gives adhesion or in the brain or blood vessels in the brain is being
attached the physical parts of CNS. compress by the tumor, it’s lessen the blood that
> made up of different types of specialize flows and can have decrease concentration of
cells or subtypes: oxygen that can perfuse in the part of the brain
§ oligodendrocytes that is affected by tumor
§ astrocytes > if there is compression of blood vessels
§ ependymal cells because of tumor, oxygen delivery will also be
 Meningiomas
decrease
 slow growing type so metastic rate is very
 Vomiting
low; benign  Visual disturbances- impairment of optic nerves
 common in middle aged woman
or optic chiasm
 support or affects meninges
 Seizures- bec. of decreased oxygen
 meninges- are the supportive structure or
 Diplopia
covering of brain and spinal cord  Hormonal effects with pituitary adenoma
 Acoustic neuromas (vestibular schwanoma)
 increased secretion of hormone that are involved
 involves and affects the cranial nerve no. 8
in pituitary gland.
(vestibulocochlear nerve)  Loss of hearing, tinnitus, and vertigo with acoustic
 vestibuloccohlear nerve- responsible for
neuroma
hearing and balance; signs: hearing loss,
vertigo, tinnitus, stagger gait.
 Pituitary adenomas
 involves the pituitary gland
 Angiomas: masses of abnormal blood vessels
 formation of tumor within the blood vessels
and metastatic tumor
 Angio- blood vessels
 Metastatic tumors
 The brain tumor is being classified by how aggressive

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4 VENTRICLES OF THE BRAIN  if we instilled positron, the tumor will hyper
 1.) 2 Lateral Ventricle metabolize the sugar
 located in left and right cerebral hemispheres  if sugar stays in location, tumor is present
 cavity that comprise or filled with CSF because of POSITRON
 2.) 4th Ventricle  EEG (Electroencephalogram)
 located in hind brain  identifying the abnormal activity or electrical
 the one that contains cerebral spinal fluid activity in the brain
 3.) 3rd Ventricle  Cytologic study of cerebrospinal fluid
 located in dienzephalon  cerebrospinal fluid- can detect the presence of
 Corpus callosum malignant cells because tumor can shed in to the
 Cerebrum CSF
 Pineal area- target by brain tumor; responsible for  Biopsy- identify malignant or benign
sleep cycle
 Cerebellum- motor and coordination Medical Management of Brain Tumors
 Brainstem- worst; problem in breathing  Specific treatment depends on the type, location, and
 Acoustic nerve accessibility of the tumor
 Pituitary area- over production of coretcosteroid or  Surgery
cortisol o Goal is removal of tumor without increasing
 Optic chiasm- vision problem neurologic symptoms or to relieve symptoms by
decompression
Diagnostic Evaluation of Brain Tumors > decompression- main or option if person has
 Neurologic examination symptoms of increase ICP like having constant
 Mental status exam- observe behavioral changes, headache, hypertension, slowed heart rate. this
mood changes, cognitive skills, perception of performs by partial craniotomy (preserve vital
patient, appearance, judgement are being structure to relieve the ICP symptoms)
assessed  Craniotomy-
 Motor reflexes  transsphenoidal surgery
 Cranial nerves assessment  stereotactic procedures
 CT scan  administration of radiation, combination
 visualization to the brain and nervous system with MRI or CT SCAN for deeper tumor
 identify size, density, edema, parts that being that are located in per regions like brainstem
affected.  no open surgery
 perform contrast enhance CT SCAN for good  Radiation therapy
visualization  internal or external radiation
 before performing, nephro should be clear  Cornerstone of treatment for many brain
because CT SCAN or CONTRAST is where tumors to minimize effect of growing tumors in
there is a administration of contrast mediz “DYE” the brain tissue by administration of IODINE
 should have normal crea and bun before  IODINE (I131)
CONTRAST CT SCAN  reducing the effect of tumor in the brain
 MRI  Chemotherapy
 helpful tool because it gives better visualization  problem is blood brain barrier
compared to CT SCAN  once chemicals are administered by chemo,
 PET scan (Positron Emission Tomography Scan) they are being blocked by the 3B’s, before
 metabolism check of the tumor they reach the brain but it limits the access
 positron- made up in sugar; sugar is used in of drugs in the CNS
imaging because tumor loves sugar.
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  TEMOZOLOMIDE: chemo drug that can o Offer preferred foods
cross 3B’s o Dietary supplements o Daily weight
 Pharmacologic therapy o Record dietary intake
 Cortecosteroids
 to limit inflammatory effects (brain
swelling)
 Dexamethasone

Assessment of the Patient with Nervous System

Metastases or Primary Brain Tumor
 Baseline neurologic exam with focus:
o Patient function, moving, and walking; adapting
to weakness and paralysis and to loss of vision and
speech; dealing with seizures
 Pain, respiratory symptoms, bowel and bladder  Stereotactic Image
function, sleep, skin integrity, fluid balance, and  Brain Mapping- using CT SCAN or MRI
temperature regulation
 Nutritional status and dietary history Spinal Cord Tumors
 Family coping and family process  Spinal cord- important condoit/ chanel in relaying
messages coming from the brain to the body (vice
Planning and Goals for the Patient with Nervous versa)
System Metastases or Primary Brain Tumor  Classified according to their anatomic relation to the
 Major goals may include: spinal cord
o Compensating for self-care deficits o Improving  Medulla- innermost part of the organ
nutrition  Intramedullary: within the cord
o Reducing anxiety  Extramedullary: intradural; within or under
o Enhancing family coping skills the spinal dura
o Absence of complications  Extramedullary-extradural: outside the dural
membrane
Nursing Interventions for the Patient with Nervous  if the patient is experiencing or had a tumor in the
System Metastases or Primary Brain Tumor spinal cord, sending of sensory information in motor
 Encourage independence for as long as possible response is affected
 Measures to improve cognitive function  Spinal cords function:
 Allow patient to participate in decision making  sensory information coming from sensory
 Allow patient to express fears and concerns receptors towards the brain
 Presence of family, friends, spiritual advisor, and  conveys message if the brain wanted to perform
health care personnel may be supportive something
 Referral to counselor, social worker, home health care,  it conveys information from the brain towards the
support groups muscles
 Referral for hospice care  sensory motor
 Improving nutrition
o Oral hygiene before meals
o Plan meals for times when patient is comfortable
and well rested
o Measures to make mealtimes as pleasant as
possible
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Signs and Symptoms of Spinal Cord Tumor Assessment of the Patient with Parkinson’s Disease
 pain- spinothalamic tract ( where pain sensations  Focus on the degree of disability and functional
travels the brain) changes that occur throughout the day, such as
 weakness- disruption of electrical signals coming responses to medication
from the brain towards the muscle. o Almost every patient with a movement disorder
 loss of motor function- action potential is disrupted has some functional alteration and may have
because of tumor that is located in spinal cord some type of behavioral dysfunction
 loss of reflexes  Quality of speech, loss of facial expression,
 loss of sensation swallowing deficits (drooling, poor head control,
coughing), tremors, slowness of movement, weakness,
Treatment depends on the type of tumor and location forward posture, rigidity, evidence of mental slowness,
 Surgical removal and confusion
 Measures to relieve compression:  Fall risk assessment
dexamethasone combined with radiation
Planning and Goals for the Patient with Parkinson ’ s
Disease
Parkinson’s Disease  Major goals may include:
 Slow, progressive neurologic movement disorder o Improving functional mobility
associated with decreased levels of dopamine o Maintaining independence in ADLs
 Imbalances of dopamine and acetylcholine o Achieving adequate bowel elimination
 Substantial Nigra: production of DOPAMINE o Attaining and maintaining acceptable nutritional
status
Signs and symptoms of Parkinson Disease o Achieving effective communication
 Cardinal: tremor (pill rolling tremor, worst in o Developing positive coping skills
resting), rigidity (stiffness), bradykinesia/akinesia
(slowerd movement and walk) Medical Management of Parkinson’s Disease
 postural instability  Treatment directed toward controlling symptoms and
 Autonomic: sweating (hyperhidrosis) , drooling, maintaining functional independence
flushing, orthostatic hypotension (prolonged  Pharmacologic treatment
lying and biglang tayo, bumabagsak ang  Levadopa
pressure), gastric and urinary retention  converted to dopamine once reaches the
 Dysphagia- eat soft diet brain
 Psychiatric changes: depression, anxiety,  once reach brain, it will be broken down by
dementia, delirium, hallucinations enzyme
 enzyme: COMT(Catechol O-Methyltransferase)
 even high doses levadopa before it reached
the brain those enzymes will break down the
levadopa before it reaches the brain
 levadopa combination with CARBIDOPA
 Table 65-1
 Surgical procedures
 Stereotactic Procedures;
 thalamotomy
 pallidotomy
 Deep Brain Stimulation (DBS)- implant
electrodes in the brain that disrupts electrical
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 signals that causes involuntary muscle Huntington Disease
movements  A chronic progressive hereditary disease that results in
 Neural transplantation choreiform movement and dementia
o Ongoing research  choreiform- rapid involuntary movement (face,
limb, trunk)
 Transmitted as an autosomal dominant trait
 Pathology involves premature death of cells in the
striatum of the basal ganglia (control of movement)
and the cortex (thinking, memory, perception,
judgment)
 Triad’s Symptoms
 Chorea- jerky movement
 Cognitive skills
 Behavioral changes
 Refer to Chart 65-4

Diagnostic Test of Huntington’s Disease

 Genetic testing
 + CAG (cytosine, adenin, guanine)
 + HTT (Huntington Gene)
 CT SCAN AND MRI

Nursing Interventions for the Patient with Parkinson’s Treatment of Huntington Disease
Disease  No treatment but CONTROL.
 Improving mobility  Benzodiazepines- if there is jerky movements;
o Progressive daily program of exercise diazepam
o Stretching and ROM exercises  Neuroleptics- olanzepine, risperidone
o Postural exercises
o Consultation with physical therapy Amyotrophic Lateral Sclerosis (ALS)
o Walking techniques for safety and balance  “Lou Gehrig disease”
o Frequent rest periods  Loss of motor neurons in the anterior horn of the
o Proper shoes spinal cord and loss of motor nuclei of the lower
o Use of assistive devices brainstem
 Enhancing self-care activities  Anterior horn- for motor; loc. in lateral portion of
o Encourage, educate, and support independence o spinal cord
Environmental modifications  Posterior horn- for sensory
o Use of assistive and adaptive devices
o Consultation with occupational therapy Signs and symptoms of Amyotrophic Lateral Sclerosis
 Supporting coping abilities  Progressive weakness and atrophy of muscle
o Set achievable, realistic goals cramps, twitching, and lack of coordination
o Encourage socialization, recreation, and  if there is reduction of motor neuron, muscle
independence fibers are also decreased leads to muscle
o Planned programs of activity wasting
o Support groups and referral to supportive services:  Spasticity, deep tendon reflex brisk, and
counselors, social workers, home care overactive
 Difficulty speaking, swallowing, breathing
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  Diagnostic Test ofALS  No specific medical or surgical treatment available
 EMG
 MUSCLE BIOPSY Assessment of the Patient Undergoing a Cervical
Discectomy
Medical Management of ALS  Determining the onset, location, and radiation of pain
 Riluzole  Assessing for paresthesia, limited movement, and
 Edaravone diminished function of the neck, shoulders, and upper
extremities
Muscular Dystrophies  Determine whether the symptoms are bilateral
 Incurable disorders characterized by progressive  Cervical spine palpated to assess muscle tone and
weakening and wasting of skeletal and voluntary tenderness
muscles  Range of motion in neck and shoulders is evaluated
 Most are inherited disorders  Health issues
 Duchenne muscular dystrophy is the most common  Mood and stress levels
and inherited as a sex-linked trait  Patient education
 Common characteristics:
 Varying degrees of muscle wasting and weakness Collaborative Problems and Potential Complications of
 Abnormal elevation in serum levels of muscle the Patient Undergoing a Cervical Discectomy
enzymes  Hematoma at the surgical site, resulting in cord
compression and neurologic deficit
Degenerative Disc Disease  Recurrent or persistent pain after surgery
 Low back pain is a significant public health disorder
and has significant economic and social costs Planning and Goals for the Patient Undergoing a
 Most back problems are related to disc disease Cervical Discectomy
 Degenerative changes occur with aging or are the  The goals for the patient may include:
result of previous trauma o Relief of pain
 Radiculopathy produces pain o Improved mobility
 Continued pressure may produce degenerative o Increased knowledge and self-care ability o
changes in the nerves with resultant changes in Prevention of complications
sensation and motor responses
 Treatment is usually conservative: rest and Nursing Interventions for the Patient Undergoing a
medications Cervical Discectomy
 Surgery may be required  Relieving pain
 Improving mobility
Post-Polio Syndrome  Monitoring and managing potential complications
 Occurs at least 15 years after polio exposure  Promoting home, community-based, and transitional
care
Signs and Symptoms
 new musculoskeletal weakness,
 fatigue
 musculoskeletal pain

Cause/ Risk Factors

 unknown; researchers suspect that with aging or
muscle overuse, the neurons not destroyed by the
poliovirus continue generating axon sprouts
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