University of Northern Philippines

Tamag Vigan City

___________________________________________________________________

COLLEGE OF HEALTH SCIENCES

In Partial Fulfillment of the Requirements

In

Nursing Care Management (NCM) 103

A Case Study on

BRAIN TUMOR

Is

PRESENTED TO:

PRESENTED BY:
Jhayvie Marie C. Cacho
III-A

September 10, 2010

I. Introduction

Brain Tumor
A brain tumor is an intracranial solid neoplasm, a tumor (defined as
an abnormal growth of cells) within the brain or the central spinal canal.

Medulloblastoma - This tumor usually arises in the cerebellum. It is the

most common brain tumor in children. It is sometimes called a primitive
neuroectodermal tumor.

Causes:
IDIOPATHIC
Risk Factors:
• Being male
• Race (Whites)
• Age - Most brain tumors are detected in people who are 70 years old
or older.
 Brain tumors are more common in children younger than 8
years old than in older children.
• Family history - People with family members who have gliomas may
be more likely to develop this disease.
• Being exposed to radiation or certain chemicals at work:
Radiation
• Formaldehyde
• Vinyl chloride - Workers who make plastics may be exposed to vinyl
chloride.
• Acrylonitrile - People who make textiles and plastics may be exposed
to acrylonitrile.

Signs and Symptoms

The symptoms of brain tumors depend on tumor size, type, and location.
Symptoms may be caused when a tumor presses on a nerve or damages a
certain area of the brain. They also may be caused when the brain swells or
fluid builds up within the skull.
 • Headaches (usually worse in the morning)
• Nausea or vomiting
• Changes in speech, vision, or hearing
• Problems balancing or walking
• Changes in mood, personality, or ability to concentrate
• Problems with memory
• Muscle jerking or twitching (seizures or convulsions)
• Numbness or tingling in the arms or legs

Diagnosis

• Physical exam - The doctor checks general signs of health.

• Neurologic exam - The doctor checks for alertness, muscle strength,

coordination, reflexes, and response to pain. The doctor also examines
the eyes to look for swelling caused by a tumor pressing on the nerve
that connects the eye and brain.

• CT scan - An x-ray machine linked to a computer takes a series of

detailed pictures of the head. The patient may receive an injection of a
special dye so the brain shows up clearly in the pictures. The pictures
can show tumors in the brain.

• MRI - A powerful magnet linked to a computer makes detailed pictures

of areas inside the body. These pictures are viewed on a monitor and
can also be printed. Sometimes a special dye is injected to help show
differences in the tissues of the brain. The pictures can show a tumor
or other problem in the brain.
• The doctor may ask for other tests:

• Angiogram - Dye injected into the bloodstream flows into the blood
vessels in the brain to make them show up on an x-ray. If a tumor is
present, the doctor may be able to see it on the x-ray.

• Skull x-ray - Some types of brain tumors cause calcium deposits in

the brain or changes in the bones of the skull. With an x-ray, the doctor
can check for these changes.

• Spinal tap - The doctor may remove a sample of cerebrospinal fluid

(the fluid that fills the spaces in and around the brain and spinal cord).
 This procedure is performed with local anesthesia. The doctor uses a
long, thin needle to remove fluid from the spinal column. A spinal tap
takes about 30 minutes. The patient must lie flat for several hours
afterward to keep from getting a headache. A laboratory checks the
fluid for cancer cells or other signs of problems.

• Myelogram - This is an x-ray of the spine. A spinal tap is performed to

inject a special dye into the cerebrospinal fluid. The patient is tilted to
allow the dye to mix with the fluid. This test helps the doctor detect a
tumor in the spinal cord.

• Biopsy - The removal of tissue to look for tumor cells is called a

biopsy. A pathologist looks at the cells under a microscope to check for
abnormal cells. A biopsy can show cancer, tissue changes that may
lead to cancer, and other conditions. A biopsy is the only sure way to
diagnose a brain tumor.

Treatment:
• Surgery is the usual treatment for most brain tumors. Surgery to open
the skull is called a craniotomy. It is performed under general
anesthesia. Before surgery begins, the scalp is shaved. The surgeon
then makes an incision in the scalp and uses a special type of saw to
remove a piece of bone from the skull. After removing part or the
entire tumor, the surgeon covers the opening in the skull with that
piece of bone or with a piece of metal or fabric. The surgeon then
closes the incision in the scalp.
• Radiation therapy (also called radiotherapy) uses high-energy rays
to kill tumor cells. The radiation may come from x-rays, gamma rays,
or protons. A large machine aims radiation at the tumor and the tissue
close to it. Sometimes the radiation may be directed to the entire brain
or to the spinal cord.

Radiation therapy usually follows surgery. The radiation kills tumor

cells that may remain in the area.

• Chemotherapy the use of drugs to kill cancer cells. The drugs may be
given by mouth or by injection. Either way, the drugs enter the
bloodstream and travel throughout the body. The drugs are usually
given in cycles so that a recovery period follows each treatment
period.
 Chemotherapy may be given in an outpatient part of the hospital, at
the doctor's office, or at home.

Children are more likely than adults to have chemotherapy. However,

adults may have chemotherapy after surgery and radiation therapy.

For some patients with recurrent cancer of the brain, the surgeon
removes the tumor and implants several wafers that contain
chemotherapy. Each wafer is about the size of a dime. Over several
weeks, the wafers dissolve, releasing the drug into the brain. The drug
kills cancer cells.

Nursing Management

• To provide a non-stimulating place of quiet.

• Monitor the patient's pain levels using the standard medical rating scale of zero through 10
• Assess for patient’s consciousness and Intracranial Pressure

• Ask the patient to talk about the surgery that lies ahead

• Give relaxation techniques to help prepare the patient to enter into the procedure ahead

• Offer ways to minimize the inevitable hair loss such as with wigs, scarves, turbans and hats.

• Assess the patient's knowledge concerning his awareness of the tumor.

II. Objectives

General Objectives:
• To enhance my socialization skills by establishing rapport with the
patient, her/his relatives and other members of the health care teams.

• To gain knowledge about the patient’s disease.

• To contribute to the patient’s overall wellness during his stay in the

hospital.

Specific Objectives:

• To monitor my patient’s vital signs effectively by being accurate and

honest about the true findings I obtained.

• To be able to render specific nursing skills and interventions to meet

the needs of my patient.
 • To be able to acquire knowledge about the patient’s case through this
case study.

III. Patient’s Profile

Name: Jerick Jimenez

Age: 11 years old
Address: San Juan, Ilocos Sur
Gender: Male
Birth date: October 5, 1998
Religion: Roman Catholic
Civil Status: Single
Nationality: Filipino
Date and Time
of Admission: July 17, 2010 @ 5:10 am
Final Diagnosis: Posterior Hydrocephalus t/c Medulloblastoma
Admitting Physician: Dr. Viado
Institution: Metro Vigan Cooperative Hospital
Operations/ Treatment:
I. Suboccipital Craniotomy, Excision of Tumor, Right Portion,
Parietal Tube, Vistrolectomy (July 22, 2010)
II. Tracheostomy (August 2, 2010)
Chief Complaint: Headache and nausea & vomiting after eating

IV. Physical Assessment

BODY FINDINGS METHOD IMPLICATION
PARTS USED

Skin • Skin is soft and • Inspecti • Normal

even; warm and on and
moist Palpatio • Normal
• Lighter colored n
palms, soles and
• Normal
nail beds • Normal
• Evenly colored
dark brown • Normal
generalized skin
color • Normal
• Skin pinches easily
• Normal
and returns
immediately to
original position
• Moles present
 visible at face and
arms
• No lesions noted
Hair • Hair is black • Inspecti • Normal
• Scalp hair is on and • Shaving the
shaved Palpatio scalp prior to
• Incision is present n craniotomy is
a standard
procedure to
minimize
entry of
microorganis
• No parasites ms to the
present incision site
• Fine vellus hair • Normal
covers the entire • Normal
body except for
the soles, palms,
lips and nipples.
Nails • Pink-colored nail • Inspecti • Normal
bed on and • Normal
• Round nail at Palpatio
approximately n
160º angle • Normal
• Nail is hard and
immobile. • Normal
• Nail bed is form;
nail plate is
firmly attached • Normal
to nail bed.
• Capillary refill in
3 seconds

Head • Head is round • Inspecti • Assymetrical

and on and due to
asymmetrical Palpatio presence of
n incision
• Hard and smooth site,post
with incision craniotomy.
Face
• Face is
symmetrical and
in oval shape • Normal
appearance
• No abnormal
movements • Normal
noted.
Neck • Light brown • Inspecti • Normal
• Minimal on • Nervous
movements system has
noted not fully-
recovered yet
from
craniotomy.
Lymph nodes • Submandibular • Palpatio • Normal
 nodes are non- n
tender upon
palpation
Eyes
Eyes • Protruding eyes • Inspecti • Increased
intracranial
on
pressure
• Symmetrical following
eyelids, warm and surgery
moist
• Lashes evenly-
spaced and curled
outward • Nervous
• Blinking system has
assymmetrical and not fully
involuntary recovered yet
from previous
• White conjunctiva operation
with relatively • Normal
visible vessels
• Sclera is white • Normal
• Color of iris is • Normal
black
( determinant of
eye color) • Normal
• No discharges
noted
Ears
Ears • Soft pinna, color • Inspecti • Normal
same as face on and
• No discharges Palpatio • Normal
• Non-tender upon n • Normal
palpation
• Normal
• Responds to
sounds
Nose, Mouth,
Throat
Nose • Consistent brown • Inspecti • Normal
color same as face on and
• In a solid Palpatio • Normal
placement n • Normal
• Sinuses non-
tender
• For nutrition
and
• Presence of
medications
intact NGT
Mouth • Lips symmetrical • Inspecti • Normal
• Lips are dark pink • Normal
• Flaky
on
• Due to mild
dehydration
• No lesions nor
• Normal
swelling
• Pinkish buccal
• Normal
mucosa • Normal
• Dark pinkish gums
• 30 teeth; stably
fixed; smooth
surfaces and
 edges; whitish to
dirty white color
Throat • Presence of intact • Inspecti • Normal
tracheostomy tube on and • Normal
• Gag reflex present Palpatio
n

Thorax • Thorax’s color • Inspecti • Normal

same as face on,
• Chest is Palpatio • Normal
symmetrical n and • Normal
• Respiratory rate Ausculta
ranges from 20-35 tion
cpm as recorded. • explosive
• Rales present opening of
small airways
maybe due to
phlegm or
respiratory
discharges
• Regular rhythms (pneumonia)
of cycles • Normal
• Difficulty of • Presence of
breathing noted phlegms in the
lungs.