1394 UNIT XII / Responses to Altered Neurologic Function
Nursing Care Plan
A Client with a Brain Tumor
Claire Lange is a 44-year-old television an- Identify measures that will help minimize the effect of the hair
nouncer. During one nights broadcast, she con- loss.
fuses several major news items so badly that her co-anchor tries Verbalize a reduction in anxiety.
to correct her. Ms. Lange responds angrily that she does not
PLANNING AND IMPLEMENTATION
need any help and then rises and storms off the set. As she leaves
Assess level of discomfort using a rating scale of 0 to 10.
the camera area, she limps noticeably and appears to drag her
Provide a quiet, nonstimulating environment.
left leg.The shows producer asks her what is wrong; she screams
Position the client for comfort, keeping the head of the bed el-
that nothing is wrongshe simply has another headache. He
evated to promote venous drainage.
follows her to her dressing room and inquires about her
Assess level of consciousness for potential increases in ICP.
headaches. She tells him that they come and go but have been
Encourage to verbalize feelings about the surgery.
getting worse lately. He then asks her if she has injured her left
Suggest measures that may help minimize the hair loss, such as
leg; she responds that the leg was weak because she was tired.
the use of turbans, scarves, hats, and wigs.
As the producer leaves the dressing room, Ms. Lange begins to
Suggest relaxation techniques to decrease anxiety.
shake and collapses on the floor. The producer recognizes that
she is having a seizure and calls for an ambulance. EVALUATION
Ms. Lange is admitted to the neurology floor of the local hos- By the time of surgery, Ms. Lange has recognized the relationship
pital for evaluation. A CT scan, MRI study, and EEG are completed between the brain tumor and the headache. She states that lying
and identify an intracranial mass. A biopsy of the mass is positive in a flat position and coughing increase the headache. The head
for malignant cells. A glioma in the frontal lobe is identified, and of the bed is kept at a 30- to 45-degree angle. Daily activities are
surgery is scheduled for that week. spaced to provide periods of rest. Ms. Lange demonstrates no
significant changes in level of consciousness. She has talked
ASSESSMENT
about the effect of the hair loss and her television responsibilities.
When Clara Rosetti, RN, enters Ms. Langes room, she sees Ms. Lange
Ms. Lange has learned that the hair preparation would be done in
looking at her shoulder-length hair in the mirror. Ms. Lange tells
surgery and that the hair would be saved for her. She states she
Ms. Rosetti that she has never in her life worn her hair any shorter,
has already consulted her hair stylist and that scarves and tur-
and Now youre going to cut it all off! She paces the room and
bans are on the way.
makes the statement,I guess the hair isnt really important if I sur-
vive this situation. She also says that she has a headache. Critical Thinking in the Nursing Process
DIAGNOSES 1. Outline interventions to decrease intracranial pressure both
Acute pain (headache), related to tumor and increase in in- before and after surgery.
tracranial pressure 2. When making your initial assessments on the morning of sur-
Disturbed body image, related to upcoming hair loss and cranial gery, you find that Ms. Lange has a decreased pulse and in-
incision creased blood pressure. She tells you her headache is worse
Anxiety, related to unknown future following surgery and suddenly vomits. What do you do now?
3. Ms. Lange asks you to be sure that she has absolutely no visi-
EXPECTED OUTCOMES tors after surgery, because she knows how ugly she will look.
Verbalize the causes of pain. How would you respond?
Verbalize an understanding of the changes in body appearance 4. Design a plan of care for Ms. Lange for the nursing diagnosis,
that are associated with the scheduled intracranial surgery Powerlessness.
(e.g., shaving of the head prior to surgery, cranial incision, facial
See Evaluating Your Response in Appendix C.
swelling postoperatively).
take an active role in their own care. Discharge planning in- Safety measures for motor deficits, sensory deficits, lack of
cludes a discussion of the following topics: medication infor- coordination, seizures, and cognitive deficits
mation; wound care; the use of wigs, turbans, hats, or color- Comfort measures for nausea, vomiting, and pain
ful scarves; and the importance of follow-up visits. In Measures for communication if aphasia is present
addition, emphasize the importance of reporting manifesta- Measures to improve vision if visual deficits are present
tions such as stiff neck, increasing headache, elevated tem- How to buy wigs and hairpieces
perature, new motor or sensory deficits, vision changes, or Referrals to support groups and community resources
seizures. Helpful resources:
Provide information about the overall treatment plan, man- American Cancer Society
agement of deficits and/or disabilities, and future needs. Spe- American Brain Tumor Association
cific teaching topics are as follows: National Brain Tumor Foundation
