Cancer is a significant global health concern, characterized by the uncontrolled proliferation of abnormal cells that can invade and damage healthy tissues and organs. While cancer can manifest in various parts of the body, the presence of a brain mass presents unique challenges and complexities in patient care. This article delves into the crucial role of nursing diagnosis in managing patients with brain masses, aiming to provide a comprehensive guide for healthcare professionals.
Brain masses, whether benign or malignant, can significantly impact neurological function and overall patient well-being. Symptoms vary depending on the size, location, and growth rate of the mass, but common signs may include persistent headaches, seizures, cognitive changes, weakness, and sensory disturbances. Early diagnosis and intervention are critical for improving patient outcomes.
Nurses play a pivotal role in the multidisciplinary care of patients with brain masses. From initial assessment to long-term management, nurses are essential in monitoring patient status, administering treatments, providing emotional support, and educating patients and their families. Accurate nursing diagnoses are the foundation for developing individualized care plans that address the specific needs of each patient.
Understanding Brain Mass Nursing Diagnoses
Nursing diagnosis is a clinical judgment about individual, family, or community experiences/responses to actual or potential health problems/life processes. It provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability. In the context of brain masses, several nursing diagnoses may be relevant, reflecting the diverse challenges patients face.
Here, we will explore some key nursing diagnoses commonly associated with brain masses, drawing upon the principles of cancer care and adapting them to the specific neurological context. While the original article focused on broader cancer nursing diagnoses, we will tailor these and introduce new diagnoses directly relevant to brain masses.
Common Nursing Diagnoses Related to Brain Masses
1. Risk for Increased Intracranial Pressure (ICP)
Brain masses, by their very nature, occupy space within the skull, a rigid compartment. This can lead to increased intracranial pressure (ICP), a life-threatening condition. Tumor growth, associated edema, and hydrocephalus can all contribute to elevated ICP.
Related Factors:
- Space-occupying lesion (brain mass)
- Cerebral edema
- Hydrocephalus
- Obstruction of CSF flow
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet. Nursing interventions are directed at prevention.
Expected Outcomes:
- Patient will maintain ICP within normal limits.
- Patient will demonstrate behaviors to minimize ICP elevation.
Assessment:
1. Monitor neurological status frequently. Changes in level of consciousness, pupillary response, motor function, and vital signs can indicate increasing ICP.
2. Assess for signs and symptoms of increased ICP. These may include headache, vomiting (especially projectile), altered mental status, seizures, and Cushing’s triad (bradycardia, hypertension, and irregular respirations).
Interventions:
1. Elevate the head of the bed to 30-45 degrees. This promotes venous drainage from the brain and can help reduce ICP.
2. Maintain normothermia. Fever can increase cerebral metabolic rate and ICP.
3. Manage pain and agitation effectively. Pain and agitation can increase ICP. Use appropriate pharmacological and non-pharmacological interventions.
4. Administer medications as prescribed. This may include osmotic diuretics (e.g., mannitol) and corticosteroids (e.g., dexamethasone) to reduce cerebral edema and ICP.
5. Avoid activities that increase ICP. Such as straining, coughing, and Valsalva maneuver. Implement strategies to minimize these activities.
2. Impaired Physical Mobility
Brain masses can cause motor deficits, weakness, paralysis, and impaired coordination, leading to impaired physical mobility. Location of the mass significantly influences the type and extent of motor impairment.
Related Factors:
- Neuromuscular impairment
- Decreased muscle strength
- Impaired balance and coordination
- Pain
- Fatigue
As evidenced by:
- Limited range of motion
- Weakness
- Paralysis
- Difficulty with ambulation
- Difficulty with transfers
Expected Outcomes:
- Patient will maintain optimal level of mobility within their limitations.
- Patient will participate in rehabilitation activities to improve mobility.
Assessment:
1. Assess motor function and strength. Evaluate muscle strength, balance, coordination, and gait. Identify specific motor deficits.
2. Assess range of motion and joint mobility. Determine limitations in joint movement and potential for contractures.
3. Assess the impact of immobility on other body systems. Monitor for complications such as pressure ulcers, constipation, and respiratory issues.
Interventions:
1. Implement a mobility program. Include range of motion exercises, muscle strengthening exercises, and progressive ambulation as tolerated.
2. Utilize assistive devices as needed. Provide walkers, canes, wheelchairs, or other devices to support mobility and prevent falls.
3. Collaborate with physical therapy and occupational therapy. These specialists can provide expert guidance and develop tailored rehabilitation plans.
4. Prevent complications of immobility. Implement pressure ulcer prevention strategies, promote bowel and bladder function, and encourage deep breathing and coughing exercises.
3. Self-Care Deficit
Neurological deficits resulting from a brain mass can significantly impair a patient’s ability to perform self-care activities such as bathing, dressing, feeding, and toileting.
Related Factors:
- Neuromuscular impairment
- Cognitive deficits
- Weakness
- Fatigue
- Pain
As evidenced by:
- Inability to perform ADLs (bathing, dressing, feeding, toileting)
- Need for assistance with ADLs
- Expressed difficulty performing ADLs
Expected Outcomes:
- Patient will participate in self-care activities to the extent possible.
- Patient will maintain skin integrity and hygiene.
Assessment:
1. Assess the patient’s ability to perform ADLs. Determine the level of assistance required for each activity.
2. Identify factors contributing to self-care deficit. Assess motor deficits, cognitive impairments, pain, and fatigue.
3. Assess the patient’s environment for safety and accessibility. Ensure the environment is conducive to self-care and minimizes risk of falls.
Interventions:
1. Provide assistance with ADLs as needed. Offer support and encouragement while promoting independence to the extent possible.
2. Adapt the environment and use assistive devices. Modify the environment to enhance accessibility and provide adaptive equipment to facilitate self-care.
3. Collaborate with occupational therapy. Occupational therapists can provide specialized interventions to improve self-care skills.
4. Maintain skin integrity. Implement strategies to prevent skin breakdown, especially in patients with limited mobility.
4. Disturbed Sensory Perception
Brain masses can disrupt sensory pathways, leading to altered sensory perception. This can manifest as visual disturbances, hearing loss, altered taste or smell, or changes in tactile sensation.
Related Factors:
- Neurological impairment
- Compression of cranial nerves
- Disruption of sensory pathways
As evidenced by:
- Changes in vision
- Hearing loss
- Altered taste or smell
- Numbness or tingling
- Vertigo
Expected Outcomes:
- Patient will adapt to sensory changes and maintain safety.
- Patient will utilize compensatory strategies to manage sensory disturbances.
Assessment:
1. Assess sensory function. Evaluate vision, hearing, taste, smell, and tactile sensation. Identify specific sensory deficits.
2. Assess the impact of sensory disturbances on daily life. Determine how sensory changes affect safety, communication, and ADLs.
3. Assess for safety risks related to sensory deficits. Identify potential hazards in the environment and implement safety measures.
Interventions:
1. Orient the patient to the environment frequently. Reduce confusion and anxiety related to sensory changes.
2. Modify the environment to enhance safety. Ensure adequate lighting, remove hazards, and provide assistive devices for sensory deficits (e.g., glasses, hearing aids).
3. Utilize communication strategies appropriate to sensory deficits. Speak clearly and face the patient for hearing impairment; use visual aids for visual impairment.
4. Educate the patient and family about sensory changes and compensatory strategies. Provide information and support to help patients adapt to sensory disturbances.
5. Acute Pain
Similar to general cancer pain, patients with brain masses can experience acute pain related to the tumor itself, increased ICP, or treatment side effects. Headaches are a common pain complaint.
Nursing Diagnosis: Acute Pain (as described in the original article, adapted to brain mass context)
Related to:
- Disease process (brain mass)
- Increased intracranial pressure
- Inflammatory process
- Treatment side effects (surgery, radiation, chemotherapy)
As evidenced by:
- Headache
- Expressive behaviors (e.g., facial grimacing, restlessness)
- Guarding behavior
- Changes in vital signs (increased heart rate, blood pressure)
- Self-report of pain
Expected Outcomes:
- Patient will report a decrease in pain.
- Patient will utilize effective pain management strategies.
Assessment:
1. Assess pain characteristics. Location, intensity, quality, onset, duration, and aggravating/relieving factors of pain, specifically headache.
2. Assess factors that exacerbate pain. Increased ICP, positioning, specific activities.
Interventions:
1. Implement pain management strategies. Pharmacological (analgesics, corticosteroids) and non-pharmacological (positioning, relaxation techniques, cool compresses).
2. Monitor pain response to interventions. Evaluate the effectiveness of pain management strategies and adjust as needed.
3. Educate the patient about pain management. Explain pain medications, non-pharmacological techniques, and encourage proactive pain reporting.
6. Anxiety
The diagnosis of a brain mass and the potential implications for neurological function and survival can evoke significant anxiety in patients and their families.
Nursing Diagnosis: Anxiety (as described in the original article, adapted to brain mass context)
Related to:
- Diagnosis of brain mass
- Uncertainty of prognosis
- Fear of neurological deficits
- Fear of treatment and side effects
- Changes in functional abilities and roles
As evidenced by:
- Expresses worry and fear
- Restlessness and irritability
- Difficulty concentrating
- Sleep disturbances
- Increased heart rate and respirations
Expected Outcomes:
- Patient will express feelings about their diagnosis and prognosis.
- Patient will utilize coping mechanisms to manage anxiety.
Assessment:
1. Assess the patient’s level of anxiety. Use anxiety scales and observe for verbal and nonverbal cues of anxiety.
2. Identify factors contributing to anxiety. Diagnosis, prognosis, fear of deficits, treatment concerns.
Interventions:
1. Provide emotional support and reassurance. Active listening, empathy, and a calm approach.
2. Provide accurate and honest information. Address patient concerns and questions about diagnosis, treatment, and prognosis in a clear and understandable manner.
3. Teach relaxation techniques. Deep breathing, guided imagery, meditation.
4. Facilitate support systems. Encourage family involvement, support groups, and counseling services.
7. Risk for Infection
Patients with brain masses, especially those undergoing surgery or radiation therapy, are at increased risk for infection. Immunosuppression related to treatment and invasive procedures contribute to this risk.
Nursing Diagnosis: Risk for Infection (as described in the original article, adapted to brain mass context)
Related to:
- Immunosuppression (treatment-related)
- Invasive procedures (surgery, catheters)
- Disruption of protective barriers (surgical incision)
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet. Nursing interventions are directed at prevention.
Expected Outcomes:
- Patient will remain free from infection.
- Patient will demonstrate infection prevention measures.
Assessment:
1. Assess for risk factors for infection. Immunosuppression, surgical site, presence of invasive lines.
2. Monitor for signs and symptoms of infection. Fever, wound drainage, redness, warmth, elevated WBC count.
Interventions:
1. Implement infection control measures. Hand hygiene, aseptic technique for procedures, wound care.
2. Monitor WBC count and other lab values. Detect early signs of infection.
3. Educate the patient and family about infection prevention. Hand hygiene, signs of infection to report, avoiding crowds during immunosuppression.
Conclusion
Nursing diagnoses are essential for providing holistic and individualized care to patients with brain masses. By recognizing and addressing common nursing diagnoses such as risk for increased ICP, impaired mobility, self-care deficit, sensory disturbances, pain, anxiety, and risk for infection, nurses can significantly contribute to improving patient outcomes and quality of life. This guide provides a framework for understanding and applying these diagnoses in clinical practice, empowering healthcare professionals to deliver comprehensive and compassionate care to patients facing the challenges of brain masses.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Cancer Center. WebMD. 2005 – 2022 WebMD LLC. From: https://www.webmd.com/cancer/default.htm
- Cancer. World Health Organization. 2022 WHO. From: https://www.who.int/health-topics/cancer#tab=tab_1
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- What Is Cancer? National Cancer Institute. Updated: May 5, 2021. From: https://www.cancer.gov/about-cancer/understanding/what-is-cancer
- Hickey, J. V. (2019). The clinical practice of neurological and neurosurgical nursing. Wolters Kluwer. (Added reference for neurological nursing specificity)
