Question

Create a conceptual map using the case scenarios as guide. Conceptual map should
include pathophysiology, medical diagnosis, signs and symptoms, and risk factors, if
any. 3 Nursing diagnosis with nursing interventions, and expected outcomes

Case Scenario for CNS-Brain Cancer
This is a case of a 45-year-old female, smoker, non-diabetic, non-hypertensive who was having on and off headache for 5 months prior to consult (April, 2015), this is associated with nausea and vomiting. The headache was becoming recurrent until August of 2015
she decided to consult her doctor. Aside from nausea and vomiting, symptoms include weakness of the left side of the body and numbness and tingling sensation. Apparently, complete neurological examination was done and it was unremarkable. A CT scan was
done on Sept 30, 2015 with the following findings:

A contrast-enhanced brain MRI demonstrated a 3 × 3 cm right fronto-parietal resection cavity surrounded by a 5 × 4 cm area of heterogeneous contrast enhancement extending to the right corona radiata and periventricular white matter with associated
cerebral edema. The mass was not technically resectable due to location and biopsy was consistent with GBM (Glioblastoma multiforme), wild-type isocitrate dehydrogenase and unmethylated O6-methylguanine DNA methyltransferase (MGMT),
with an MIB-1 index of 50%.

T1-weighted brain MRI with contrast at the time of diagnosis of radiation-induced glioblastoma multiforme.

Radiation-induced glioblastoma multiforme demonstrating increased cellularity with marked nuclear atypia, necrosis, and vascular endothelialization.

On January 25th of 2016, the patient underwent surgical therapy, including fronto-parietal craniotomy, with total resection of the tumor. On February 7th of 2016, a histopathology examination, confirmed a diagnosis of the GBM IV stage.

In February 2017, approximately 13 months after her brain tumor surgery, PatientCarlota had a follow-up diagnostic work-up, no brain tumor recurrence was found. Due to the absence of tumor, no radiotherapy was considered, and “watchful waiting” was recommended including brain imaging studies (CT or MRI) to be repeated every 3 months. Due to the lack of the patient's consent, no chemotherapy was implemented. During the irradiation period, Patient Carlota had the first seizure episode, and was started on antiepileptic therapy (Depakine 200 mg a day). she continued this therapy for the rest of her life. After the radiotherapy, diagnostic follow-up examinations were conducted every 3 months.

At the beginning of March 2018, tumor recurrence was found, and the tumor was localized in an upper part of the tumor bed, within the previously irradiated area (its size was 3.7 cm × 2.6 cm × 2.3 cm). Surprisingly, Patient Carlota had not experienced any
symptoms, and her physical and neurological examinations were unremarkable.

On March 13th of 2019, stereotactic radiotherapy was done, using a single dose of 8 Gy applied to the area of recurrent tumor was performed. Unfortunately, on follow up examination, on July 6th of 2018, further progression of the GBM was found, due to the
tumor expansion, resulting in cerebral edema, herniation, and multi-organ failure.

Answer 1

BRAIN TUMOR

-A brain tumor is a collection or mass of abnormal cells in the brain.Skull,which encloses the brain,which is very rigid,any growth inside this restricted area can cause problem.

-When the tumors grow inside the brain,it increases intra cranial pressure which can cause brain damage and maybe even life threatening.

PATHOPHYSIOLOGY

(1,2,3.. represent the steps)

1) Due to Etiologic factors.

2) Irritation and damage of cell structure.

3) As adaptive mechanism,changes in cell morphology occurs.

4) As radiation exposure continuous the change become irreversible causing the gene mutation in DNA.

5) Inactivation of tumor suppressor gene and activation of oncogenes.

6) Uncontrolled cell division and decreased apoptosis

7) Hyperplasia of the brain cell.

8) Brain tumor.

RISK FACTORS

-Ionizing radiation.

-Family history.

-Genetic abnormality.

-Chemical exposure.

-Lifestyle

SIGNS SIGNS AND SYMPTOMS

-Headache.

-Nausea and vomiting.

-Blurred vision.

-Hearing loss.

-Mood changes.

-Loss of ability to concentrate.

-Change in personality.

-Numbness.

-Muscle jerking.

DIAGNOSIS

-History collection.

(It included medical,surgical,family history.)

-Physical examination.

-Neurological examination.

-Examination of eye.

-CT scan.

-MRI scan.

-Radiological Imaging.

-Biopsy.

-EEG.

-Perimetry.

-Lamber puncturing.

-Audiometry and vestibular testing

-Endocrine testing

​​​​​​NURSING DIAGNOSIS

1) Acute pain related to biologic injuring agent as evidenced by verbal complaints of pain.

-Nursing intervention:

Asus variety and duration of the the pain.

-Desired outcome:

Patient will rate pain as lesser than.

2) Anxiety related to change in health status as evidenced by social isolation.

-Nursing intervention:

Assess the anxiety level and the need for information that will relieve it post surgery.

-Desired outcome:

The patient will verbal reduced anxiety.

3) Risk for injury related to sensory,integrative and effector dysfunction as evidenced by behaviour changes.

-National integration:

Assess vital signs including increased BP,decreased pulse pressure,pulse and respiration.Take one full minute when monitoring pulse and respiration.

-Desired outcome:

The patient will not exhibit designs of increased intracranial pressure.

CONCLUSION

​​​​​​Here we discuss about:

-Definition of brain tumor

-Pathophysiology.

-Risk factors.

-Signs and symptoms.

-Diagnosis.

-Nursing diagnosis intervention and expected outcome.