Primary Nursing Diagnosis

Decreased intracranial adaptive capacity

OUTCOMES. Neurological status; Neurological status: Consciousness; Fluid balance

INTERVENTIONS. Cerebral perfusion promotion; Cerebral edema management; Neurological monitoring; Surveillance; Surveillance: Safety; Positioning: Neurological; Vital signs monitoring; Medication management


The type of treatment used for brain cancer depends on the type of tumor (see Table 3). The primary modes of treatment include surgery, radiotherapy, and pharmacologic therapy.

SURGICAL. Surgery remains the primary treatment modality. A craniotomy is done to remove larger tumors. This involves making a surgical opening in the cranium to remove the tumor and inspect various areas of the brain; reconstruction is required. Stereotactic surgery involves insertion of a needle through a small opening in the skull to "suction out" the small tumor. The goals of surgery are (1) total removal of the tumor, (2) subtotal removal to relieve symptoms, or (3) procedures to protect the brain from damage, for example, placement of a shunt to relieve hydrocephalus. Other modalities are used in combination. After the surgery, the patient needs careful monitoring for increased ICP. Notify the surgeon if the bone flap becomes elevated, which is a sign of increased ICP. The physician usually manages cerebral swelling and elevated ICP with fluid restriction (usually 1500 mL or less in 24 hours), steroids, shunt placement, and osmotic diuretics such as mannitol.

RADIATION. For tumors that are not accessible to surgical removal, radiation may be used. Locally contained tumors receive direct beam radiation focused on the lesion. For multiple lesions, especially metastatic brain lesions, whole-brain radiation therapy (WBRT) is used. Radiation is usually not used in children younger than 2 years of age because of the long-term effects—panhypopituitarism, developmental delay, and secondary tumors.

Pharmacologic Highlights

Medication or Drug Class





Varies by drug

Some germ cell tumors respond well to a combination of vincristine, bleomycin, methotrexate, and cisplatin.

Chemotherapy plays a very minor role In treatment of brain metastases. The blood-brain barrier prevents delivery to the tumor of the cytotoxic agents in high concentrations.


The first priority is to ensure that the airway is patent. Keep equipment to manage the airway (endotracheal tube, laryngoscope, nasal and oral airway) within easy access of the patient. Make sure that working endotracheal suction is at the bedside. Note that an obstructed airway and increased levels of carbon dioxide contribute to increased ICP in patients with a space-occupying lesion. Keep the patient comfortable but not oversedated. If the patient is awake, encourage him or her to avoid Valsalva's maneuver and isometric muscle contractions when moving or sitting up in bed to limit the risk of increased ICP. Perform serial neurological assessment to watch for sudden changes in mental status. To reduce ICP and optimize lung expansion, place the patient in semi-Fowler position. Keep the head in good alignment with the body to prevent compression on the veins that allow for venous drainage of the head. Avoid hip flexion. Assist the patient to turn in bed and perform coughing, deep breathing, and leg exercises every 2 hours to prevent skin breakdown, as well as pulmonary and vascular stasis. As soon as allowed, help the patient get out of bed and ambulate in hallways three to four times each day. If the patient has sensory or motor deficits, work with the rehabilitation team to encourage activities of daily living and increased independence.

Patients who have been newly diagnosed with brain cancer are often in emotional shock, especially when the disease is diagnosed in the advanced stages or is inoperable. Encourage the patient and family to verbalize their feelings surrounding the diagnosis and impending death.

Assist family members in identifying the extent of home care that is realistically required by the patient. Arrange for visits by a home health agency. Suggest supportive counseling (hospice, grief counselor), and if necessary, make the initial contact. Local units of the American Cancer Society offer assistance with home care supplies and support groups for patients and families. Also refer patients to the American Brain Tumor Association, the Brain Tumor Society, and the National Brain Tumor Foundation. Instruct the patient to use the pain scale effectively and to request pain medication before the pain escalates to an intolerable level. Consider switching as-needed pain medication to an around-the-clock dosing schedule to keep pain under control.

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