Pathophysiologic Results of Neurologic Oncologic Disorders

Manifestations depend upon the tissues infiltrated and compressed by the neoplasm

Pathophysiologic events may include:Increase ICPSeizuresHydrocephalusAltered pituitary function

Oncologic TumorsBrain tumors

Benign or malignantClassification is based upon location and

histological characteristicsTypes of primary tumors

Gliomas (arises from glial cells)Meningiomas Acoustic neuromas (tumor of the eighth cranial

nerve)Pituitary adenomas

Angiomas—masses of abnormal blood vesselsMetastatic tumors

Brain TumorsSymptoms are dependent upon the location and size of

the lesion and the compression of associated structuresManifestations:

Localized or generalized neurologic symptomsSymptoms of increased ICPHeadacheVomitingVisual disturbances

Hormonal effects with pituitary adenomaLoss of hearing, tinnitus, and vertigo with acoustic

neuroma

Diagnostic EvaluationNeurologic examinationCT scanMRICytological study of cerebral spinal fluidBiopsy

Medical ManagementSpecific treatment depends upon the type,

location, and accessibility of the tumorSurgery

Goal is removal of tumor without increasing neurologic symptoms or to relieve symptoms by decompression

Radiation therapyExternal beam radiationBrachytherapy

Chemotherapy

Spinal Cord TumorsClassified according to their anatomic relation to

the spinal cordIntramedullary: within the cordExtramedullary: extradural; outside the dural

membraneManifestations include pain, weakness, and loss

of motor function, loss of reflexes, loss of sensation

Treatment depends upon type of tumor and locationSurgical removalMeasures to relieve compression: dexamethasone

combined with radiation

Parkinson’s DiseaseAssociated with decreased levels of dopamine

due to destruction of cells in the substantia nigra in the basal ganglia; this effects the neurotransmission of impulses

Manifestations: tremor, rigidity, bradykinesia, postural instability, depression and other psychiatric changes, dementia, sleep disturbances,

Medical management Pharmacologic treatmentSurgical proceduresOther therapies

Pathophysiology of Parkinson’s Disease

TreatmentLevodopaAnticholinergicsAmantadine hydrochloride (antiviral)Monoamine Oxidase Inhibitors (inhibit

dopamine breakdown)

Nursing diagnosisImpaired physical mobility related to muscle

rigidity and motor weaknessSelf-care deficits (feeding, dressing, hygiene, and

toileting) related to tremor and motor disturbanceConstipation related to medication and reduced

activityImbalanced nutrition, less than body requirements,

related to tremor, slowness in eating, difficulty in chewing and swallowing

Impaired verbal communication related to decreased speech volume, slowness of speech, inability to move facial muscles

Ineffective coping related to depression and dysfunction due to disease progression

Alzheimer's DiseaseThe most common cause of dementiaA chronic, progressive, degenerative brain

disorder that effects 4.5 million people in the United States

Research suggests oxidative stress plays a role in the pathophysiology of this disease

Degenerative Disk Disease Most back problems are related to disk disease.Degenerative changes occur with aging or are

the result of previous trauma. In herniation of the intervertebral disk

(ruptured disk), the nucleus of the disk protrudes into the annulus (the fibrous ring around the disk), with subsequent nerve compression.

Continued pressure may produce degenerative changes in the nerves with resultant changes in sensation and motor responses.

Normal Spinal Vertebral and Ruptured Vertebral Disk

Clinical ManifestationsA herniated disk with accompanying pain

may occur in any portion of the spine: cervical, thoracic (rare), or lumbar.

The clinical manifestations depend on the location, the rate of development (acute or chronic), and the effect on the surrounding structures.

Low back pain with muscle spasms, followed by radiation of the pain into one hip and down into the leg (sciatica).

Paresthesia

ManagementTreatment is usually conservative—rest and

medications.Surgery may be required.Discectomy: removal of herniated or extruded

fragments of intervertebral diskLaminectomy: removal of the bone between

the spinal process and facet pedicle junction to expose the neural elements in the spinal canal; this relieve compression of the cord and roots

Hemilaminectomy: removal of part of the lamina and part of the posterior arch of the vertebra

Partial laminectomy or laminotomy: creation of a hole in the lamina of a vertebra

Nursing Process: The Care of the Patient with Cervical Diskectomy—AssessmentDetermining the onset, location, and

radiation of painAssessing for paresthesia, limited movement,

and diminished function of the neck, shoulders, and upper extremities

Determine whether the symptoms are bilateral

Cervical spine palpated to assess muscle tone and tenderness

Range of motion in neck and shoulders is evaluated

Health issuesPatient education

Nursing Process: The Care of the Patient with Cervical Diskectomy—Diagnoses

Acute pain related to the surgical procedureImpaired physical mobility related to the

postoperative surgical regimenDeficient knowledge about the postoperative

course and home care management

Nursing Process: The Care of the Patient with Cervical Diskectomy—Collaborative Problems/Potential Complications

Hematoma at the surgical site, resulting in cord compression and neurologic deficit

Recurrent or persistent pain after surgery

Nursing Process: The Care of the Patient with Cervical Diskectomy—Nursing InterventionsRelieving painImproving mobilityMonitoring and managing potential

complicationsPromoting home and community-based care