Nursing care for high-grade glioma patients and treatment modalities

¶ … Brain Tumors

Primary brain tumor (PBT) patients have numerous and multifarious physical, mental and emotional needs that may negatively impact the patients\' as well as their caregivers\' psychology. HGG or high-grade glioma patients particularly suffer poor prognosis, in addition to decreased life expectancy. They typically undergo swift deterioration of mental and physical functioning. Furthermore, they also typically display a vigorous set of needs all through the course of their care trajectory, right from the diagnostic period through the tumor re-emergence stage and palliative stage. Intense changes occur in both their physical performance and psychological performance (i.e., behavior, mood, and cognitive changes and distress) (Trad, et al., 2015).

Nurse care sticks to the rules outlined by the SAE program (Sistematizacao da Assistencia de Enfermagem, translated as Nursing Care Systematization) via the NP (nursing process) put into action in the nation of Brazil during the seventies by Wanda Aguiar Horta. It may be construed as the real-world implementation of nursing profession theory to the area of patient care. This process comprises of the following 5 steps: examination, nurse diagnosis, care planning, care execution, and appraisal. Nursing staff employ the above structure as a care optimization technique aiding interdisciplinary communication with regard to patient healthcare (Magalhaes, et al., 2015).

Gliomas

Presentation

HGGs represent cancerous, typically fast-progressing brain tumors grouped under the following categories depending on their histopathologic characteristics: glioblastoma or GBM and anaplastic gliomas (oligo astrocytoma, astrocytoma, and oligodendroglioma). HGG-diagnosed individuals generally display increasing and sub-acute neurological symptoms and indications which differ depending on the tumor site in the person\'s brain. Brain MRIs (magnetic resonance imaging) offer confirmation of mass lesions. However, for differentiating between HGG and other metastatic and primary tumors of the brain, tissue diagnoses are eventually needed (Batchelor & Curry, 2016).

Treatment Modalities

Tissue diagnoses are vital in case of individuals suspected of having HGG. This may be achieved during surgical resection or separately (via biopsy procedure). The process of biopsy is utilized as a standalone technique when lesions prove non-receptive to resection, or when general patient health status disallows surgery, or when it is not possible to eliminate a meaningful quantity of the tumor tissue. Resection forms the first step in HGG treatment. Maximal resection whilst preserving neurological functioning represents a key objective in preliminary treatment of HGG. A balance should be attained between surgery levels and neurological function maintenance. Pre-surgical positron emission tomography (PET) scans and echo-planar or functional MRIs can aid in optimizing definition of tumor volume and minimizing surgery-inflicted injuries to speech areas through enabling pre-surgical definition of normal and impacted brain regions and functional brain tissue mapping, respectively. PET\'s significance has been demonstrated using 103 brain tumor-diagnosed individuals, of whom 40 suffered from HGG. MET (L-[Methyl]-11C Methionine) -- PET and FDG (fluorodeoxyglucose) -- PET images combined with information from MRI scans guide the tumor\'s maximal operative resection. On the whole, PET alters tumor resection aims among four in five patients. It is not known whether the modified resection volumes present any prognostic implication; however, the capacity of targeting hyper-metabolic regions through operation helps undertake prioritization with potential clinical advantages (Batchelor & Curry, 2016).

Patient Education

While considerable novel studies have surfaced with regard to cancerous PBT patients\' and caregivers\' psychosocial needs, wellbeing and experiences since the year 2005, it is largely observational and not many novel interventions are tested by researchers. Reviewed research works reveal numerous common themes, including communication issues (Ford, Catt, Chalmers, & Fallowfield, 2012).

1. HGG-diagnosed individuals generally display neurological symptoms and indications which differ depending on the tumor site in the person\'s brain. Brain MRIs (magnetic resonance imaging) offer confirmation of mass lesions. However, for differentiating between HGG and other metastatic and primary tumors of the brain, tissue diagnoses are eventually needed (Batchelor & Curry, 2016).

1. In case of freshly-diagnosed HGG patients (including astrocytic astrocytoma as well as glioblastoma multiforme (GBM)), maximal operative resection is advised as opposed to biopsy, in line with neurological function maintenance (Batchelor & Curry, 2016).

1. Age, histologic tumor grade and type, performance status, and progressively well-described molecular aspects like isocitrate dehydrogenase (IDH) 1 or 2 mutations, Management (methyl guanine methyl transferase) promotor methylation and 1p19q co-deletion (chiefly in case of oligodendroglial tumors) represent the most salient elements impacting HGG patients\' survival and health outcomes (Batchelor & Curry, 2016).

Meningiomas

Presentation

Meningiomas present symptoms through numerous means. Symptoms might emerge due to underlying cortex irritation, cranial nerves or brain compression, vascular brain injury, or hyperostosis and superimposing soft tissue invasion. Secondary meningioma symptoms and indications might surface or worsen at the time of pregnancy; however, normally, they subside following childbirth. Physical results echo the above symptoms and also encompass signs resulting from increased intracranial pressure, underlying parenchyma compression, cranial nerve involvement, and subcutaneous tissue and bone involvement by meningiomas (Haddad, 2016).

Treatment Modalities

Meningioma treatment has proved to be disappointing and restricted to either perioperative medicines or medicines administered when every other treatment method has proven unsuccessful. While a majority of meningiomas develop slowly with a small mitotic rate, several cases indicate clinical benefit with tumor stasis or regression following radiotherapy. But randomized trials fail to corroborate the above outcomes. The idea of non-malignant meningiomas\' development represents a key consideration with regard to their effective management. Roughly forty percent of 273 meningioma occurrences (among 244 patients) grew in four years\' time. Non-calcification, peritumoral edema and T2 MRI hyper-intensity predicted growth during the follow-up phase. Further, increased risks were linked to age25-millimeter diameter tumor (Haddad, 2016).

The following constant meningioma resection principles have been defined:

1. Wherever possible, every hyperostotic or involved bone ought to be removed. Both involved dura and tumor-free dural rim ought to be resected (here, duraplasty is carried out).

1. Removal of dural tails surfacing on the MRI scans is recommended, despite some being tumor-free. Provisions to harvest an appropriate dural substitute (fascia lata or pericranium) ought to be made.

1. Commercial dural substitutes may be utilized as well. If possible, always begin by coagulation of artery feeders to meningiomas.