Nursing Management 1 PARASAGITTAL MENINGIOMA Nursing management of a patient with Parasagittal Meningioma Nursing Management 2 Nursing management of patient with PARASAGITTAL MENINGIOMA P. A a 41 years old male was brought to the hospital due to the chief complaint of headache and dizziness. During the interview, the patient stated that 2 days prior to admission, he was having a severe headache associated with blurring of vision and dizziness. He took paracetamol which provided temporary relief without any consultation done. He was prompted to seek medical attention on March 23, 2011 due to persistent headache.
He underwent MRI scan and revealed that the left part of his brain have a tumor that can lead him to be diagnosed with other signs and symptoms of having a Parasagittal Meningioma. According to Dienpenbrock (2004), Meningiomas are slow-growing and most often occur in middle aged adults. The standard treatment is surgery with the complete removal or partial dissection. Nursing management should focus on the treatment and preventing the effect of increased intracranial pressure or ICP by closed monitoring vital signs, and motor functions should also be checked because specific motor deficits may occur depending on the tumor’s location.
Pathophysiology Parasagittal meningiomas form near the falx, a groove that runs along the brain fromfront to back, according to medical experts at the Brigham and Women’s Hospital. Meningiomas may occur intracranially or within the spinal canal. They are thought to arise from arachnoidal cap cells, which reside in the arachnoid layer covering the surface of the brain. Meningiomas commonly are found at the surface of the brain, either over the convexity or at the skull base. In rare cases, meningiomas occur in an intraventricular or intraosseous location.
The problem of classifying meningioma is that arachnoidal cells may express both mesenchymal and epithelial characteristics. Other mesodermal structures also may give rise to similar tumors (eg, hemangiopericytomas or sarcomas). The classification of all of these tumors together is controversial. Nursing Management 3 The current trend is to separate unequivocal meningiomas from other less well-defined neoplasms. Undoubtedly, advances in molecular biology will allow scientists to determine the exact genomic aberration responsible for each specific neoplasm.
Parasagittal meningioma causes symptoms like: Headache that is due to the increase the normal pressure levels within the brain. The severity of headache pain can range from mild to severe and can localize within any region of the head. Leg weakness can also occur. Typically, a meningioma that forms on the left side of the falx causes right leg weakness, while a meningioma that forms on the right side of the falx causes left leg weakness, explain medical experts with the Merck Manual. In certain cases, sensations of weakness can affect both legs and can experience difficulty standing or walking normally.
Vision Problems is also present because of increased pressure within the brain it can affect the optic or eye nerve. If the optic nerve is damaged or pinched, he or she can develop vision problems as a symptom of this condition, report health experts with the Mayfield Clinic. Affected people can experience blurred or cloudy vision, which may contribute to headache symptoms or sensations of dizziness. Cognitive dysfunction or Personality Changes may affect people as stated by professionals with the Brain Science Foundation. A person who is normally quiet or reserved can suddenly become talkative and outgoing.
Alternatively, social people may appear abruptly withdrawn or depressed. Some of these are signs and symptoms manifested by P. A. that can lead him to be diagnosed to have Parasagittal meningioma. Nursing Management 4 History P. A. , a 41 years old male was complaining of headache and some episodes of dizziness. He was admitted and diagnosed to have Parasagital Meningioma. According to him, it was his third time to be hospitalized. He stated that he had no previous illness, surgeries and medication therapy. The patient does not have any history of any diseases such as hypertension, diabetes ellitus, heart disease and lung disease. He is having an allergy with fish and doesn’t have any allergies to drugs. He’s avoiding to eat pork because of his religion Islam. Nursing Physical Assessment P. A is conscious alert and coherent. The patient vital signs were as follows: body temperature 37. 5 degree Celsius, pulse rate 81bpm, blood pressure 120/70 mmHg, respiratory rate 17cpm. The client voice was soft and talks pretty slow. He appeared to be disabled. We asked the client about his feelings. He was quite emotional about his situation.
He is having headache and also stated the he was experiencing pain at the level of 8. This was related from the surgery he had which can also cause him increase intracranial pressure. The patient had a visible curve on his left parietal head. And that was from the recent surgery he had. The patient is unable to move his right arm, probably due to the left affected part of the brain that would cause few or complex disability on his right hemisphere. The patient’s lower extremities particularly his legs are quite skinny and very weak. He was unable to walk and currently using a wheelchair and assistance from his siblings.
He had some wound marks and also has several gunshot marks on his upper and lower right leg. He appeared to have some weakness. The patient did not have any intravenous line, and he is currently wearing eyeglasses due to his vision problems which were caused by his brain condition. He said that the pain was sustained for several days. Nursing Management 5 Related Treatments According to Mayfield clinic a parasagittal meningioma can increase the normal pressure levels within the brain. This pressure elevation can cause headache symptoms in people with this condition. Encourage the patient to verbalize his feelings.
Monitoring of patient’s pain is very important together with adequate bed rest and proper drug compliance to relieve headache, drugs: (Celecoxib) TID. Another thing is that, a meningioma that forms on the left side of the falx causes right leg weakness, while a meningioma that forms on the right side of the falx causes left leg weakness, explain medical experts with the Merck Manual. For this reason safety is the priority for the patient, proper assistance, range of motion exercise, physical therapy, adequate nutrition and drug compliance, Rest between activities provides time for energy conservation and recovery.
If the optic nerve is damaged or pinched, people with a parasagittal meningioma can develop vision problems as a symptom of this condition, report health experts with the Mayfield Clinic. For this reason, wearing eyeglasses will help to improve the patient’s visual problems related to his condition. Parasagittal meningiomas that develop near the front portion of the falx can lead to significant brain dysfunction in affected people, warn medical professionals with the Brain Science Foundation.
People with this condition can experience unusual memory loss or can have difficulty with logical decision-making, drugs: (Nurocer. , Adjunct in the treatment of myoclonus of cortical origin; dementia ; other disorders/states w/c include alcoholism, vertigo, cerebrovascular accidents, behavioral disorders. Depakote, valproates 5-15 mg/kg/day), for this situation understanding the patient’s situation with proper drug compliance to treat these symptoms, and a nurse-patient relationship is also an important independent therapeutic approach for this.
Must prioritized safety and closely monitoring the patient symptoms is a must to ensure that the patient is responding well to the treatments. Nursing Management 6 Nursing Care Plan Based on what Hickey (2003) have said, one of the complication that may be prevented is headache. So P. A’s nursing diagnosis is chronic pain related to brain trauma as evidenced by verbal reports, guarding behaviour and limited range of motion. Some of the assessment that suggests that the patient was having chronic pain was disorientation, increasing irritability and facial grimacing when palpitated.
His vital signs were as follows: body temperature 37. 5 degree Celsius, pulse rate 81bpm, blood pressure 120/70 mmHg, respiratory rate. The goal is to relieve the pain from pain scale of 8 to 3 and to decrease the facial grimacing. The nursing interventions for P. A’s nursing diagnosis were as follows: First is to establish rapport to gain the patient’s trust. Next is to perform comprehensive assessment of pain (location, duration, onset, intensity). These assess the pain felt by the patient. Next is to assess vital signs, noting high blood pressure, rapid heartbeat and increase in body temperature.
Physical signs and complaints associated with chronic pain should also be noted. Administer medications as ordered by the physician. Provide patient with health teaching such as: having a bed rest and encouraged to stay on non-stimulating environment to reduce or lessen the pain that triggers him. During the nursing interventions the patient is responsive and tried his very best to help him feel more comfortable. Nursing Management 7 Recommendations In order for P. A to continue his recovery and improve his state of well being, he must adhere to all the orders made by his physician.
He must also learn how to provide opportunity to re-energize and refocus on tasks at hand because he was expected to have easy fatigability. Encourage the patient to ask questions regarding his concerns regarding his health to his care providers. References * Smeltzer, Bare, Hinkle, Cheever (2008). Medical Surgical. Brunner and Suddarth’s (Eleventh Edition). Pages 2302-2306. * Mayfield Clinic: Meningiomas * Brigham and Women’s Hospital: Meningioma * Brain Science Foundation: Meningiomas * Merck Manual: Meningiomas * Meningiomas. org: Parasagittal Meningiomas