SPINAL CORD TUMORS
Tumors are classified according to their anatomic relationship to the spinal cord.
CLASSIFICATIONS OF SPINAL CORD TUMORS
- They includes intramedullary lesions(within the spinal cord),extramedullary intradural lesions(within or under the spinal dura),and
- Extra medullary extradural lesions(outside the dural membrane)
CLINICAL MANIFESTATIONS
Tumors that occur within the spinal cord exerts pressure on it causing symptoms ranging from localized or shooting pain and weakness and loss of reflexes above the tumor.Sharp pain occurs in the area innervated by the spinal roots that arise from the cord in the region of the tumor.
ASSESSMENT AND DIAGNOSTIC FINDINGS
Neurological examination and diagnostic studies.Neurological examination includes assessment of pain,loss of reflexes,loss of sensation of motor function and presence of weakness or paralysis.
Additional tests includes elevated ESR,X Rays,Radionucleotide studies,CT Scan and MRI,Biopsy.
MEDICAL MANAGEMENT
Treatment for intraspinal tumors depends on depends on the type and location of the tumor and presenting factors and physical status of the patient.Other treatment modalities are partial removal of the tumor,decompression of the spinal cord,chemotherapy and radiation therapy,particularly for intramedullary tumors and metastatic lesions.
For patients with epidural spinal cord compression resulting frommetastatic cancer(most common from breast,prostate or lungs)high dose dexamethasone combined with radiation therapy is effective.
SURGICAL MANAGEMENT
Tumor removal is desirable but not always possible.Microsurgical procedures have improved the prognosis for patients with intramedullary tumors.Prognosis depends on the degree of neurological impairment at the time of the surgery and the speed with which the symptoms have occurred and the origin of the tumor.Patients with extensive neurological deficits before the surgery doesnot make significant functional recovery even after the tumor is removed.
NURSING MANAGEMENT
Providing preoperative care
Objectives of preoperative care includes recognition of neurological deficits through ongoing assessment,pain control and management of altered activities of daily living resulting from sensory and motor deficits and bowel and bladder disturbances.
Patient is evaluated for coagulation disorders.A history of aspirin intake has to be noted because aspirin can delay hemostasis postoperatively.Breathing exercises are taught and demonstrated.
Assessing the patient after the surgery
Patient is noted for deterioration in neurological function.Frequent neurological tests are done to assess the strength and sensation of the upper and lower extremities.Assessment of the sensory function involves pinching of the skin of arms,legs and trunk.Vital signs are monitored at regular intervals.
Managing pain
Prescribed pain medication should be administered in adequate amounts and at appropriate intervals to relieve pain and discomfort.Bed is kept flat initially.The nurse turns the patient as a unit,keeping the shoulders aligned and the back straight.Sidelying position is much comfortable,because this imposes less pressure on the surgical site.Placement of a pillow between the knees of the patient prevents knees flexion.
Monitoring and managing potential complications
If the tumor is in the cervical area,possibility of respiratory complications are more.Nurse monitors the patient for asymmetric chest movement,abdominal breathing and abnormal breathsounds.For high cervical tumor lesions the ET Tube should be in placeuntil adequate respiratory function is ensured.Patient is encouraged to do deep breathing and coughing exercise.Area over the bladder is palpated and a scanning is done to rule out distension.Monitor for urinary dysfunctions,an intake and output chart is usually maintained.Abdomen is auscultated for bowel sounds.Staining of the dressing indicates leakage of CSF from the surgical site which can lead to serious infection or inflammatory reactions in the surrounding tissue in the post operative period.
PROMOTING HOME AND COMMUNITY BASED CARE
Teaching patient self care
Patient is assessed for the ability to perform the activities independently in the home.Patient with residual sensory impairment is cautioned about the dangers about the extremes in temperature ,They should be alerted to the dangers of heating devices(eg:hot water bottles,heating pads)..Patient is taught to check the skin integrity.Patients with impaired motor functioning is trained for use of assistive devices such as cane,walker or wheelchair.Patient and family members are educated regarding the pain management strategies,bowel and bladder management and assessment of signs and symptoms that should be reported.
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