Perioperative Whole-Course Nursing of an Elderly Patient with Right Frontal Glioblastoma Complicated by Type 2 Diabetes: A Case Report Based on the 5A Nursing Model

Abstract

Background: Glioblastoma (WHO grade IV) is the most aggressive primary intracranial malignancy in adults. Elderly patients often present with comorbid diabetes and multiple postoperative complications, posing substantial challenges to perioperative nursing. This case report summarizes our experience in managing a 68-year-old man with right frontal glioblastoma complicated by type 2 diabetes mellitus using the 5A nursing model (Assess, Advise, Agree, Assist, Arrange). Case presentation: Within 24 hours of admission, a five-dimensional advanced health assessment stratified nursing problems into priority, medium-priority, and low-priority. Preoperative interventions focused on intracranial pressure monitoring, constipation management, and glycemic control. During the neurosurgical intensive care unit (NICU) phase, bundle care was delivered to prevent ventilator-associated pneumonia (VAP); early dysphagia screening and stepwise rehabilitation were initiated; and stratified mechanical prophylaxis of venous thromboembolism (VTE) was applied. In the recovery phase, multidisciplinary early mobilization and fall/seizure safety management were provided, followed by a closed loop of short-term follow-up and home care guidance after discharge. Results: The patient was hospitalized for 18 days. No cerebral herniation, unplanned extubation, pressure injury, deep vein thrombosis, or aspiration pneumonia occurred. At discharge, the Kubota water drinking test improved from grade 4 to grade 2, right limb muscle strength recovered from grade 2 to grade 4, and fasting blood glucose stabilized at 7-8 mmol/L. Conclusions: The 5A nursing model enabled dynamic assessment, precise intervention, and continuity of care throughout the perioperative trajectory in this complex high-grade glioma case. This approach may be valuable for neurosurgery specialty nursing practice.