chemotherapy of gynekologi
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NURSING CARE PLAN
PATIENT
WITH GYNECOLOGY CHEMOTHERAPY
Ni Ketut Alit A
Nursing Faculty Airlangga University
Surabaya East Java
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REFERENCES
Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care, The
Nurse and The Family5thed , St Luis : CV Mosby Company.
Black, J.M. & Matassarin E, (1997). Medical Surgical Nurs ing:Cl in ical Management for con t inui ty of c are. J.B. Lippincott.co.
Smeltzer, S.C., & Bare, B. (2003). Brun ner and Suddarth 's Textbook
of Medical-Surg ical Nurs ing (10thed.). Philadelphia: LippincottWilliams & Wilkins.
Ignativicius & Bayne. (2001). Medical and Surg ical Nurs ing .Philadelphia: W.B. Saunders Company.
Luckman & Sorensen. (2000). Medical Surgic al Nursin g. Philadelphia:W.B. Saunders Company.
Journals and article related to..
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TERMINOLOGY
Neoplasm
new plasmaabnormal tissue growth with rapid
growth
Benign no metastasis
Malignant
local invasion and destructive growthwicked
Metastasis
spread form primary via lymphatic and/or circulatory
system
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DEFINITIONS
1. Cancer is a disease of the cell
2. Large group of diseases characterized by:
a. Abnormal cell structure(no differentiation)
b. Uncontrolled growth (proliferation)
c. Ability to spread (metastasis)
d. Ability to invade normal tissue (lack contact inhibition)
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SURGERY
Curative
Prophylactic
Diagnostic
Staging
Palliative
Adjuvant or Supportive
Reconstructive/Rehabilitative
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RADIATION
Highest energy rays that can kill any cell or tissue
May be external source (brachytherapy)
Curative
Palliative 60% will receive XRT
Divided into doses or fractions
(Preserve normal cellular growth)
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CHEMOTHERAPY
Cytotoxic drugs that destroy cancer cells or prevent
cellular replication by interfering with DNA and RNA
and vital cellular proteins
Goal is to reduce the number of cells to a small
number that can be (theoretically) handled by the
immune system
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PRINCIPLES OF CANCER
TREATMENT
CURE
CONTROL
PALLIATION
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GENITAL CANCER
Cervical
Endometrial
Ovarian Testicular
Breast
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CANCERBACKGROUND
1. Family of complex diseases
2. Affect different organs and organ systems
3. Normal cells mutate into abnormal cells
4. Eventually harm and destroy host 5. Historically, cancer is a dreaded disease
6. Cancer accounts for about 25% of death.
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SIDE EFFECT OF CHEMOTHERAPY
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MYELOSUPPRESSION
NEUTROPENIA
THROMBOCYTOPENIA
ANEMIA
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NEUTROPENIA/LEUKOPENIA
Assess risk factors
(Age, renal and liver function, nutrition, bone marrow, other
medications, prior chemotherapy and/or radiation)
Manifestations include
fever >38 C or 100.4F (no classic signs)
cough, SOB
skin redness or tenderness, (mouth, perianal, rectal)
urinary symptoms (dysuria frequency, hematuria,
hesitancy)
indwelling devices (VADs, pain, edema, swelling,
induration at site)
sepsis (hypotension, agitation, decreased urine)
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PREVENTION
No fresh fruits or vegetables, no pepper, live
plants or potting soil
No exposure to live vaccines or pet excreta
Avoid others with colds Strict hand washing and personal hygiene
Mouth care at least 4 times daily
No trauma or invasive procedures
Prevent constipation and pressure sores
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Management:
BC lines and peripheral, urine, sputum
Good physical assessment
Antibiotics immediately (broad spectrum coverage)
Patient education
Vital signs at least every 4 hours or more
Assess for chills, cough, pain
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THROMBOCYTOPENIA
Assess risk factors
chemotherapy / radiation
DIC
disease infiltration NSAID's
petechaie
hemorrhage (skin, GI, GU)
headaches, confusion, somnolence
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Management
Institute bleeding precautions
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ANEMIA DECREASED RED BLOOD CELLS
Assess for
chemotherapy
kidney damage
tumor infiltration
bleeding, hemorrhage
age, appetite
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Management:
Rest, slow position changes
Oxygen
Iron
Transfusion
Patient education on signs and symptoms
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I SYMPTOM
60% patien ts experience nausea and
vom it ing , etc..
Patterns
Anticipatory (starts and may last several hours to days)
Acute (0-24 hours)
Delayed (1-4 days)
medications, stress management
Assess for weight loss, albumin, hydration
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OTHERNOTABLESIDEEFFECTS
Up to 80% develop mouth sores
Skin reaction : hypersensitivity, hyper pigmentation,
photo sensitivity, Ulceration Hair loss : damage is to shaft (thinning and breakage),
damage to roots (complete alopecia), loss begins about
2 weeks after treatment, regrowth may take up to 3-5
months after treatment
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NURSING CARE- NURSING DIAGNOSIS
Anxiety
1. Therapeutic interactions with client and family.
2. Availability of community resources for terminally ill.
B. Disturbed Body Image1. Includes loss of body parts ; loss of energy, ability to be productive
2. Fear of rejection, stigma
C. Anticipatory Grieving
1. Facing death and making preparations for death.2. Offer realistic hope that cancer treatment may be successful
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NURSING CARE- NURSING
DIAGNOSIS
D. Risk for Infection
E. Risk for Injury
F. Altered Nutrition: less than body requirements
G. Impaired Tissue Integrity
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