nursing care plan patient with gynecology chemotherapy
DESCRIPTION
NURSING CARE PLAN PATIENT WITH GYNECOLOGY CHEMOTHERAPY. Ni Ketut Alit A Nursing Faculty Airlangga University Surabaya East Java. REFERENCES. Bobak LM & Jensen MD (1993 ) Maternity & Gynecologyc Care, The Nurse and The Family 5 th ed , St Luis : CV Mosby Company. - PowerPoint PPT PresentationTRANSCRIPT
NURSING CARE PLAN
PATIENT WITH GYNECOLOGY CHEMOTHERAPY
Ni Ketut Alit ANursing Faculty Airlangga University
Surabaya East Java
REFERENCES
Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care, The Nurse and The Family 5th ed , St Luis : CV Mosby Company.
Black, J.M. & Matassarin E, (1997). Medical Surgical Nursing: Clinical Management for continuity of care. J.B. Lippincott.co.
Smeltzer, S.C., & Bare, B. (2003). Brunner and Suddarth's Textbook of Medical-Surgical Nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Ignativicius & Bayne. (2001). Medical and Surgical Nursing. Philadelphia: W.B. Saunders Company.
Luckman & Sorensen. (2000). Medical Surgical Nursing. Philadelphia: W.B. Saunders Company.
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TERMINOLOGY
Neoplasm “new plasma”…abnormal tissue growth with
rapid growthBenign no metastasisMalignant local invasion and destructive
growth…”wicked”Metastasis spread form primary via lymphatic and/or
circulatory system
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)
SURGERY
Curative
Prophylactic
Diagnostic
Staging
Palliative
Adjuvant or Supportive
Reconstructive/Rehabilitative
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)
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
CANCER BACKGROUND
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.
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 (VAD’s, pain, edema, swelling,
induration at site) sepsis (hypotension, agitation, decreased urine)
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
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
THROMBOCYTOPENIA
Assess risk factors chemotherapy / radiation DIC disease infiltration NSAID's petechaie hemorrhage (skin, GI, GU) headaches, confusion, somnolence
Management
Institute bleeding precautions <50,000/mm3
Decrease activity and no lifting or straining/Valsalva
High fiber, increase fluids, stool softeners
No razors, nail clippers, douching, tampons, water-soluble lubricants, no flossing, guiac/hemocult, pad counts
Maintain SBP <140mm/Hg
No IM injections, apply pressure to all sites, no NSAIDS, administer platelets per protocol
Educate patients signs and symptoms
ANEMIA=DECREASED RED BLOOD CELLS
Assess for chemotherapy
kidney damage
tumor infiltration
bleeding, hemorrhage
age, appetite
Management:
Rest, slow position changes
Oxygen
Iron
Transfusion
Patient education on signs and symptoms
GI SYMPTOM
60% patients experience nausea and vomiting, 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
OTHER NOTABLE SIDE EFFECTS
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
NURSING CARE- NURSING DIAGNOSIS
Anxiety1. 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 productive2. Fear of rejection, stigma
C. Anticipatory Grieving1. Facing death and making preparations for death.2. Offer realistic hope that cancer treatment may be successful
NURSING CARE- NURSING DIAGNOSISD. Risk for InfectionE. Risk for InjuryF. Altered Nutrition: less than body requirementsG.Impaired Tissue Integrity