chemotherapy of gynekologi

8/10/2019 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
http://www.naturalawakenings.com/images/dep-skin.gif


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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
http://www.naturalawakenings.com/images/dep-skin.gifhttp://www.naturalawakenings.com/images/dep-skin.gif


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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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chemotherapy of gynekologi

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