Transcript chemotherapy

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 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.

Journals and article related to..
TERMINOLOGY
Neoplasm
 “new plasma”…abnormal tissue growth with
rapid growth
Benign
 no metastasis
Malignant
 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
PRINCIPLES OF CANCER
TREATMENT
CURE
CONTROL
PALLIATION
GENITAL CANCER
•
•
•
•
•
Cervical
Endometrial
Ovarian
Testicular
Breast
CANCER BACKGROUND
1.
 2.
 3.
 4.
 5.
 6.

Family of complex diseases
Affect different organs and organ systems
Normal cells mutate into abnormal cells
Eventually harm and destroy host
Historically, cancer is a dreaded disease
Cancer accounts for about 25% of death.
SIDE EFFECT OF CHEMOTHERAPY
MYELOSUPPRESSION
NEUTROPENIA
THROMBOCYTOPENIA
ANEMIA
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
Anxiety
1. Therapeutic interactions with client and family.
2. Availability of community resources for terminally ill.
B. Disturbed Body Image
1. 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
NURSING CARE- NURSING
DIAGNOSIS
D.
E.
F.
G.
Risk for Infection
Risk for Injury
Altered Nutrition: less than body requirements
Impaired Tissue Integrity