Transcript ASUHAN KEPERAWATAN PADA TN. S DENGAN CA. …

NURSING MANAGEMENT TO Mr. S, PATIENT
WITH PEDIS EPIDERMOID CARSINOMA AT
SURGERY WARD A3 DR KARIADI HOSPITAL
BY:
Toto Dinar W
Cancer is diseases characterized by excessive,
uncontrolled growth of abnormal cells,
which invade and destroy other tissues
Cancer usually develops gradually over many years,
the result of a complex mix of environmental,
nutritional, Life Style, and hereditary factors.
According to World Health Organization about 6, 25 million people
suffer cancer every year. Epidermoid carsinoma includes the tenth
of most common cancer In Indonesia. In Dr. Karyadi hospital there
are seven cases of epidermoid cancer.
Psychologycal aspect, family and Nurse support
Epidermoid carcinoma is a cista caused by
epidermoid cell which invades and grows to the
subcutis tissues because of severe trauma
(Mansjoer, 2000).
Squamous cell carcinoma is malignant neoplasma
of the keratinocytic shaped from more differentiated
epidermis cells (Anugrah, 1995)
Squamous cell carcinoma is keratinocytic tumor
affected
the skin and mucous membranes, with variated
malignancy degree (Harahap, 2000).
Sunlight
Chemical
Carsinogen
Heredity ras
Chronic ulcer
Imunosuppressive
Therapy
Chronic exposure of sunlight, chemical carsinogen,
trauma, heredity disorder, Imunosuppressive Therapy
can damage epidermis cell via RNA chain breaking.
RNA chain breaking will make epidermis cells be poorly
differentiated.
These poorly diferentiated cell become uncontrolled
growth and hyperplasia
which invade and destroy surroundings tissues. Function
of the skin regeneration become to be disturbed.
If this conditions is so long, it can damage
the tissues and may be skin ulcer and damage lower
layers.
well differentiated
moderately
differentiated
poorly differentiated
1. Colored nodul like normal skin, smooth surface without
crusta or ulcer with clearer limited side.
2. redness nodul with popilomatosa or verukosa like
cabbage flower
3. Ulcer with crusta on the side surface rise and less
redness
4. Squamouse cell carcinoma of the normal skin often
more quickly invade and metastases, than lesion
appeared by actinic keratoses.
Early detection and treatment are the keys to survival
Surgical operation.
Radiotherapy
1. Pain related to periphery nerve tissues
destruction
2. Anxiety related to threatening or altered health
status, situation crisis.
3. Risk for infection related to transmission
microorganism secondary to wound.
4. Impaired Skin integrity related to inflammation
between dermis and epidermis secondary cancer
cell.
5. Ineffective individual coping related to lack of
family support system.
Assesment was on July 20- 21 2005
Mr. S, 6O years old, moeslem, Javanese race, farmer, address:
sembung, kedonan district, Blora. The client admitted on July 5 th
2005, at 3 p.m. with medical diagnosis Pedis Epidermoid
Carcinoma.
The Chief complaint is pain in the left leg because of his ulcer.
About 2 months ago there were tumor in the left leg, the client felt
itchiness and then it rounded up. The ulcer became putrid. The
client said that he could not have activated because of pain and
fear with his bleeding wound. The client said his disease as a
God’s punishment.
There were ulcer about 6 cm on the sinistra pedis, unflat wound,
bleeding, unpleasant odor, wound penetrated reach the leg bone.
Hb, 11, 00 gr/dl, Ht 33, 5 %, Leucocyte 11. 700 /mikro L,
Trombocyte: 471.000 /mikro L
Therapy programme
Amoxycillin 3 x 500 mg, mefenamat acid 3 x 500 mg.
1. Pain related to periphery nerve tissues destruction
secondary cancer cell.
Subjective data the client complain pain on the
left leg.
Objective data there were ulcer about 6 cm. on
the lef leg.
2. Risk for infection related to transmission
microorganism secondary to wound
Subjective data client said that his ulcer have not
yet recovered.
Objective data there were ulcer about 6 cm. on
the lef leg, dirty wound unpleasant odor,
leucocyte 11. 700 /mikro.
3. Risk for hipovolemic shock related to disorder of trombocyte cell
secondary cancer cell.
Subjective data client said wound bleeding
Objective data blood leak around the wound, wound easy to bleed,
blood pressure 100/60 mmHg, Trombocyte 471.000/mikro
4. Anxiety related to deficit of knowledge about disease process,
medicine,and other therapy.
Subjective data the client said that he has not known about
medicine procedures.
Objective data The client appeared be upset, asked about therapy
programe.
5. Ineffective individual coping related to lack of family support
system.
Subjective data the client said his illness as God punishment.
Objective data The client had a daydream.
1. Pain related to periphery nerve tissues destruction
secondary cancer cells.
Acute pain is condition in which an individual experience and
report their terrific uncomfortable for six month or less
(Carpenito, 2001).
Pain appeared because of invading of cancer cells to the
dermis which have blood vessel and nerve tissues. It will
stimulate norciceptor to send impuls to the cortex cerebry.
The main priority in this implementation are to teach
distraction and relaxation.
After doing nursing care the problem can be solved.
2. Risk for infection related to transmission
microorganism secondary to wound.
Risk for infection is the state in which an individual has an
increased susceptibility for invation by pathogenic or
opportunistic organism.
According to carpenito Risk for infection can be related to
decrease body immune system secondary to cancer.
Risk for infection appeared because cancer cells have destroyed
lymph tissues in homolateral, so T sitotoxic lymphocytes damaged
by cancer cell.
The main priority in this implementation is to take care wound.
After doing nursing care, a part of the problem can be solved.
3.
Risk of hipovolemic shock related to cell disorder of
trombocyte secondary cancer cell.
Hipovolemic shock is imbalance between blood volume
with vascular cavity which can be caused loss of intravascular
fluid for the example bleeding.
The writer takes this diagnosis because of thrombositosis
and it will cause bleeding to patient.
The main priority in this implementation are to give motivation
the patient to drink a lot of water and take blood sample.
After doing nursing care the problem can be solved.
Superi or
vena cava
Aortic artery
Pulmonary artery
Pulmonary veins
Pulmonary veins
Left atrium
Pulmonary valve
Mitral val ve
Right atri um
Left ventricl e
Tricuspi d val ve
Chordae tendi nae
Interventricul ar
septum
Right ventri cle
Inferior
vena cava
Papil lary muscles
Descending aorta
HEA RT
4. Anxiety related to deficit of knowledge about disease process,
medicine, and other therapy.
Anxiety is the state in which an individual or group
experience worried and activate the autonomy nerve system
in responding to unclear threatening.
The writer takes this diagnosis because patient with
carcinoma often feel powerlessness and scare to be dead.
The main priority in this implementation is to give
information about his disease and therapy programme, and
to do ECG examination.
After doing nursing care the problem can be solved.
5.
Ineffective individual coping related to lack of family support
system.
Ineffective individual coping is impairment of adaptive
behaviors and problem solving abilities of person in
meeting life’s demand and role.
The writer takes this diagnosis because Ineffective
individual coping mechanism can appears if family support
decrease.
The main priority in this implementation is to give health
education about factors which can make quickly in healing.
After doing nursing care the problem can be solved.
In nursing management patient with pedis epidermoid carcinoma
have to include bio, phsyco, sosio, cultural.
The writer took five diagnosis namely pain, risk for infection,
risk for hipovolemic shock, anxiety, ineffective individual coping.
Four diagnosis can be solved and one diagnosis be solved a part.
Using sun block
Washing hand
Take care the wound in aseptic and antiseptic tehnicque
Using therapeutic communication
Involving family.
SKIN ANATOMY