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.

Journals and article related to..

TERMINOLOGYNeoplasm “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

DEFINITIONS1. 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)

SURGERYCurative

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. 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.

SIDE EFFECT OF CHEMOTHERAPY

MYELOSUPPRESSIONNEUTROPENIA

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/mm3Decrease activity and no lifting or

straining/ValsalvaHigh fiber, increase fluids, stool softenersNo razors, nail clippers, douching, tampons,

water-soluble lubricants, no flossing, guiac/hemocult, pad counts

Maintain SBP <140mm/HgNo IM injections, apply pressure to all sites, no

NSAIDS, administer platelets per protocolEducate patients signs and symptoms

ANEMIA=DECREASED RED BLOOD CELLS Assess for

chemotherapykidney damagetumor infiltration bleeding, hemorrhageage, 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 DIAGNOSISAnxiety1. 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