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Organization of nursing care for cancer patients. Nursing process when caring for patients with pre-tumor, benign tumors Caring for patients with a benign tumor of the uterus

Nursing care for neoplasms.

Currently, more than 2.3 million patients with cancer are officially registered in the Russian Federation. Medical care is needed not only for patients undergoing diagnostic examination and treatment, but also for those who have become disabled people of the 1st and 2nd groups after radical treatment. They need physical, psychological, and social help.

A tumor is a pathological process that is accompanied by the uncontrolled proliferation of atypical cells. The main difference between tumors according to their clinical course: benign and malignant (Table 4.2). A benign tumor can also be life-threatening if it is located near a vital organ.

A tumor is considered recurrent if it appears again after treatment: a cancer cell remains in the tissues that can give rise to new growth. Metastasis is the spread of a cancerous process in the body: with the flow of blood or lymph, the cell is transferred from the main focus to other tissues and organs, where it produces new growth.

Tumors vary depending on the tissue from which they originate.

Benign tumors:

epithelial:

Papillomas (papillary layer of skin);

Adenomas (glandular);

Cysts (with cavity);

Differential diagnosis of benign and malignant tumors

Sign	Tumor
benign	malignant
Histology	Minor cell changes	Atypical cells
Shell	Eat	Absent
Height	Slow, expansive	Fast, infiltrating
Size	Big	Rarely big
Skin defect	Does not ulcerate	Ulcerates
Blood supply to the tumor	Good blood supply in all parts (“hot” tumor)	Blood supply only to the periphery (necrosis in the center of the tumor) (“cold” node)
Metastases	None	Present
Relapses	None	Possible
General condition	Satisfactory as	Cachexia
patient	rule

muscular (fibroids):

Rhabdomyomas (striated muscle);

Leiomyomas (smooth muscle);

Fatty (lipomas);

bone (osteoma);

vascular (angiomas):

Hemangioma (blood vessel);

Lymphangioma (lymphatic vessel);

connective tissue (fibromas);

From nerve cells (neurinoma);

From brain tissue (gliomas);

Cartilaginous (chondromas);

Mixed (fibroids, etc.).

Malignant tumors:

Epithelial (glandular or integumentary epithelium), cancer (carcinoma);

Connective tissue (sarcomas);

Mixed (liposarcoma, adenocarcinoma), etc.

Stages of tumor development:

Stage I: the tumor is very small, does not grow into the organ wall and has no metastases;

Stage II: the tumor does not extend beyond the organ, but there may be a single metastasis to the nearest lymph node;

Stage III: the size of the tumor is large, the wall of the organ grows: there are signs of decay, it has multiple metastases;

Stage IV: germination into neighboring organs or multiple distant metastases.

Examination of the oncological process

The nurse participates in the examination of the patient both at home, when she first suspected the presence of cancer, and in a medical institution. By interviewing the patient, observing him, and conducting a physical examination, the nurse collects the necessary information.

When preparing an anamnesis, the nurse must ask about the duration of the disease (long periods are not typical for oncological diseases), and ask what the patient discovered. It is possible that with external forms of cancer the tumor is visible on the skin or in soft tissues; sometimes the patient himself discovers a certain formation by palpating the abdominal cavity or mammary gland. This forces him to see a doctor.

Tumors can be discovered accidentally during fluorography, during endoscopic examinations for another reason, or during a clinical examination. Perhaps the patient pays attention to the discharge that appears; hemorrhagic (bloody) discharge is especially suspicious of an oncological process. The tumor destroys the vessel wall, so there may be pulmonary, gastric, intestinal, uterine or urological bleeding and bloody discharge from the nipple.

Symptoms of cancer depend on the organ affected, but there are also common features of the disease. As a rule, the onset of the process is imperceptible and there are no specific signs of a tumor. The patient may not complain about a specific organ, but notes increasing weakness, malaise, and loss of appetite (therefore, there may be weight loss).

There will be no signs of severe intoxication, but there will be pallor, an unclear increase in body temperature to small numbers (without signs of a cold or other reasons). The blood test will show signs of anemia and an accelerated ESR.

Due to cancer, the patient may lose interest in previous hobbies and activities. He does not always tell the doctor or nurse about all the changes he has noticed. He may not attach significance to them or may not associate them with the disease. Keeping in mind cancer alertness, the nurse needs to actively identify signs of a possible disease in the patient, and not just listen to complaints.

When collecting anamnesis, it is necessary to find out whether the patient has chronic inflammatory diseases for which he is registered (chronic gastritis or stomach ulcer, etc.). Such diseases are considered precancer: a cancer cell, entering the body, invades chronically altered tissue, that is, the risk of tumor formation increases. The same risk group includes benign tumors and all processes of tissue degeneration. Perhaps the patient has harmful working conditions that increase the risk of cancer.

In addition to the interview, the nurse observes the patient (movements, gait, physique, general condition) and notes signs characteristic of oncology. Then she proceeds to a physical examination: external examination, palpation, percussion, and auscultation are performed. Knowing the normal anatomical structure, the nurse notes deviations from the norm. Based on observation, questioning and examination, the nurse makes a conclusion about the presence or absence of pathology. In all cases of suspected tumor, the nurse must refer the patient for examination to an oncologist at the oncology clinic. Using the knowledge of medical psychology, the nurse must correctly present to the patient the need for such an examination by an oncologist and not cause him stress, categorically writing an oncological diagnosis or suspicion of it in the direction.

The examination can be prescribed to a patient with suspected cancer to make a primary diagnosis or as an additional examination of a cancer patient to clarify the disease or stage of the process.

When making a primary diagnosis, you should always remember the stages of the process and strive for early diagnosis. The decision on examination methods is made by the doctor, and the nurse draws up a referral, conducts a conversation with the patient about the purpose of a particular method, tries to organize the examination in a short time, gives advice to relatives about the psychological support of the patient, and helps the patient prepare for certain examination methods.

If an additional examination is carried out in order to resolve the issue of a benign or malignant tumor, then the nurse should highlight the priority problem (fear of detecting a malignant process) and help the patient solve it, talk about the possibilities of diagnostic methods and the effectiveness of surgical treatment and advise him to give consent to the operation in the early stages.

For early diagnosis use:

X-ray methods (fluoroscopy and radiography);

Computed tomography;

Radioisotope diagnostics;

Thermal imaging research;

Biopsy;

Endoscopic methods.

The nurse must know which methods are used in outpatient settings, and which ones are used only in specialized hospitals; be able to prepare for various studies; know whether the method requires premedication and be able to administer it before the study (for more details, see Chapter 4). The result depends on the quality of the patient’s preparation for the study. If the diagnosis is unclear or not specified, then a diagnostic operation is resorted to.

Certain types of cancer

Esophageal cancer occurs mainly in elderly and senile people. Most often, the process is localized in the middle and lower third of the esophagus. Patients complain of difficulty passing food through the esophagus. Symptoms of dysphagia develop gradually: first, solid food does not pass and the patient is forced to drink it with water, then he switches to mushy food, and then liquid food does not pass either. As a result, cachexia develops and the patient suddenly loses weight. This causes an unpleasant odor from the mouth.

Chest pain radiating to the left shoulder can be mistaken for heart disease. Common oncological symptoms include weakness, adynamia, loss of appetite, and weight loss. In addition, patients note an aversion to meat foods and increased salivation. To clarify the diagnosis, X-ray examination and biopsy are used.

Treatment depends on the stage of the process, the location of the tumor, the condition of the body (age, concomitant diseases), the presence of metastases, etc. Metastasis to the lymph nodes of the neck and mediastinum occurs by the lymphogenous route, to the liver and lungs by the hematogenous route. Life expectancy is about a year.

The main treatment method for tumors of the lower third of the esophagus is surgery, and for tumors of the upper and middle third - radiation therapy.

During radical surgery, either part of the esophagus with the tumor is removed and the remaining part is connected to the stomach, or the thoracic esophagus with the tumor is completely removed and a gastrostomy tube is placed to feed the patient. After 6-12 months. plastic surgery is performed and the removed part of the esophagus is replaced with a section of the small intestine. If it is impossible to carry out a radical operation, a palliative one is performed - a gastrostomy tube to feed the patient.

First, medical procedures are performed by medical svetla. then she teaches relatives or the patient himself how to attach and disconnect the funnel after feeding, how to attach the probe under the bandage, how to rinse the tube if it is clogged, how to care for the skin around the fistula, etc.

For severe pain, narcotic analgesics and antispasmodics are prescribed. The rest of the treatment is carried out according to the general principles of treating cancer patients.

Lung cancer is common in older men, especially smokers. In St. Petersburg, the disease ranks first among other oncological diseases.

A risk factor, in addition to smoking, is the presence of chronic inflammatory lung diseases. Lung cancer has a high mortality rate due to late consultation with a doctor. In the initial stages there are no specific symptoms of cancer, and nothing forces the patient to seek medical help.

The patient has a cough, which can be explained by many reasons. When the cough becomes persistent, blood appears in the sputum, chest pain due to the involvement of the pleura in the process, sudden weight loss, weakness, this is far from an early stage of the process. The tumor can grow endophytically (along the wall of the bronchus) and exophytically (into its lumen). Such a tumor blocks the lumen of the bronchus and causes its obstruction. The consequence of this will be atelectasis of the lung or lobes of the lung.

Lung cancer metastasizes early to nearby lymph nodes. Enlargement of the supraclavicular nodes indicates a late process. With the blood flow, metastases spread to other organs, most often to the liver, skeletal bones (frequent fractures are possible), and kidneys.

A manifestation of oncological alertness will be a mandatory examination of the patient by an oncologist, even with slight hemoptysis, since this may already indicate tumor disintegration and ulceration. The tumor can grow into a vessel and cause severe pulmonary hemorrhage. In later stages, cachexia will develop. The examination methods are the same as for all cancer patients. Life expectancy is 2-3 years. The most effective treatment method is lobectomy or pneumonectomy in combination with chemotherapy and radiation therapy.

Breast cancer is the most common form of malignant breast tumor. Factors contributing to cancer:

Heredity,

Age (women over 40 are more likely to get sick, but young people can also, in which case the disease is more malignant in terms of the speed of development of the disease),

Early onset of menstruation (before 12 years of age) and late cessation (after 50 years of age),

Lack of childbirth and lactation, abortion;

Benign tumors;

X-rays;

Obesity and diabetes.

Breast cancer has 4 stages (Table 4.3).

Stages of breast cancer

More often, one gland is affected; the woman herself discovers a lump in the outer upper quadrant of the gland. It may be nodular or diffuse, and minor pain is possible. A “lemon peel” subsequently appears over the compaction. The tumor adheres to the surrounding tissue and asymmetry of the nipple line appears. Then the nipple retracts, and bloody discharge from the nipple appears. If such signs occur, you should immediately consult an oncologist.

When a skin ulcer appears in place of the “lemon peel”, this is a sign of tumor disintegration (Fig. 4.2, see color insert). Metastases through the lymphatic and blood vessels spread to the axillary, supra- and subclavian lymph nodes. Among the examination methods, medical examinations and self-examination of the mammary gland are important, which contributes to early diagnosis. In the future - mammography, ultrasound, biopsy and other methods.

Pregnancy and childbirth have a beneficial effect on benign tumors, but accelerate the course of malignant ones. Life expectancy varies - from several months to several years. In the early stages, the best method is mastectomy. In the later stages of the process - hormones, radiation and chemotherapy.

Prevention of breast cancer:

Regular self-examination of the glands;

Regular sex life;

Breastfeeding;

Regular examinations by a gynecologist, surgeon or oncologist;

Rational fortified diet;

Limiting the consumption of canned foods and smoked foods;

Taking antitumor vitamins A, E, C;

Healthy lifestyle without bad habits;

Correct work and rest schedule;

No stressful situations.

After a mastectomy you need:

Provide bed rest with the head of the bed elevated;

Place oilcloth on the side of the wound, as it gets wet;

Take care of drainage in the armpit;

Remember about psychotrauma;

Provide exercise therapy to develop the shoulder joint.

After a mastectomy, a woman should not:

Sunbathe and stay in the sun for a long time;

Take physiotherapy;

Take vitamin B 12 and folic acid, aloe and other biostimulants;

Use hormones;

Gain weight;

Perform abortions, get pregnant and give birth.

Stomach cancer is an oncological disease that threatens the patient’s life and can develop against the background of chronic gastritis or ulcers, a benign stomach tumor, or independently of these diseases. Most often, the process is localized in the antrum of the stomach. Tumors can grow either endophytically or exophytically. There are no specific signs of cancer. They depend on the growth and location of the tumor. The patient develops weakness, loss of appetite, weight loss, and sometimes nagging pain in the stomach. A tumor of the cardiac region is manifested by belching and vomiting, of the antrum - heaviness in the stomach after eating, rumbling in the abdomen, and sometimes vomiting.

Cancer of the fundus of the stomach proceeds for a long time without signs of disease, cancer of the lesser curvature destroys blood vessels and causes vomiting of blood. It is necessary to check with the patient whether there are chronic stomach diseases, anemia, weight changes, weakness and aversion to meat foods. In the later stages, the patient himself palpates the tumor or notices signs of ascites.

Treatment. The main method is surgery in combination with chemotherapy and radiation. Whether radical or palliative surgery will be performed depends on the stage of the process, metastases, age and condition of the patient. During radical surgery, the stomach, omentum, lymph nodes, and sometimes the spleen are removed. The operation is difficult and not every patient can perform it. Palliative surgery alleviates the patient’s condition, as it eliminates the consequences of cancer (for example, stenosis), but there is no cure.

Preoperative preparation is mandatory, since the patients are weakened. Problems in the postoperative period are similar to the problems of a patient after gastrectomy. Long-term problems: dieting, restoration of the patient’s psychological state, social and everyday problems.

Long-term results of the operation:

Of those operated on for pyloric cancer, about 50% of patients live for 3 years, 28% for 5 years;

Of those operated on for cancer of the cardiac part and body of the stomach, about 30% of patients live for 3 years, less than 20% live for 5 years.

Colon cancer It occurs equally often in men and women, mainly at the age of 40 years. The most common form is adenocarcinoma. Localization - sigmoid and cecum, less often in other parts of the intestine. A special feature is long-term existence without metastases to the lymph nodes.

A tumor, like a stomach tumor, arises on the mucous membrane of the wall, and then grows into all layers of the organ. Complaints appear only when intestinal function is impaired. As a result, patients consult a doctor already in the late stages of the process.

Complaints can be of abdominal pain, dull, mild, nagging, only with the development of OKN their character changes. The patient loses his appetite, belching, nausea, and a feeling of heaviness in the stomach appear. The stool is unstable, with impurities of blood and mucus. The stomach is swollen. General condition typical for cancer patients.

A patient with suspected cancer should be examined by an oncologist. A Gresersen test for occult blood in the stool and an endoscopic examination are required.

The main method of treatment is surgery. Preoperative preparation consists of cleansing the intestines: a slag-free diet 2-3 days before surgery, a laxative the day before and enemas in the evening and morning on the day of surgery.

Long-term results: after surgery, from 30 to 80% of operated patients live 5 years.

Rectal cancer, due to its malignancy, is of greatest importance among all tumor diseases. Unlike other tumor locations, patients complain of pain that appears in the early period of the disease, as with esophageal cancer, and is quite pronounced. Pain is associated with the act of defecation and the presence of sensitive nerve endings in the anus. Another complaint and problem will be pathological discharge from the intestines, mucous, bloody or purulent. Discharge is observed at the beginning of defecation. They differ from hemorrhoidal bleeding in color: not scarlet, but brownish. The stool is unstable, there is a feeling of not having a bowel movement, and a false urge to defecate.

Having identified such problems, the patient should be referred for a consultation with an oncologist, where he will undergo all the necessary examinations. If the diagnosis is confirmed, then urgent surgical treatment is needed. Metastases spread to nearby and then to distant lymph nodes. The appearance of a rectal cancer tumor is shown in Fig. 4.3 (see color insert). During the operation, bowel resection is performed with a colostomy. If a radical operation fails, then during palliative intervention an anastomosis will be performed to alleviate the patient’s condition. Comprehensive cancer treatment includes radiation and chemotherapy.

If the diagnosis is not confirmed, and a benign tumor in the form of a polyp is discovered, then it should also be removed, since it is constantly injured by feces.

Prostate cancer- malignant tumor. Causes: hormonal disorders, heredity, environmental conditions. Priority problems in the early stages of the disease: aching pain in the perineum with radiation to the sacrum and rectum; in the later stages, dysuria occurs; with metastasis - pain in the bones, kidneys, swelling of the lower extremities. Surgical intervention - radical prostatectomy is effective for stages I - II of the tumor. These patients are treated conservatively (female sex hormones) according to a special regimen by a urologist-oncologist.

Treatment of a cancer patient

The decision on the method of treating the patient is made by the doctor. The nurse must understand and support the doctor’s decisions to perform or refuse surgery, the timing of surgery, etc. Treatment will largely depend on the benign or malignant nature of the tumor.

Surgery is the most effective method of treating malignant tumors. It is not the only method; chemotherapy and radiation therapy are also used. Like every operation, the method contains a certain danger, but there are also specific dangers: the spread of cancer cells throughout the body during the operation, the danger of not removing all cancer cells, which can cause a relapse.

By analogy with the concepts of “asepsis” and “antiseptics,” in oncology there are the concepts of “ablastics” and “antiblastics.”

Ablastics is a set of measures aimed at preventing the spread of tumor cells in the body during surgery. The following actions are expected:

Do not injure the tumor tissue and make an incision only through healthy tissue:

Quickly apply ligatures to the vessels in the wound during surgery;

Bandage the hollow organ above and below the tumor, creating an obstacle to the spread of cancer cells;

Delimit the wound with sterile napkins and change them during the operation;

Change gloves, instruments and surgical linen during surgery.

Antiblastics is a set of measures aimed at destroying cancer cells remaining after tumor removal. Such events include:

Use of a laser scalpel;

Irradiation of the tumor before and after surgery;

Use of antitumor drugs;

Treating the wound surface with alcohol after tumor removal.

In addition to ablastic and antiblastic measures, zonality is observed in oncological operations: not only the tumor itself is removed, but also possible sites of cancer cell retention: lymph nodes, lymphatic vessels, tissue around the tumor by 5-10 cm. For example, in breast cancer, not only the tumor itself is removed gland, but also the pectoralis major muscle, fiber, axillary, supraclavicular and subclavian lymph nodes.

If it is impossible to perform radical surgery, palliative surgery is performed. It no longer requires the implementation of the entire complex of measures for ablastic and antiblastic, as well as compliance with the principle of zoning.

Radiation therapy is based on the fact that the tumor cell is more sensitive to radioactive radiation than other cells. Radiation destroys the cancer cell, not the cells of healthy tissue. Tumor growth stops because the cancer cell has already lost the ability to divide and multiply. Tumors of different types have different sensitivity, so radiation therapy can be both the main and additional method of treating a patient.

Types of exposure:

External (through the skin);

Intracavitary (uterine cavity or bladder);

Interstitial (into tumor tissue).

The nurse must be aware of the complications associated with radiation therapy, warn the patient about them, help him physically overcome the difficulties of the treatment process and be psychologically prepared for this treatment.

In connection with radiation therapy, the patient may experience problems:

On the skin (in the form of dermatitis, itching, alopecia - hair loss, pigmentation);

The body's general reaction to radiation (in the form of nausea and vomiting, insomnia, weakness, heart rhythm disturbances, lung function, and changes in blood tests).

Chemotherapy– impact on the tumor process with drugs. Chemotherapy provides the best results in the treatment of hormone-dependent tumors. When treating other tumors, the results are not so good and the method is auxiliary.

Groups of drugs used to treat cancer patients:

Cytostatics that stop cell division;

Antimetabolites that affect metabolic processes in a cancer cell;

Antitumor antibiotics;

Hormonal drugs;

Immunity boosters;

Drugs affecting metastases.

Immunomodulator therapy is the use of biological response modifiers that stimulate or suppress the immune system. Genetic engineering has developed a sufficient number of biological response modifiers that are being tested:

Cytokines are protein cellular regulators of the immune system. Examples:

interferons - produced by the immune system in response to dangerous infections or irritants; when a cancer cell appears in the body, they begin to be produced to suppress its growth;

Colony-stimulating factors (proteins that affect blood cells), they stimulate the reproduction of blood cells;

Monoclonal antibody proteins act on tumor cells without affecting healthy ones.

About 15% of cancer patients who give informed consent participate in clinical experiments.

Most often, not just one method, but complex treatment is used in treating a patient. When solving the patient’s problems, giving him recommendations, during examination one should strive to diagnose the disease at an early stage, and during treatment - to ensure the patient’s recovery. Since the most effective method is the surgical method, in case of a malignant process it is first necessary to evaluate the possibility of a quick operation. And the nurse should adhere to this tactic and recommend that the patient give consent to surgery only if other treatment methods are ineffective.

The disease is considered cured if:

The tumor was completely removed;

No metastases were found during surgery;

For 5 years after the operation the patient has no complaints.

Caring for cancer patients

When caring for a cancer patient, a sister needs to remember that she is dealing with a person who, due to illness, has quickly lost his independence from others, his capabilities are seriously limited. It is quite difficult for him to realize the emerging dependence on others at the initial stage, especially since it will manifest itself in the simplest things. Over time, if the disease progresses, the addiction will become more severe.

To achieve better results in treatment, the active participation of the patient and his loved ones is necessary. To do this, they must have certain information about the disease and the possibilities of a particular treatment method. Only a doctor can give such information.

Already during the treatment process, when the patient has received information from the doctor, the nurse talks about the chosen method of treatment, the expected results, and side effects. She informs the patient about medical procedures, prepares him for them, teaches the patient to help himself in caring for a postoperative wound, stoma or drainage, and gives advice on diet and physical activity.

If radiotherapy is used, the nurse explains methods for preventing radiation complications and teaches how to care for the skin in the radiation zone. When using chemotherapy, the nurse helps the patient deal with the side effects of the drugs and teaches how to treat the oral cavity so that there is no ulcerative stomatitis. All these measures are designed to prevent potential problems for the patient.

The patient's complaints and the patient's problems are not the same thing. For example, with ulcerative stomatitis, the patient will complain of pain and burning in the oral cavity, but only when ulcers appear on the mucous membrane will the complaints and the existing problem coincide (a coincidence is not necessary!). The sister not only solves the existing problem, but also anticipates the appearance of stomatitis. She knows that if certain measures are not taken, this problem will arise, and she works to solve this potential problem even if there are no complaints from the patient.

The nurse should ensure that medications are taken on time and blood tests are taken regularly. She monitors the patient’s condition, fills out the necessary documentation: a hospice nursing care plan, a pain assessment sheet, a stool observation sheet, etc.

It is also necessary to monitor the patient’s skin, since the appearance of petechiae indicates a change in the blood coagulation system and the possibility of bleeding. Patients may experience nausea and vomiting as a reaction to cytostatics. The patient’s nutrition and the need for intensive therapy depend on this.

Nausea rating:

0th degree - absence of nausea;

1st degree – the ability to eat through the mouth is slightly reduced;

2nd degree - the ability to eat through the mouth is significantly reduced, but the patient can still eat;

3rd and 4th degree - eating is almost impossible.

Vomiting assessment:

0th degree - no vomiting;

1st degree - vomiting 1 time in 24 hours;

2nd degree - vomiting 2-5 times in 24 hours;

3rd degree - 6 times or more, IV infusions are required;

4th degree - parenteral nutrition and intensive care.

One of the important aspects of the treatment process is chemotherapy. The difference between therapeutic and toxic doses of drugs is very small, so when administering them, the nurse must be precise and attentive. An insufficient dose will not provide a therapeutic effect, and an overdose will cause renal and cardiopulmonary failure, bleeding and suppression of bone marrow function. It is also necessary to monitor for a possible allergic reaction in the form of anaphylactic shock.

Algorithm of actions of a nurse during chemotherapy

1. Patient preparation:

Make sure that this is the same patient (not a namesake);

Make sure he is aware of the nature of the treatment;

Check the blood test and its date;

Check the patient's pulse, blood pressure, body weight and temperature and record;

Collect allergy history;

Assess the possibilities of intravenous administration;

Give premedication.

2. Preparation of the drug:

Find out the dose, rate of administration, volume of solution;

Obtain the required amount of the drug;

Prepare a kit in case of a reaction to the drug;

Have a dropper and other materials necessary for intravenous administration;

Treat hands;

Wear a robe and gloves;

Administer the drug according to the instructions.

3. Performing venipuncture using the technique of this manipulation.

4. Administration of the drug:

Check the patient's condition before and during administration;

Monitor the venipuncture site;

Make sure that the syringe with the chemotherapy drug is intact;

Check the dropper and container with solutions;

Slowly introduce solutions;

Check blood return during administration and when changing each drug;

Rinse the needle (catheter) between injected drugs with saline to prevent their interaction;

Rinse the needle and vein before completing the procedure;

Apply pressure to the vein for a few minutes after removing the needle with a sterile cloth, then apply a sterile bandage.

5. After introduction:

Collect used materials and tools;

Assess the patient's condition;

Make sure that the patient can call a doctor or nurse if necessary;

Fill out the documentation for the drug administration.

During this manipulation, you must strictly follow

technique, since tissue necrosis occurs when the drug gets under the skin. If the drug does not enter a vein, then the following appears:

Swelling at the venipuncture site;

Burning around the needle;

Hyperemia;

No blood return.

If such a complication occurs, it is necessary to immediately stop administering the drug, inject the area with novocaine and put cold. If a large amount of the drug is ingested, then these measures will not be enough; surgical excision of the necrosis will be necessary (this is why it is important to carefully monitor the administration process!).

Working with chemotherapy drugs is an occupational hazard, so the nurse must reduce the risk by following safety rules:

Work with the drug only with gloves, a mask and a long robe;

Know that a doctor is diluting the drug, and be sure to use a fume hood;

Use only disposable syringes;

Do not allow the drug to spill;

Wipe up thoroughly if spills occur;

Pack empty ampoules in plastic bags and dispose of them according to the rules;

Rinse syringes thoroughly after use, disinfect according to instructions and discard.

After discharge from the hospital, the nurse helps the patient organize his life at home and solve his problems, as far as possible, at home. He needs various types of rehabilitation. In a hospital setting, the patient's ability to perform elements of self-care is quite limited. The first steps of rehabilitation are teaching him the elements of self-care. There are general problems of any person - the need for food, drink, sleep, etc. But there are also problems of a specific person, his interests and habits.

Possible physiological problems include:

Pain of various types;

Problems related to skin hygiene (wetting of the dressing with discharge of various types, presence of drainage, violation of the integrity of the skin due to a wound, stoma or bedsore);

Problems related to breathing (shortness of breath, cough, etc.);

Radiation therapy in combination with chemotherapy is widely used to treat rectal cancer before or after surgery. nursing activities in the preoperative and postoperative period Psychological preparation of the patient Positive thinking a powerful tool for psychological preparation for surgery and recovery after it. Psychological preparation of the patient for surgery is almost impossible without the help of loved ones and relatives. Whenever possible, psychologists recommend not giving up your usual daily routine in anticipation of...

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Introduction

Main part

Chapter 1 Oncology

1.5 Colon cancer. Symptoms Diagnosis and treatment

Chapter 2 Nursing activities

2.1 Preparation for instrumental research methods.

2.2 Management of patients in the preoperative and postoperative period

Conclusion

References

Applications

Appendix 1 (title)

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INTRODUCTION

The medical commandment “one must take care of health from a young age” has long become a popular medical commandment. Unfortunately, many of us understand the meaning of this folk wisdom only in adulthood, and often in old age. It is no secret that healthy people often do not realize this advantage and, in the end, pay for such frivolity. The main factor in maintaining health, human life expectancy, physical and creative performance is a healthy lifestyle in its broadest interpretation.

So, today the mortality rate in Russia is the highest in Europe. We lag behind not only the countries of Western Europe, but also Poland, the Czech Republic, Romania and the Baltic countries. One of the main causes of death in the population is malignant tumors. For example, in 2005, 285 thousand people died from malignant neoplasms! The most common tumors were lung, trachea, stomach, and breast tumors.

Oncology (Greek Onkos mass, tumor + logos teaching) a field of medicine that studies the causes, mechanisms of development and clinical manifestations of tumors and develops methods for their diagnosis, treatment and prevention.

In essence, cancer occurs when a certain cell or group of cells begins to multiply and grow randomly, displacing normal cells in the body of a person of any age.The digestive organs are highly susceptible to the development of cancer. The reason for this is the changed living conditions change in food products, change in lifestyle from physically active to passive, change in daily routine. For many, such changes are inevitable, for many they are pleasant. However, the statistics of aggressive digestive system cancer make it clear how important it is to eat and move properly for those who want to live a normal life.

Modern diagnostic and treatment methods make it possible to timely detect malignant neoplasms and cure more than half of children and adults.

I chose this topic because it is relevant in our time, also to broaden one’s horizons, and also because it can affect any person.

The purpose of my work:

Learn about the causes of cancer;
Study methods of nursing interventions in the diagnosis and treatment of tumors;
And also learn how to carry out nursing activities for patients with oncological diseases of the digestive system.

To achieve this goal, I set myself the following tasks:

Development of skills in working with scientific literature;
The ability to choose the main thing;
Structure the text;
Competency in expressing your thoughts;
Expanding the horizons of knowledge in the field of oncology;
Using the acquired knowledge in your practical activities.

Object: cancer patients.

Subject of research:

Causes of cancer;
Classification of tumors of the digestive organs;
Prevention and treatment of cancer;
Nursing activities.

CHAPTER 1 ONCOLOGY

1.1 General concepts about oncology. Types of cancer of the digestive organs

Oncology (from the Greek Onros bloating, logos science) is a science that studies the causes, mechanisms of development and clinical manifestations of tumors and develops methods for their diagnosis, treatment and prevention.

In essence, cancer occurs when a certain cell or group of cells begins to multiply and grow randomly, displacing normal cells.

Based on their ability to spread in the body, tumors are divided into two groups:

Benign (not having the ability to grow into adjacent tissues);
Malignant (capable of growing in certain tissues and moving to other parts of the body, giving rise to secondary tumors and metastases).

In the structure of mortality of the Russian population, cancer ranks second after cardiovascular diseases. In humans, the most studied causes of cancer are radiation, chemical carcinogens and viruses.

Biological properties of tumors

Accelerated growth;
The ability of cells to constantly divide (lack of cellular aging);
Unregulated migration;
Loss of contact inhibition by a malignant cell during its growth and reproduction;
Ability to metastasize;
Progression of the malignant process.

1.2 Tumors of the digestive tract in children

Juvenile intestinal polyps

This is the most common type of intestinal tumor in children. Typically, polyps (Appendix 1.1) occur in children older than 12 months. and only in rare cases in adolescents over 15 years of age.

Symptoms of the disease

Metabolic disorders (associated with disorders of digestion, absorption and intestinal motility);
Painless rectal bleeding (blood may be on the surface of the stool or mixed with it);
Iron deficiency anemia (due to microscopic blood loss).

Diagnostics

Diagnosis is made based on rectal examination. About 1/3 of the polyps are accessible to finger detection, although it is quite difficult to feel them.
During sigmoidoscopy, polyps appear as smooth, pedunculated formations containing gray-white cysts.
Irrigoscopy with double contrast allows you to identify polyps that are beyond the reach of the sigmoidoscope.
Currently preferred to use.

Treatment and prevention

Surgical treatment is indicated for patients with juvenile polyposis.

Patients should be systematically monitored for many years after surgical treatment. At least once a year, patients undergo gastroscopy, colonoscopy and intestinal fluoroscopy.

Familial polyposis

Familial polyposis most often develops during puberty (13-15 years), later (up to 21 years) the frequency of its occurrence increases. The disease is characterized by a progressive course with obligatory malignant degeneration.

Symptoms of the disease

Unstable stool (diarrhea, mucus, sometimes blood in the stool);
Anemia, general weakness, intoxication, and developmental delay gradually develop.

Diagnostics

Proctological examination of the patient, colonoscopy and irrigoscopy.

A proctological examination of the patient includes four consecutive

stage:

examination of the perianal area;

digital examination of the rectum;

examination of the rectum using a rectal speculum;

sigmoidoscopy (examination of the rectum and distal parts of the sigmoid colon using a sigmoidoscope, if necessary, taking a biopsy).

Treatment

The only chance to save the patient’s life is timely radical surgery.

Familial adenomatous polyposis of the colon

This is a precancerous disease, characterized by the presence of a large number of adenomatous polyps (Appendix 1.2) in the distal colon. The literature describes cases of the appearance of polyps
early in life, but usually occur towards the end of the first decade and into adolescence.

Symptoms of the disease

There is diarrhea and bleeding;
Malignancy may occur in children over 10 years of age.

Diagnostics

The diagnosis is made based on the results of an X-ray examination (double-contrast barium enema shows multiple storage defects);
As well as sigmoidoscopy and colonoscopy, in which polyps of different sizes are visible.

Treatment and prevention

Surgical treatment.

After colectomy, patients require upper GI endoscopy every 6 months for 4 years.

1.3 Esophageal cancer. Symptoms Diagnosis and treatment

The esophagus connects the pharynx to the stomach, through which food is swallowed. Although swallowing only lasts seconds, exposure to certain foods and drinks, including alcohol and inhaled tobacco smoke, causes damage to the mucous membrane that creates favorable conditions for the development of cancer.

Etiology

Environmental pollution (work in mines, metallurgy, asphalt fumes, chimney sweeps and other harmful conditions);
Overweight;
Erosion of the esophagus (when drinking caustic liquids, the esophagus is primarily affected, where very large scars and deformations remain).

Symptoms of the disease

Disturbances in swallowing and moving food;
Pain behind the sternum or in the upper abdomen (due to difficulty swallowing food);
Weight loss.

Diagnosis and treatment

Esophagoscopy.
It often happens that the esophagus is so narrowed due to the tumor located in it that the esophagoscope cannot be passed through. In this case, an X-ray examination (Appendix 2.1) is used for diagnosis, in which the patient must drink a special mixture of barium, and then the location of the obstructions and the size of the tumor are determined.
To determine the spread of the tumor outside the esophagus, additional studies are carried out: x-ray of the lungs, ultrasound examination (sonography) of the abdominal cavity, computed tomography of the chest and abdomen, etc.

Esophageal cancer is treated surgically, gastrostomy is performed, as well as chemotherapy and radiation therapy.

Prevention

It is necessary to systematically undergo preventive examinations and inform the doctor about any health problems, difficulty swallowing, or passing rough food.

Since external factors contributing to the development of esophageal cancer include poor nutrition (abuse of very hot, pickled foods, deficiency of vitamins A and C, as well as smoking and alcohol abuse), for preventive purposes it is advisable to give up bad habits and normalize nutrition.

1.4 Stomach cancer. Symptoms Diagnosis and treatment

Stomach cancer ranks first among cancer tumors of other localizations. On average, people over the age of 60...65 get sick with it. Cases of the disease in people under 40 years of age have become more frequent. Most often, stomach cancer occurs in middle-aged men, and the likelihood of the disease increases with age.

Etiology

Particular risk factors are diseases in which stomach cancer occurs more often than in a healthy stomach. These are the so-called precancerous conditions of the stomach:

Chronic atrophic gastritis inflammatory condition that causes dryness of the stomach lining;
Pernicious anemia, which is caused by impaired absorption of vitamin B12 in the stomach.
Infection with the microbe Helicobacter pylori, which causes specific inflammation and ulcers of the gastric mucosa.
Polyps in the stomach and colon - their size and structure are decisive.

Symptoms of the disease

Minor Sign Syndrome:

Change in taste;
Feeling of heaviness in the stomach when eating a small amount of food;
Feeling of fullness in the stomach;
Morning sickness, belching;
Weakness;
In later stages milena.

Diagnosis and treatment

The most accurate answer about the presence of stomach cancer, as well as esophageal cancer, will be given by gastroscopy. Using gastroscopy, you can observe the condition of the stomach, detect changes, and take a biopsy;
An X-ray examination of the stomach with a barium mixture is used (Appendix 2.2);
Treatment of stomach cancer is usually surgical - gastrectomy followed by chemotherapy and radiation therapy.

1.5 Rectal cancer. Symptoms Diagnosis and treatment

Rectal cancer occurs in both sexes at approximately the same rate. Statistics show that about 90% of cancer sufferers are over 50 years of age.

Etiology

Improper lifestyle (alcohol, smoking, physical inactivity, poor hygiene);
Excessive consumption of spicy and fatty foods;
Family predisposition;
Polyps;
Ulcers;
Proctitis.

Symptoms of the disease

Violation of the act of defecation (alternating constipation and diarrhea);
Bleeding (stool mixed with blood);
False urges;
The shape of feces changes (“sheep stool” - in small portions, “ribbon stool”);
Profuse bleeding (with a large tumor).

Diagnosis and treatment

The best result in diagnosing diseases of the rectum is provided by rectoscopy, which allows taking a biopsy.
In some cases, the intestine can be examined using irrigoscopy (Appendix 2.3).

As with any cancer, the best results are obtained by surgery - a colostomy.

Radiation therapy in combination with chemotherapy is widely used to treat rectal cancer before or after surgery.

Prevention

Prevention of rectal cancer mainly comes down to timely radical treatment of intestinal polyposis, as well as proper treatment of colitis in order to prevent it from becoming chronic.

An important preventive measure is normalizing nutrition, reducing the content of meat products in the diet, and combating constipation.

CHAPTER 2 NURSING ACTIVITIES

2.1 Preparing the patient for instrumental research methods

Esophagoscopy

Explain to the patient the purpose of the upcoming study and the essence of the preparation;
The day before: sedatives are prescribed (bromine preparations, sodium bromide and potassium bromide, as well as valerian and motherwort preparations), sometimes tranquilizers (mezapam, phenazepam, sibazon), at night - sleeping pills (nitrazepam, flunitrazepam);
Limit drinking, exclude dinner;
On the day of the procedure, food and liquid intake is excluded, the procedure is performed on an empty stomach;
30 minutes before the procedure, adults are prescribed to administer 1 ml of a 2% solution of promedol or 0.5 x 1.0 ml of a 0.1% solution of atropine sulfate subcutaneously. In children under 5 years of age, esophagoscopy is usually performed without anesthesia;
Removable dentures must be removed;
The patient should be warned that at the moment of insertion of the esophagoscope he will experience an unpleasant sensation of suffocation (it should be recommended to breathe calmly, evenly, not to strain the muscles of the abdomen and the back of the head, and not to lean back);

Gastroscopy