Minggu, 26 Agustus 2012

NURSING CARE AT PATIENTS WITH OVARIAN CANCER

In the third post, I will discuss about CARE NURSING PATIENT INJURY TO THE HEAD, and may be useful and do not forget the comments.
Thank you for the health gods gave to me so at night I will share about nursing care in patients with ovarian cancer.
Hopefully this article useful for friends who need the information.
Do not forget to comment ...


A. Definition
 
Cancer is a disease of the cells with the characteristics of the failure or interruption in regulating hemostatisnya multiplication and function in multicellular organisms (Monuaba, 2001: 699)."Tumor Malignant ovarian tumors with a collection of diverse histogenesis" (Sjamsuhidajat, 1997: 990)B. EtiologyOvarian cancer can also occur due to several factors: nullipara women, giving birth the first time at the age above 35 years and women who have a family history of ovarian cancer, breast cancer or colon cancer (www.indomedia.com).In addition, nutrient addition to the amount of high fat dietary factors with low nutritional value are also likely to increase the occurrence of ovarian cancer (Manuaba, 2001: 670).Greatest risk of developing ovarian cancer is a continuous ovulation entrupsi long time. The use of methods of birth control pills, multiple pregnancies and breastfeeding decreased the frequency of ovulation seems to provide protection against cancer incidence (Donielle & Jane, 2000: 165).
     
C. PathophysiologyThe growth of the primary tumor followed by infiltration into the surrounding tissue causing a variety of complaints such as feeling of obstruction, eat a little feel full faster, frequent bloating, decreased appetite. The tendency to do dirongga abdominal implantation is a hallmark of malignant ovarian tumors that produce ascites. Ovarian cancer is a collection of tumors with diverse histiogenesis, can be derived from the three dermoblast (ektodermal, entodermal, mesodermal) with histological properties and biological diverse (Manuaba, 2001: 400).
Ovarian cancer can also cause pressure on the bladder and rectum that can cause feelings of urination (in pengertia if any do not suffer usually urinate about 400 cc, then in patients with ovarian cancer is only 200 cc urinate normally would go back again pee and when the tumor can be felt more major complaints include lower abdomen tense and enlarged, and the suppression of the organs in the pelvic cavity which can cause more pain during intercourse., and severe pain may also be felt when the tumor rupture or twisted while in the advanced stage of fluid accumulation can occur in the abdomen or chest cavity which can cause shortness of breath, which can then lead to propagation of the tumor gets the pelvic organs such as the intestines and the abdominal cavity, omentum, liver, and spleen and abdominal wall ( www.indomedia.com).
Clinical stage of ovarian cancer according to FIGOSTADIUM CLINIC FIGOSTADIUM I Growth limited to the ovaries.He
 
Growth limited to one ovary does not exist on the outer surface of the tumor, ovarian capsule intekeIb
 
Both ovaries without ascites, inteke tumor on the outer surface, inteke ovarian capsule.Ic
 
Tumors of the outer surface of the ovary with one or two capsules ruptor or with ascites containing malignant cells or washing peritonial positive.STADIUM II growth in one or both ovaries with pelvic spread.IIa spread or metastases to the uterus or fallopian.Spread IIb other pelvic keorgan.IIc As stage IIa and IIb, but with tumor on the surface, capsule rupture or with ascites containing malignant cells or washing peritonial positive.STADIUM III
 
Tumor on one or both ovaries with teritonium implants outside the pelvis and the presence of lymph retroperinal or iguinal. Too superficial liver metastasis stage III.In macroscopic tumor limited to the true pelvis, but there is histological proven malignant keusus pacification smooth.IIa
 
In macroscopic tumor limited to the true pelvis without lymph node, but it is evident there is a spread of microscopic histological peritorium abdominal surface.IIIb
 
Tumor on one or two ovaries contained histological proven growth on the surface of the abdominal peritoneum with a diameter less than 2 cm. Without node.IIIc
 
There are more than 2cm abdominal implantation, with or inguinal lymph retropenial positive.There STADIUM IV distant metastases. Positive pleural fluid cytology. Metastases to the liver parenchyma.(Manuaba, 2001: 678)D. Clinical ManifestationsThere are no signs and early symptoms of ovarian cancer-specific. This is the main reason so many tumors which are found only when the tumor extends (Danielle & Jane, 2000: 165).Ovarian cancer is often diagnosed at a new more advanced stage in which time the tumor had begun pressing the surrounding organs. But the signs and symptoms of ovarian cancer may include:1. Stomach discomfort2. Gastrointestinal disorders are continuous, such as diarrhea, bloating, constipation.3. Dirongga severe pain and pelvis.4. An increase or decrease in weight is not clear why.5. Swelling of abdominal pain6. Vaginal bleeding that is unusual7. Nausea and vomiting.8. Loss of appetite.9. Frequent urination.10. Shortness of breath.11. Fever.12. Pain during intercourse.(Www.indomedia.com)E. Examination SupportEfforts are made is by doing regular examination which includes:1. Genekologik clinical examination to detect the presence of ovarian cysts or enlargement of the other.2. Enlargement Ultrasonography (USG) if necessary by means of Doppler to detect blood flow.3. CT-Scaning/MRI if necessary.4. Examination of tumor markers (tumor marker).
                                                                            
(Www.indomedia.com)F. ComplicationComplications in patients with ovarian carcinoma is often difficult to distinguish the things that are caused by the treatment. Infertility is the result of surgery in premenopausal patients. Chemotherapy with cisplatin associated with nausea, vomiting and bone marrow suspresi, there may also be a potential problem ototoksik, nephrotoxic and neurotoxic. Uncontrolled recurrent disease associated with intestinal obstruction, ascites, fistula and lower extremity edema. (Danielle & Jane, 2000: 166).
G. ManagementGenerally, the management of malignant ovarian tumors based on the clinical level, the type of tumor and the histopathological picture.At the clinical level I and II base surgery with removal of the uterus, adneks, omentum and appendix. At the clinical level III and IV base surgery is removal through surgery is a total hysterectomy with removal of the fallopian tubes and ovaries (Smelzer & Bare, 2002: 1569).Nurses also need to provide comprehensive care kerperawatan includes physical, psychological and emotional impact of the patient and family as well that given that ovarian cancer patients for life expectancy and a lower cure rate, duration of treatment and high medical costs, the role of the nurse is very important as motivator by providing support, care, increase patient confidence, and encourage patients to pray according to his beliefs encourage patients to keep alive the spirit of involving family (Smeltzer & Bare, 2002: 1570).



H. Hysterectomy1. DefinitionHysterectomy is the act of removal of the uterus, through the surgery. The most common malignancy and conditions for certain malignancies (Smeltzer & Bare, 2002: 1562).2. Indication
 
Cancer, endometriosis dysfunction uterine bleeding, nonmalignal growth in the uterus, cervix and adenoksa, prolapse, pelvic, uterine injury that can not be repaired and precancerous cervical dileher. (Smeltzer & Bare, 2002: 1562).3. Types of HysterectomyBased on extensive and the uterus are removed, the action can be categorized three types of hysterectomya. Subtotal hysterectomy: "Appointment supravaginalb. Total hysterectomy: "The appointment of the body and cervix such as removal of the uterus, cervix, and ovaries.c. Radical hysterectomy: "The appointment of mounting network kedinding appointed to the pelvis and the third term vaginal tract, such as the removal of the uterus, admeksa, vagina, proximal and bilateral noduslimfe through an incision adomen".(Smeltzer & Bare, 2002: 1570).
4. Management of Post HisterktomiBleeding can occur after hysterectomy post. To detect complications early, monitor the patient's vital signs monitored for drainage of abdominal bandage if action abdomen is used. In preparation for the startup of the hospital. Nurses provide guidance regarding restrictions on activities to enhance the healing and prevention of post-operative bleeding.Because the position during surgery, post-operative edema and immobility, patients at risk of developing deep vein thrombosis and pulmonary embolus. To minimize this risk, use elastic stockings, besides patients are encouraged and assisted to change positions frequently, even under the pressure of the knee should be avoided. The nurse helps the patient to ambulate early in the postoperative period and the patient is encouraged to exercise the legs and feet. When he was in bed. Besides nurses assess for the presence of deep venous thrombosis (pain in the legs, homan positive sign). Because patients may be discharged in a day or two after the surgery given instructions to avoid sitting in a chair for a long time with the pressure on the knee, sitting with legs crossed, and immobility.Bladder dysfunction, difficulty in urination due to the possibility of a post-operative can be installed before the surgery and left the short period after surgery, if the catheter is attached to the catheter is usually removed soon after the patient ambulation. Once the catheter is detached, haluran urine of patients monitored in addition, assessed for abdominal distension.(Smeltzer & Bare, 2002: 1563).
5. Complications of hysterectomya. HemorrhageHimoragi postoperative usually arise because the bond regardless or because of deficient blood cessation efforts. Bleeding that flow out easily known, difficult to know which is bleeding in the abdominal cavity.(Hanifa, 1999: 670)
b. Venous Thrombosis Profundabecause the position during surgery, postoperative edema and immobility of the patient to the risk of deep vein thrombosis and pulmonary embolus.(Smeltzer & Bare, 2002: 1564)c. Content of Urinary DysfunctionBecause of the possible difficulty in urination posca operation.(Smeltzer & Bare, 2002: 1564)
I. Nursing Diagnosis1. Impaired sense of comfort (pain) associated with tissue breakdown secondary to postoperative wound.2. Body image disturbance associated with changes in sexuality, fertility, and relationships with couples and families.3. Activity intolerance related to pain4. High risk of infection associated with ketidakadekuatan second defense of immunosuppressants.5. High risk of infection associated with bacterial invasion sekunber oprerasi wound.6. Risks relating primarily to shock hipovelamik secondary bleeding ca.ovarium.
J. Focus InterventionNursing problems that may arise in the client with ovarian cancer are:1. Impaired sense of comfort pain associated with tissue breakdown secondary to postoperative wound.Objective: sense of comfort pain decreased.Expected outcomes: Eskspresi clients face relaxed, reduced pain scale, stable vital signs.Intervention:a. Assess the originator of the intensity, quality, location, and duration of pain.b. Monitor vital signs.c. Provide information to clients that pain natural thing.d. Teach relaxation and distraction techniquese. Provide a comfortable position.
 
(Carpenito, 2001: 45)2. Body image disturbance associated with changes in sexuality, fertility, and relationships with couples and families.
      
Objective: The client receives himself after losing the ovary.
      
Criteria results: Clients can receive its state.
      
Intervention:a. Review knowledge lkien.b. Give information about the side effects of a hysterectomy.c. Give the client's mental suprot.d. Listen kelihan clients.e. Encourage the family to provide support and accept klienapa presence.
                                                
(Smeltzer & Bare, 2001: 1563)3. Activity intolerance related to ketrbatasan activity.
      
Objective: The client able to meet the needs of independent ADLExpected outcomes: An increase in exercise and activityIntervention:a. Assess the client's ability activity patternsb. Help patients to make ends meet.c. Help patients active passive exercises gradually.d. Provide appropriate therapy doctors advicee. Involve the family in patient care.
 
(Carpenito, 2001: 2)

4. High risk of infection associated with ketidakadekuatan second defense of immunosuppressants.Objective: Not an infectionExpected outcomes: There were no signs of infection.Intervention:a. Assess for signs of infectionb. Monitor vital signs.c. Increase hand washing procedures.d. Collaboration antibiotics.e. Collaboration routine blood checks.
 
(Doengoes, 2000: 1010)5. Tnggi risks associated with invasive bacterial infection sekunber oprerasi wound.Objective: Not terjad infections.
      
Expected outcomes: There were no signs of infection, surgical wound healed according to the stage of wound healing, vital signs nomal.Intervention:a. Assess for signs of infection.b. Perform wound care with aseptic technique.c. Pantu laboratory results.d. Give antibiotics as advice.
                                                           
(Carpenito, 2001: 2004)
6. Risks relating primarily to shock hipovelamik secondary bleeding ovarian cancer.Objective: hypovolemic shock does not occurExpected outcomes: systolic blood pressure 110-120 mmHg, diastolic 80-85 mm Hg, pulse 60 -80 x / min, breathing 16-24 times / min, akral warm, not cold sweat
Intervention:a. Monitor signs of hypovolemic shock.b. Assess for signs of hypovolemic shock.c. Monitor expenditure pervagina.d. Monitor vital signs(Doengoes, 1999: 1008)
REFERENCES
 Carpenito, Juall Lindo (2000). Handbook of Nursing Diagnosis. ed.8. Jakarta: EGC Doengoes, E. Marilgnn. (1999). Nursing Care Plans: Guidelines for Planning and Documenting Patient Care. Ed. 3 Jakarta: EGC Long, Barbara (1996) Medical Surgical Nursing 3. New York: Foundation for Nursing Education Alumni Association Padjajaran. Manuaba, Ida Bagus. (2001). Understanding Women's Reproductive Health: Jakarta: Arcan Price & Wikon (1995). Pathophysiology. Eda. Book 2. Jakarta: EGC Sjamsuhidajat (1997). Books Teachings of Surgery: Jakarta: EGC Smeltzer & Bare (2002). Medical Surgical Nursing. Vol. 2 eed 8. Jakarta: EGC Wikrjosastro. Hanifa. (1997). Science Content: Library Development Foundation Sarwono Prawirahardjo: Jakarta. Wikrjosastro. Hanifa. (1999). Science Content.: Yayasan Bina Library Sarwono Prawirahardjo: Jakarta

Thank you hopefully useful.....

Tidak ada komentar:

Posting Komentar