NURSING CARE PLAN PATIENT WITH GYNECOLOGY CHEMOTHERAPY

1. NURSING CARE PLANPATIENTWITH GYNECOLOGY CHEMOTHERAPY Ni Ketut Alit A Nursing Faculty Airlangga University Surabaya East Java

2. REFERENCES • Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care, The Nurse and The Family 5thed , 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..

3. 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

5. 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)

6. SURGERY Curative Prophylactic Diagnostic Staging Palliative Adjuvant or Supportive Reconstructive/Rehabilitative

7. 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)

8. 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

9. PRINCIPLES OF CANCER TREATMENT CURE CONTROL PALLIATION

10. GENITAL CANCER • Cervical • Endometrial • Ovarian • Testicular • Breast

11. 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.

12. SIDE EFFECT OF CHEMOTHERAPY

13. MYELOSUPPRESSION NEUTROPENIA THROMBOCYTOPENIA ANEMIA

14. 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)

15. 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

16. 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

17. THROMBOCYTOPENIA • Assess risk factors • chemotherapy / radiation • DIC • disease infiltration • NSAID's • petechaie • hemorrhage (skin, GI, GU) • headaches, confusion, somnolence

18. 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

19. ANEMIA=DECREASED RED BLOOD CELLS • Assess for • chemotherapy • kidney damage • tumor infiltration • bleeding, hemorrhage • age, appetite

20. Management: • Rest, slow position changes • Oxygen • Iron • Transfusion • Patient education on signs and symptoms

21. 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

22. 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

23. 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

24. NURSING CARE- NURSING DIAGNOSIS D. Risk for Infection E. Risk for Injury F. Altered Nutrition: less than body requirements G. Impaired Tissue Integrity

25. CARE For better health....