B. Etiology 1 . Cerebral infarction ( 80 % )a. embolism1 ) cardiogenic embolisma) Atrial fibrillation or other arrhythmiasb ) left ventrikek mural thrombusc ) mitral or aortic valve diseased ) Endocarditis2 ) paradoxical embolism ( patent foramen ovale )3 . Aortic arch embolismb . Aterotrombotik ( blood vessel disease medium-high )1 ) Disease ekstrakarniala) the internal carotid arteryb ) the vertebral artery2 ) Disease intrakarniala) the internal carotid arteryb ) middle cerebral arteryc ) the basilar arteryd ) Lakuner ( perforans small artery occlusion )2 . Intracerebral hemorrhage ( 15 % )a. hypertensiveb . Arteriovenous malformationc . amyloid angiopathy3 . Subarachnoid hemorrhage ( 5 % )4 . Other causes ( can lead to infarction or hemorrhage )a. Thrombosis dinus durab . Carotid or vertebral artery dissectionc . Central nervous system vasculitisd . Moya - moya disease ( occlusion of a large intracranial arterial progressive )e . migrainef . hypercoagulable conditiong . Misuse of drugs ( cocaine or amphetamines )h . Haematological disorders ( sickle cell anemia , polycythemia , or leukemia )i . atrial myxoma
C. PathophysiologyThrombosis ( disease trombo - occlusive ) is the most frequent cause of stroke . Cerebral arteriosclerosis and cerebral circulation slowdown is the main cause of cerebral thrombosis , which is a common cause of stroke . Signs of cerebral thrombosis varies . Onset of the headache is not common . Some patients experience dizziness , seizures , and cognitive changes or some other common onset . In general, cerebral thrombosis did not occur suddenly , and temporary loss of speech , hemiplegia or paresthesias in half body weight may precede the onset of paralysis in a few hours or days .Thrombosis occurs usually has something to do with the local damage blood vessel walls due atrosklerosis . The process of atherosclerosis is characterized by fatty plaque in the intima layer of the artery . Sereberi artery intima part becomes thin and stringy , whereas cells - muscle cells disappeared . Lamina interna elastika torn and frayed , so the vessel lumen partially filled by the sclerotic material . Plaques tend to form at branching or places - places curved . Thrombi were also associated with a place - such a special place . Vessels - vascular risk in order to have less and less are as follows : internal carotid artery , vertebral and basilar part of the bottom . Intima loss will make connective tissue exposed . Platelets stick to the exposed surface so that the surface of the blood vessel walls become rough . Platelets will let go of the enzyme , adenosine diphosphate mechanisms that initiate coagulation . Fibrinotrombosit stopper can be detached and form emboli , or it can remain in place and eventually all that will be clogged artery perfectly .Embolism : embolism sereberi including second leading cause of many strokes . Embolism patients are usually younger than patients with thrombosis . Most sereberi emboli originating from a thrombus in the heart , so the real problem faced is the embodiment of heart disease . Although less common , embolus may also originate from atheromatous plaques karotikus sinus or internal carotid artery . Each part of the brain can suffer embolism , but usually embolus embolus will clog parts - small parts .. the most frequently affected artery embolus sereberi is sereberi media , especially the top .Cerebral hemorrhage : cerebral hemorrhage including third leading cause of all cases GPDO ( Brain Blood Vessel Disorders ) and a tenth of all cases of the disease . Intracranial hemorrhage is usually caused by the rupture of cerebral arteries . Extravasation of blood occurs in the brain and / or subarachnoid , so the networks are located nearby will be displaced and depressed . Blood is very irritating to the brain tissue , resulting in vasospasm in arteries around the bleeding . These spasms can spread throughout the brain and the circle wilisi hemisper . Blood clot that initially resemble soft red jam will eventually dissolve and shrink . In the light of histological brain located around the clot can swell and undergo necrosis . Because the action of the enzyme - enzyme liquefaction process will occur , thus forming a cavity . After several months of all necrotic tissue will be replaced by astrocytes and capillaries - new capillaries to form the fabric around the cavity earlier . Finally cavities filled by fibers - fibers that experienced astroglia proliferation . Subarachnoid hemorrhage is often associated with rupture of an aneurysm . Most aneurysms of the circle of wilisi . Hypertension or bleeding disorders facilitate the possibility of rupture . Often there is more than one aneurysm .
D. CLINICAL1 . sudden headache .2 . Paraesthesia , paresis , Plegia part of the way .3 . dysphagia4 . aphasia5 . Impaired vision6 . Changes in cognitive abilities
E. RISK FACTORSWhich can not be changed : age , male gender , race , family history , history of TIA or stroke , coronary heart disease , atrial fibrillation , and heterozygous or homozygous for homo cystinuria .That can be changed : hypertension , diabetes mellitus , smoking , alcohol and drug abuse , oral contraceptives , increased hematocrit , asymptomatic carotid bruit , hyperuricemia , and dispidemia .
F. ACUTE STROKE UNIT IN EMERGENCYTime is brain is an expression that shows the importance of stroke treatment as early as possible , because the ' therapeutic window ' of a stroke is only 3-6 hours . Management of rapid , precise , and accurate , emegang dasil major role in determining the end of treatment . Things that should be done is :1 . Stabilization of patients with ABC action2 . Consider intubation bil a kesadaranstupor tau respiratory failure or coma3 . Put an intravenous infusion line with normal saline solution 0.9 % in water and saline 0.45 % , due to brain edema memperhebar4 . Give oxygen 2-4 liters / minute via nasal cannula5 . Do not give food or drink by mouth6 . Create recording electrocardiogram (ECG ) and chest X-ray did Rongen photo7 . Take samples for blood tests : complete examination of peripheral blood with platelets , blood chemistry ( glucose , electrolytes , urea and creatinine ) . Asa prothrombin and partial thromboplastin time8 . If there is any indication, do the following tests : jadar alcohol , liver function , arterial blood gases , and toxicology screening9 . Enforce diagnosis based on history and physical examination10 . CT scans or magnetic resonance tool when available . If not, the Siriraj score to determine the type of stroke .G. Nursing care1 . ASSESSMENT1 . Changes in level of consciousness or responivitas as evidenced by the movement , refused to change its position and response to stimulation , oriented towards the time, place and person2 . Presence or absence of a volunteer or involuntary limb movements , muscle tone , posture and head position .3 . Flaksiditas stiffness or neck .4 . Eye opening , comparative pupil size , and pupil reaction to light and ocular position .5 . Color of the face and extremities , skin temperature and humidity .6 . Quality and frequency of pulse , respiration , arterial blood gases as indicated , body temperature and arterial pressure .7 . Ability to speak8 . The volume of fluid you drink and urine volume issued every 24 hours .2 . MANAGEMENTa. Acute phase :
Maintain vital functions : airway, breathing , oxygenation and circulation
Reperfusion with trombolityk or vasodilation : Nimotop
Prevention of increased ICP
Reduce cerebral edema with diureticsb . Post acute phase
Prevention spatik paralysis with antispasmodics
program Fisiotherapi
Handling psychosocial problemsc . First Aid In Stroke PatientsFirst Aid In Stroke ( By way of bleed on each end of the leaf tips of fingers and ears ) . There is one best way to provide first aid to people who had suffered a STROKE . This way can save lives in addition to the patient , also does not cause any side effects . The first aid is aid EMERGENCY guaranteed to work 100 % .As we know , people who had suffered a STROKE , whole blood in the body will drain very fast towards the blood vessels in the brain . If the activities of aid given terlambatsedikit course , the blood vessels in the brain will not withstand the flow of blood flowing profusely and will soon be broken little by little .In the face of such circumstances not to panic but to be quiet . Sipenderita should remain its original place where he fell ( eg in the bathroom , bedroom , or anywhere else ) . DO NOT MOVED ! ! ! because by moving the patient from the original will hasten rupture small blood vessels in the brain .Patients should be assisted take a good sitting position in order not to fall again , and at that time extravasation can be done . It is best to use a syringe , but if not there , then NEEDLE SEWING / pin / pin can be used to advance first sterilized by burning over the fire . As soon as sterile needles , do the stabbing on 10 END FINGER . Insertion point is approximately 1cm from the tip of the nail . Each finger is quite stabbed one time only in the hope of every finger dispense 1 drop of blood . Extravasation can also be assisted by the push of blood if it was not out of his fingertips . In a period of approximately 10 minutes , the patient will regain consciousness soon .When sipenderita looks lopsided mouth / not normal , then BOTH EARS sipenderita LEAF - DRAWN TO PULL until goldenReddish . After that do 2 TIMES stabbing at each END DOWN LEAF EAR so that 2 drops of blood out of each end of the ear . Thus in a few minutes form the mouth sipenderita will return to normal .After the state sipenderita recovered and no significant abnormalities , then take sipenderita carefully to the doctor or the nearest hospital to get further help .
4 . Nursing Diagnosisa. Damage to physical mobility bd decreased muscle strength , controlb . Ineffective tissue perfusion related to cerebral hemorrhage . brain edemac . B.d self care less physical weaknessd . Verbal communication b.d damage brain damagee . Risk of damage to skin integrity bd mechanical factorsf . Decrease the risk of infection b.d primary defense
5 . INTERVENTIONNo Diagnosis Goals / Interventions Rationale KH1 . Damage to physical mobility bd penuruna n NOC muscle strength : Ambulation / maintained normal ROM .After the act of nursing 5x24 hoursKH :o The joints are not stiffo No muscle atrophy occurs NIC :1.Terapi exercisejoint mobilityo Explain to the client & kelg purpose joint movement exercises .o Monitor the location and discomfort during exerciseo Use loose clothingo Assess client's ability to moveo Encourage active ROMo Teach ROM active / passive on the client / family .o Change the client's position every 2 hours .o Assess development / progress exercises2 . Self Care Assistanceo Monitor client independenceo assist the client in terms of self-care : eating , bathing , toileting .o Teach the family in meeting self-care clients .Movement of active / passive aims to maintain flexibility of jointsPhysical and psychological disabilities clients can reduce their daily self-care and can be fulfilled with the help of clients that personal hygiene can be maintained2 . Ineffective cerebral tissue perfusion bd brain hemorrhage , edema o NOC : cerebral tissue perfusion . After the act of nursing for 5 x 24 hours with adequate tissue perfusion indicator :o adequate tissue perfusion is based on peripheral pulse pressure , the warmth of the skin , urine output is adequate and there is no interference with respiration NIC : Nursing circulationIncrease in brain tissue perfusionactivity :1 . Monitor neurologic status2 . monitor the status of respitasi3 . monitor heart sounds4 . place the head with a slightly elevated position and in a neutral position5 . appropriate medication management order6 . Oxygen is given as indicated 1 . tk identify trends and potential increase ICT awareness and find out the location . Extensive CNS damage and progress2 . Respiratory irregularity can give you an idea location of damage / increase in ICT3 . Bradycardia could occur as a result of brain damage .4 . Lowers arterial pressure by improving drainage and improve circulation5 . Prevention / treatment decreased ICT6 . lowering hypoxia3 . Decrease the risk of infection bd primary defense NOC : Risk Control After nursing action for 3 x 24 hours the client does not have an infectionKH :o Clients are free of signs of infectiono The client is able to explain the signs and symptoms of infection NIC : Prevent infection1 . Observe and report signs and symptoms of infection , such as redness , warm , discharge and an increase in body temperature2 . assess client netropeni temperature every 4 hours , reported if the temperature is more than 380C3 . Using electronic or mercury thermometer to assess temperature4 . Record and report the value of laboratory5 . Assess skin color , skin moisture , texture and turgor do proper documentation on any changes6 . Support for the consumption of a balanced diet , the emphasis on protein for the formation of the immune system1 . Onset of infection with the immune system is activated and signs of infection appear2 . Clients with netropeni not produce enough heat inflammatory response because it is usually a sign and often the only sign of3 . Temperature values have important consequences for the proper treatment4 . Lab values correlated with client history and physical examination to give him a holistic view5 . Can prevent skin damage , skin intact is the first defense against microorganisms6 . Immune function is affected by protein intake4 . Self-care deficit bd physical weakness NOC : Self Care Assistance ( bathing , dressing , eating , toileting .After the act of nursing for 5 x 24 hour client can meet the needs of self-careKH :- The client is free from odor , can feed themselves , and dress himself
NIC : Self Care1 . Observation of the client's ability to bathe , dress and eat .2 . Assist the client in a sitting position , make sure the head and shoulders upright for eating and 1 hour after meals3 . Avoid exhaustion before eating , bathing and dressing4 . Encourage clients to continue to eat little but often1 . By using direct intervention to determine appropriate interventions for clients2 . Seated position helps prevent ingestion and aspiration3 . Improve energy conservation and activity tolerance improved self-care skills4 . To increase appetite5 . Risk of damage to the skin intagritas bd mechanical factors NOC : maintain skin integrityAfter a 5 x 24- hour care skin integrity remains adequate indicators:No significant damage to the skin characterized by redness , sores decubitus NIC : Give stress management1 . Perform replacement loom every day and place the appropriate mattress2 . Monitor the skin area kemerahan/pecah23 . monitor the depressed area4 . give masage on back / depressed area and provide moisturizing pad area pecah25 . monitor nutritional status1 . Improve comfort and reduce the risk of itchinglajutan damage kulità 2 integrity . Indicates the initial symptoms3 . Depressed area usually less than optimal circulation allows for trigger blisters4 . facilitate the circulation of. 5. Good nutritional status can help prevent skin integrity keruakan .6 Lack of knowledge bd less access to health information NOC : Knowledge increased clientKH :- The client and family understanding of disease Stroke , care and treatment NIC : Health Education1 . Assess the client's readiness and ability to learn2 . Assess the knowledge and skills of previous clients about the disease and its effect on the desire to learn3 . Give the most important material on the client4 . Identify the main source of support and attention to the client's ability to learn and support the behavior change necessary5 . Assessing the family wishes to support changes in client behavior6 . Highly priced hasi evaluation pembelajarn through demonstrations and restates the material being taughtThe learning process depends on the particular situation , the interaction of social , cultural and environmental valuesNew information is absorbed meallui previous facts and assumptions and biases affect the process of transformationInformation will be more striking when explained from a simple concept to complexFamily support is needed to support behavior change.
A malignant lung tumor in lung tissue (Price, Pathophysiology, 1995).
Lung cancer is an abnormality of cells - cells undergoing proliferation in the lung (Underwood, Pathology, 2000).
B. Etiology.
Although the exact etiology of lung cancer is not known, but there are several factors that seem to be responsible for the increased incidence of lung cancer:
Smoking.
Undoubtedly a major factor. A definitive statistical relationship has been established between heavy smokers (more than twenty cigarettes a day) of lung cancer (bronchogenic carcinoma). Smokers like this has a tendency to ten times greater than in light smokers. Furthermore the previous heavy smokers who had quit his habit and will return to the risk of non-smokers in about 10 years. Carcinogenic hydrocarbons have been found in the tar from tobacco cigarettes which if applied to the skin of animals, causing tumors.
Irradiation.
A high incidence of lung carcinoma in cobalt miners in Schneeberg and radium miners in Joachimsthal (more than 50% died of lung cancer) associated with the presence of radioactive material in the form of radon. This material is thought to be the etiologic agent operative.
Occupational lung cancer.
There is a high incidence of workers exposed to nickel carbonyl (nickel smelters) and arsenic (weed killers). Workers breaking hematite (lungs - pulmonary hematite) and people - people who work with asbestos and chromate are also experiencing an increase in incidents.
Air pollution.
Those who live in cities have lung cancer rates are higher than in those who live in the village and even has been known carcinogens from industrial and diesel vapor in the atmosphere in the city.
(Thomson, Pathology Lecture Notes, 1997).
Genetic.
There is a change / mutation of several genes that play a role in lung cancer, namely:
Proton oncogene.
Tumor suppressor gene.
Gene encoding the enzyme.
Theory of oncogenesis.
The occurrence of lung cancer based on the appearance of a tumor suppresor gene in the genome (oncogenes). The existence of tumor suppressor genes initiator change by eliminating (deletion / del) or insertion (insertion / INS) most couples alkaline composition, appearance and or neu/erbB2 erbB1 genes play a role in anti-apoptosis (cell mechanisms to die naturally-programmed cell death) . Changes in gene display this case led to the target cells in the lung cells turn into cancer cells with growth autonomic properties. Thus cancer is a genetic disease that is limited to the beginning and then become aggressive target cells in the surrounding tissue.
Tumor suppressor gene predisposing
Inisitor
Deletions / insertions
Promoter
Tumor / autonomy
Progresor
Expansion / metastasis
Diet.
Reported that low consumption of beta-carotene, vitamin A seleniumdan cause high risk of lung cancer.
(Medicine, 2001).
C. CLASSIFICATION.
According to the WHO classification for Lung and Pleural Neoplasms - Lung (1977):
Bronchogenic carcinoma.
Epidermoid carcinoma (squamous).
Cancer is derived from the surface of the bronchial epithelium. Epithelial changes including metaplasia, or dysplasia caused by long-term smoking, typically precedes the onset of tumors. Centrally located around the hilum, and large protruding into the bronchi. Tumor diameters rarely exceed a few centimeters and are likely to spread directly to the hilar lymph nodes, chest wall and mediastinum.
Small cell carcinoma (oat cell included).
Usually located around the middle of this bronki.Tumor main ramification arising from cells - Kulchitsky cells, the normal component of the bronchial epithelium. Formed from cells - cells with a small nucleus and cytoplasm hiperkromatik little soupy. Early metastasis to the mediastinal and hilar lymph nodes, as well as hematogenous spread to organs - organs distal.
Adenocarcinoma (including alveolar cell carcinoma).
Shows the cellular structure such as bronchial glands and may contain mucus. Most arise in the peripheral parts of the bronchial segment and sometimes - sometimes can be associated with local scar tissue in the lungs - pulmonary and chronic interstitial fibrosis. Lesions often spreads through the blood and lymph vessels in the early stages, and still do not show clinical symptoms - symptoms until the occurrence of distant metastases.
Large cell carcinoma.
A cell - malignant cells are large and very poorly with large cytoplasm and nucleus size wide - range. Cells - these cells are likely to arise in the lung tissue - the peripheral lung, grows quickly with extensive and rapid deployment to places - places far away.
Combined adenocarcinoma and epidermoid.
Other - Other.
1). Carcinoid tumors (adenomas bronchi).
2). Bronchial gland tumors.
3). Papillary tumors of the epithelial surface.
4). Mixed tumors and Karsinosarkoma
5). Sarcoma
6). Not classified.
7). Mesothelioma.
8). Melanoma.
(Price, Pathophysiology, 1995).
D. Clinical manifestations.
Early symptoms.
Local mild stridor and dyspnea that may be caused by bronchial obstruction.
Common symptoms.
Cough
Probably due to irritation caused by the tumor mass. Cough starts as a dry cough without sputum formed, but evolved to the point where the molded thick and purulent sputum in responding to secondary infections.
Hemoptysis
Sputum Sputum faintly through the surface of the blood due to an ulcerated tumor.
Anorexia, fatigue, weight loss.
E. STADIUM.
Table TNM Staging System for Lung Cancer - Lung: 1986 American Joint Committee on Cancer.
Gambarn TNM Definition Primary tumor (T)
T0
Tx
TIS
T1
T2
T3
T4
Regional lymph nodes (N)
N0
N1
N2
N3
Distant metastasis (M)
M0
M1
Group stage
Hidden carcinoma TxN0M0
Stage 0 TISN0M0
T1N0M0 stage I
T2N0M0
Stage II T1N1M0
T2N1M0
Stage IIIA T3N0M0
T3N0M0
Each stage IIIb T N3M0
T4 every NM0
Stage IV Any T, any N, M1
No evidence of primary tumor
Hidden cancers seen in the cytology of bronchial washings but not visible on the radiogram or bronchoscopy
Carcinoma in situ
Tumors ≤ 3 cm in diameter surrounded by lung - lung or visceral pleura were normal.
Tumor with a diameter of 3 cm or in any measure which has been attacked resulting in atelectasis or visceral pleura that extends to the hilum; must be within 2 cm distal to the carina.
Tumors in any size with direct extension to the chest wall, diaphragm, pleura mediastinalis, or pericardium without the heart, great vessels, trachea, esophagus, or vertebral body, or within 2 cm of the carina but does not involve the carina.
Tumors in any size that has been attacking the mediastinum or the heart, great vessels, trachea, esophagus, vertebral koepua, or carina, or the existence of a malignant pleural effusion.
Can not be seen in the regional lymph nodes metastasis.
Peribronkial metastasis and / or gland - ipsilateral hilar glands.
Metastasis in the lateral or mediastinal lymph nodes IPSI subkarina.
Or mediastinal nodes metastasis - contralateral hilar lymph nodes; gland - scalenus or supraclavicular lymph nodes ipsilateral or contralateral.
There are no known distant metastases
Distant metastases present in certain places (like the brain).
Sputum containing cells - malignant cells but not proven the existence of a primary tumor or a metastasis.
Carcinoma in situ.
Classification of tumors including T1 or T2 without any evidence of metastases in regional lymph nodes or distant sites.
Classification of tumors including T1 or T2 and there is evidence of lymph node metastasis in peribronkial or ipsilateral hilar.
Including classification T3 tumors with or without evidence of lymph node metastasis in peribronkial or ipsilateral hilar, there is no distant metastasis.
Each tumor with hilar lymph node metastasis in contralateral mediastinal tau, or the scalenus or supraclavicular lymph nodes, or any classification that included T4 tumors with or without regional lymph node metastasis, there is no distant metastasis.
Any tumor with distant metastsis.
Sources: (Price, Pathophysiology, 1995).
F. Pathophysiology.
Of aetiological attack branching segments / sub bronchus causing lost cilia and desquamation resulting in the deposition of carcinogens. With the deposition of carcinogens that cause metaplasia, hyperplasia and dysplasia. When peripheral lesions caused by metaplasia, hyperplasia and dysplasia penetrate the pleural space, pleural effusion usually arises, and can be followed by direct invasion on the costal and vertebral bodies.
Centrally located lesions derived from one of the largest branches of the bronchi. This causes lesions and ulcerations obstuksi bronchus followed by suppuration in the distal part. Symptoms - symptoms may include cough, hemoptysis, dyspnoea, fever, and unilateral dingin.Wheezing can terdengan on auscultation.
In later stages, weight loss usually indicate the presence of metastases, particularly in the liver. Lung cancer can be metastatic to the structure - such as the lymph nodes nearby structures, the esophageal wall, pericardium, brain, bone frame.
G. DIAGNOSTIC EXAMINATION.
Radiology.
Posterior thorax - anterior (PA) and leteral and chest tomography.
A simple initial examination that can detect lung cancer. Describe the shape, size and location of the lesion. May declare the air mass at the hilum, pleural effuse, atelectasis erosion ribs or vertebrae.
Bronkhografi.
To look at the branching bronchial tumor.
Laboratory.
Cytology (sputum, pleural, or lymph nodes).
Conducted to assess the presence / stage carcinoma.
Pulmonary function tests and GDA
Can be done to assess the capacity to meet the ventilation requirements.
Skin test, the absolute number of lymphocytes.
Can be done to evaluate immune competence (common in lung cancer).
Histopathology.
Bronchoscopy.
Allows visualization, parts washing, and cleaning cytological lesions (bronchogenic carcinoma magnitude can be determined).
Trans thoracic biopsy (TTB).
Biopsy with TTB especially for lesions located peripheral to the size <2 cm, the sensitivity reached 90-95%.
Thoracoscopic.
Pleural biopsy tumor area gave better results with thoracoscopic way.
Mediastinosopi.
Umtuk obtain tumor metastasis or lymph nodes involved.
Thoracotomy.
Totakotomi for lung cancer diagnostic done when wide - range of non-invasive and invasive procedures previously failed to obtain tumor cells.
Imaging.
CT-Scanning, to evaluate the lung parenchyma and pleural tissue.
MRI, to show the state of the mediastinum.
H. MANAGEMENT.
Goal of cancer treatment may include:
Curative
Prolong disease-free survival and improve client.
Palliative.
Reducing the impact of cancer, improve the quality of life.
Rawat home (Hospice Care) in terminal cases.
Reduce the physical and psychological impact of cancer on patients and families better.
Supotif.
Supporting curative treatment, palliative and terminal sepertia nutrition, blood transfusion and blood component, anti-pain medications and anti-infective.
(Medicine, 2001 and Doenges, Nursing care plan, 2000)
Surgery.
Aim at lung cancer surgery as other lung diseases, to pick-up all diseased tissue as possible while maintaining lung function - which is not affected by lung cancer.
Toraktomi exploration.
To mengkomfirmasi suspected diagnosis of pulmonary disease or carcinoma thoracic particular, to perform a biopsy.
Pneumonectomy lung removal).
Bronchogenic carcinoma lobectomy does not fit in with all lesions can be removed.
Lobectomy (removal of the lung lobe).
Bronchogenic carcinoma is confined to one lobe, bronkiaktesis bleb or bulla emfisematosa; lung abscess; fungal infections; tuberkulois benign tumor.
Segmental recession.
Is pengankatan satau or more lung segments.
Wedge recession.
Benign tumors with well defined, tumor metas picking, or a localized inflammatory diseases. Is the removal of the surface of the lungs - pulmonary wedge shaped (ice chunks).
Decortication.
An appointment of material - material from pleural fibrin viscelaris)
Radiation
In some cases, radiotherapy is performed as a curative treatment, and can also as adjuvant therapy / palliation in tumors with complications, such as reducing the effects of obstruction / suppression of blood vessels / bronchi.
Kemoterafi.
Chemotherapy is used to disrupt the pattern of tumor growth, to treat patients with small cell lung tumor or the metastasis as well as to complement the extensive surgery or radiation therapy.
I. NURSING CARE OF CLIENTS WITH LUNG CANCER.
1. ASSESSMENT.
Preoperatively (Doenges, Nursing Care Plan, 1999).
1). Activity / rest.
Symptoms: weakness, inability to maintain regular habits,
dyspnea due to inactivity.
Symptoms: Lethargy (usually advanced stage).
2). Circulation.
Symptoms: JVD (vana caval obstruction).
The sound of the heart: pericardial friction (showing effusion).
Tachycardia / dysrhythmias.
Finger clubbing.
3). Ego integrity.
Symptoms: Feelings taku. Fear the results of surgery
Resist the harsh conditions / potential malignancy.
Signs: Anxiety, insomnia, repeated question - again.
4). Elimination.
Symptoms: Diarrhea intermittent (small cell carcinoma).
Increased frequency / amount of urine (hormonal imbalance, epidermoid tumor)
5). Food / liquids.
Symptoms: Weight loss, poor appetite, decreased input
food.
Difficulty swallowing
Thirst / increased fluid intake.
Signs: Petite, or the appearance of less weight (advanced stage)
Edema of the face / neck, chest, back (vena cava obstruction), facial edema / periorbital (hormonal imbalance, small cell carcinoma)
Glucose in the urine (hormonal imbalance, epidermoid tumor).
6). Pain / comfort.
Symptoms: Chest pain (not normally exist in the early stages and are not always
at an advanced stage) which can / can not be influenced by changes in position.
Shoulder pain / hand (especially on large cell or adenocarcinoma)
Intermittent abdominal pain.
7). Breathing.
Symptoms: Cough cough mild or changing patterns of normal and or
sputum production.
Shortness of breath
Workers exposed to pollutants, dust industry
Hoarse, vocal cord paralysis.
History of smoking
Signs: dyspnea, increased work
Increased tactile fremitus (showing consolidation)
Krekels / wheezing on inspiration or expiration (airflow disruption), krekels / wheezing settled; pentimpangan trachea (lesion area).
Hemoptysis.
8). Security.
Symptoms: Fever may be a (big or cell carcinoma)
Redness, pale skin (hormonal imbalance, small cell carcinoma)
9). Sexuality.
Signs: Gynecomastia (hormone changes neoplastic cell carcinoma
large)
Amenorrhoea / impotent (hormonal imbalance, small cell carcinoma)
10). Counseling.
Symptoms: family risk factors, cancer (especially lung), tuberculosis
Failure to improve.
Postoperative (Doenges, Nursing Care Plan, 1999).
- Characteristics and depth of breathing and the patient's skin color.
- Frequency and rhythm of the heart.
- Laboratory tests related (GDA. electolyte serum, hemoglobin and hematocrit).
- Monitoring of central venous pressure.
- Nutritional status.
- Status extremity mobilization particularly in the upper extremity on the side of the operation.
- Conditions and characteristics of the water seal drainage.
1). Activity or rest.
Symptoms: Changes in activity, reduced sleep frequency.
2). Circulation.
Signs: rapid pulse, high blood pressure.
3). Elimination.
Symptoms: decreased frequency of elimination CHAPTER
Signs: urinary catheter attached / no, characteristics of urine
Bisng intestine, samara or clear.
4). Food and fluids.
Symptoms: Nausea or vomiting
5). Neurosensori.
Symptoms: Impaired movement and sensation below the level of anesthesia.
6). Pain and discomfort.
Symptoms: Complaints of pain, pain characteristics
Pain, discomfort from a variety of sources such as incision
Or effects - the effects of anesthesia.
2. NURSING NURSING DIAGNOSIS AND PLANS.
Preoperatively (Gale, Oncology Nursing Care Plans, 2000, and Doenges, Nursing Care Plan, 1999).
1). Damage to gas exchange
Can be connected:
Hypoventilation.
Outcomes:
- Demonstrate improved ventilation and adequate oksigenisi with GDA in the normal range and are free of symptoms of respiratory distress.
- Participated in the treatment program, the ability / situation.
Intervention:
a) Assess the respiratory status with frequent, noted an increase in the frequency or respiratory effort or change in breathing pattern.
Rationale: Dyspnea is a compensatory mechanism of the airway resistance.
b) Record the presence or absence of additional sound and the sound added, for example krekels, wheezing.
Rational: decreased breath sounds can be, not the same or does not exist in the area sakit.Krekels is evidence of increased fluid within the network as a result of increased permeability of the alveolar-capillary membrane. Wheezing is evidence of resistance or in connection with the narrowing of the airway mucus / edema and tumor.
c) Assess adanmya cyanosis
Rational: oxygenation significant decline occurred before cyanosis. Central cyanosis of "organ" warm example, the tongue, lips and ears are the most indicative.
d) Collaboration of moist oxygen as indicated
Rational: Maximizing oxygen preparation for the exchange.
e) Keep an eye or draw the series GDA.
Rationale: Shows ventilation or oxygenation. Used as a basis for evaluation or therapy keefktifan indicator therapy needs change.
2). Ineffective airway clearance.
Can be connected:
- Loss of airway ciliary function
- Increased number / viscosity of pulmonary secretions.
- Increased airway resistance
Outcomes:
- Declare / show loss of dyspnea.
- Maintain a patent airway with breath sounds clean
- Removing the secretions without any difficulties.
- Demonstrate behaviors to improve / maintain airway bersiahn.
Intervention:
a) Record the change effort and breathing patterns.
Rationale: The use of intercostal muscle / abdominal and nasal dilation showed increased breathing effort.
b) Observation ekspensi decline and the chest wall.
Rational: Expansion dad limited or no relation to fluid accumulation, edema, and secretions in sexy lobe.
c) Record the characteristics of cough (eg, settling, effective, not effective), also sputum production and characteristics.
Rational: Characteristics cough may change depending on the cause / etiology failed perbafasan. Sputum when there may be many, thick, bloody, adan / or puulen.
d) Maintain the position of the body / head right and use airway device as needed.
Rationale: Allows maintain upper airway patent airway when pasein affected.
e) Collaboration of bronchodilators, aminophylline example, albuterol etc.. Keep an eye for the adverse effects of drugs, examples of tachycardia, hypertension, tremors, insomnia.
Rationale: Drugs given to relieve bronchial spasms, reduce viscosity of secretions, improve ventilation, and facilitate disposal of secretions. Require a change in dose / drug choice.
3). Fear / anxiety.
Can be connected:
- Crisis situations
- The threat to / change in health status, fear of death.
- Psychological factors.
Outcomes:
- Declare awareness of anxiety and healthy ways to cope.
- Recognize and discuss fear.
- Looks relaxed and report anxiety levels can be decreased to diatangani.
- Demonstrate problem solving and effective use of resources.
Intervention:
a) Observation of increased anxiety, emotional instability.
Rational: The worsening disease can cause or increase anxiety.
b) Maintain a calm environment with little stimulation.
Rationale: Reduce anxiety by increasing relaxation and energy savings.
c) Show / Aids with relaxation techniques, meditation, imagination guidance.
Rationale: Provide an opportunity for the patient to handle ansietasnya own and feel controlled.
d) Identify the client perspsi against existing threats by the situation.
Rational: Helping the introduction of anxiety / fear and identify actions that can help to individuals.
e) Encourage the patient to recognize and express feelings.
Rationale: The first step in overcoming the feeling is the identification and expression. Encouraging self-acceptance situation and ability to cope.
4). Lack of knowledge about the condition, action, prognosis.
Can be connected:
- Lack of information.
- Errors of interpretation of information.
- Less remember.
Outcomes:
- Explain the relationship between the disease process and treatment.
- Describing / states diet, medication, and program activities.
- Identify the correct signs and symptoms that require medical attention.
- Make a plan for further treatment.
Intervention:
a) Encourage learning to meet the needs of patients. Rippling information in a clear / concise.
Rational: Recover from failed pulmonary disorders can severely hamper the scope of patient attention, concentration and energy for receiving information / new task.
b) Provide verbal and written information about the drug
Rationale: The provision of safe medication use instructions memmampukan patients to follow the proper course of treatment.
c) Assess nutritional counseling on meal plans; needs of high-calorie foods.
Rationale: Patients with severe respiratory problems typically experience weight loss and anorexia that require enhanced nutrition for healing.
d) Provide guidelines for activity.
Rationale: Patients should avoid too tired and activities counterbalance istirahatdan period to increase the stretch / stamina and prevent the consumption / excessive oxygen demand.
Postoperative (Doenges, Nursing Care Plan, 1999).
1). Damage to gas exchange.
Can be connected:
- Appointment of lung tissue
- Impaired oxygen supply
- Decrease in the oxygen-carrying capacity of the blood (blood loss).
Outcomes:
- Demonstrate improved ventilation and adequate tissue oxygenation with GDA in the normal range.
- Free of symptoms of respiratory distress.
Intervention:
a) Record the frequency, depth and ease breathing. Observation of the use of accessory muscles, breathing lips, skin changes / mucous membranes.
Rationale: Respiratory increased as a result of pain or as an initial compensatory mechanism to the loss of lung tissue.
b) Auscultation of the lungs for air gerakamn and abnormal breath sounds.
Rational: Consolidation and lack of air movement on the operated side in patients pneumonoktomi normal. However, patients must demonstrate lubektomi normal airflow in the remaining lobes.
c) Maintain the patient's airway kepatenan to provide position, exploitation, and use of tools
Rationale: Airway obstruction affecting ventilation, interfere with gas exchange.
d) Change position often, place the patient in the supine position until the seat is tilted position.
Rational: Maximizing lung expansion and drainage of secretions.
e) Encourage / assist with breathing in and breathing exercises with proper lip.
Rationale: Increases maximum ventilation and oxygenation and reduce / prevent atelectasis.
2). Ineffective airway clearance
Can be connected:
- Increased number / viscosity of secretions
- Limitations of chest movement / pain.
- Weakness / fatigue.
Outcomes:
Showed patency of the airway, with fluid secretions easily removed, clear breath sounds, and breathing was noisy.
Intervention:
a) Auscultation of the chest for breath sounds and characteristics of the secretions.
Rationale: Respiratory noise, crackles, and wheezing showed retention of secretions and / or obstruiksi airway.
b) Assist patients with / instructed to breath deeply and cough effectively with high seating position and pressing area of the incision.
Rational: The sitting position allows maximal lung expansion and suppression of cough menmguatkan efforts to mobilize and remove secretions. Emphasis is performed by nurses.
c) Observation of the amount and character of sputum / secretions aspiration.
Rationale: Increased number of colorless discharge / runny initially normal and should decrease according to the progress of healing.
d) Encourage oral fluid intake (at least 2500 ml / day) in cardiac tolerance.
Rational: to maintain adequate hydration secretions lost / increase in spending.
e) Collaboration of bronchodilators, expectorants, and / or analgesics as indicated.
Rationale: Eliminates spasm of the bronchi to improve air flow, dilute and reduce the viscosity of secretions.
3). Pain (acute).
Can be connected:
- Surgical incision, tissue trauma, and internal neurological disorders.
- The chest tube.
- The invasion of cancer to the pleura, chest wall
Outcomes:
- Report neyri lost / controlled.
- Looks relax and sleep / rest well.
- Participate in activities desired / needed.
Intervention:
a) Ask the patient about pain. Determine the characteristics of pain. Create a range of intensity on a scale of 0-10.
Rational: Assist in the evaluation of painful symptoms due to cancer. The use of scales assist patients in assessing the level of pain and provide a tool for the evaluation of analgesics keefktifan, improve pain control.
b) Assess the verbal statements and non-verbal pain patients.
Rational: Ketidaklsesuaian between verbal cues / nonverbal clues can provide a degree of pain, the need / keefketifan intervention.
c) Write down the possible causes of pain patofisologi and psychology.
Rationale: Incision posterolateral more uncomfortable for the patient than the anterolateral incision. Besides fear, distress, anxiety and loss of appropriate cancer diagnosis can interfere with the ability of cope.
d) Encourage states tentangnyeri feelings.
Rational: Fear / problems can increase muscle tension and reduce pain perception threshold.
e) Provide comfort measures. Encourage and teach the use of relaxation techniques
Promote relaxation and distraction.
4). Anxiety.
Can be connected:
- Crisis situations
- Threats / health status changes
- The ancman death.
Outcomes:
- Recognize and discuss the fear / problem
- Demonstrate appropriate range of feelings and facial appearance seemed to relax / rest
- Declare an accurate knowledge of the situation.
Intervention:
a) Evaluate the level of understanding of patient / significant other about the diagnosis.
Rationale: The patient and those closest to hear and assimilate new information that includes no changes in self-image and lifestyle. This involves understanding the perception of individual arrangement of pressure maintenance and provide the information necessary to select the appropriate interventions.
b) Acknowledge the fear / problems and encourage patients to express feelings
Rational: Support enables patients began open or accept the reality of cancer and its treatment.
c) Accept the denial of patients but do not be corroborated.
Rationale: When the extreme denial or ansiatas affect the progress of healing, the patient needs to confront the issue of how to explain and emebuka completion.
d) Provide an opportunity to ask and answer honestly. Ensure that patients and caregivers have the same understanding.
Rational: Creating trust and reduce misperceptions / incorrect interpretation of information ..
e) Involve the patient / significant other in treatment planning. Give time to prepare events / treatment.
Rational: It can help improve some feeling of control / independence in patients who feel powerless tek in receiving treatment and diagnosis.
f) Provide fiik patient comfort.
Rationale: It is difficult to accept the issue of when the experience of extreme emotions / physical discomfort settled.
5). Lack of knowledge about the condition, action, prognosis.
Can be connected:
- Less or do not know the information / source
- One interperatasi information.
- Less remember
Outcomes:
- Declare understanding the ins and outs of the diagnosis, the treatment program.
- Perform the necessary procedures correctly and explain the reasons such action.
- Participate in the learning process.
- Change in lifestyle.
Intervention:
a) Discuss the diagnosis, plan / sasat this therapy and the expected results.
Rationale: Provide specific information individuals, making knowledge to learn about management at home. Radiation and chemotherapy can accompany surgical intervention and important information to enable the patient / significant other to make informed decisions.
b) Strengthen explanation surgeon about surgical procedures to provide appropriate diagram. Enter this information in the discussion of short-term expectations / length of healing.
Rationale: The duration of rehabilitation and prognosis depends on the type of surgery, preoperative conditions, and the length / degree of complication.
c) Discuss the need to evaluate the treatment plan when I go home.
Rationale: Assessment of respiratory status and evaluation of public health imperative to ensure optimal healing. Also provides an opportunity to refer issues / questions in a bit of stress....
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