Tampilkan postingan dengan label surgical. Tampilkan semua postingan
Tampilkan postingan dengan label surgical. Tampilkan semua postingan
A. Definition
Cholecystitis is inflammation of the gallbladder is an acute inflammatory gallbladder wall with upper right abdominal pain, tenderness and heatbody. Are two classifications namely acute and chronic ( Brooker , 2001).
Acute cholecystitis is inflammation of the gallbladder wall, usually is the result of the presence of gallstones in the cystic duct, which issudden attack causing tremendous pain.
Chronic cholecystitis is a chronic inflammation of the gallbladder wall, which is characterized by recurrent attacks of abdominal pain and severe sharp.
Cholesistektomy is the surgical removal of the gall bladder (usually forrelief of gallstone pain).
B. Etiology
Approximately 95 % of patients with acute gallbladder inflammation, have gallstones. Sometimes a bacterial infection causes inflammation. Acute cholecystitis without stones is a serious illness and tendarise after the occurrence of :
-injury
-surgery
-burn
-sepsis ( infection that spreads throughout the body
-severe diseases ( especially people who receive food throughinfusion in the long term ).
Before secsara suddenly felt a tremendous pain in the abdomenabove, patients usually do not show signs of gallbladder disease. Chronic cholecystitis caused by recurrent attacks of acute cholecystitis, that causes thickening of the gallbladder wall and shrinkageempedu. On bladder finally gallbladder bile is not able to accommodate. The disease is more common in women and increase the number of eventsat the age above 40 years. Risk factor is a history of chronic cholecystitisprevious acute cholecystitis.
C. Pathophysiology
The gall bladder has a function as a place to store bile andconcentrate the bile fluid in it by way of absorbing water andelectrolyte. Bile is a liquid produced by the cell electrolyteliver. In normal individuals, bile flows into the gallbladder at the time of Oddi valve closed. In the gallbladder, bile is concentrated by absorb water. Degrees shown by the increase in concentration solids. Stasis of bile in the gallbladder may lead to progressive supersaturation and precipitation changes in the chemical composition of these elements. Metabolic changes caused by changes in the composition of bile, stasisbile, can cause infection of the gallbladder.
D. Symptom
The onset of symptoms can be triggered by eating fatty foods.
Symptoms can include :
- Early signs of inflammation of the gallbladder is usually a pain in the right abdomen top.
- Pain is intensified when the patient breathe deeply and often spread to right shoulder
- Usually there is nausea and vomiting
- Abdominal tenderness
- In a few hours , the abdominal muscles become stiff right hand .
- At first, mild fever, which is the longer tends to rise .
- The attack reduced pain within 2-3 days and then disappear within 1 week .
- Chronic digestive disorders
- Abdominal pain is not clear ( vague )
- Belching .
E. Complication
High fever, chills, increased leukocyte count and cessation of movement intestine ( ileus ) may indicate the occurrence of abscesses, gangrene or perforation of the bladder bile. Attack with jaundice ( jaundice ) or backflow of bile into in the liver showed that the bile duct was blocked partially by stone bile or by inflammation. If blood tests show elevated levels of the enzyme amylase, may there has been inflammation of the pancreas ( pancreatitis ) caused by blockage bile duct stones in the pancreas ( pancreatic duct ).
F. Investigations
- CT scan of the abdomen
- Oral Kolesistogram
- Abdominal ultrasound .
- Blood tests ( looking for elevated white blood cells)
G. Medical Management
- The usual treatment is surgery .
- Cholecystectomy surgery can be done through the abdomen or throughlaparoscopy .
- Patients who have a high surgical risk due to other medical conditions, recommended for low-fat diet and lose weight.
- Can be given antacids and anticholinergic drugs.
H. Nursing Management
-Assessment Assessment is the first step in the process and basic nursing thorough ( Boedihartono , 1994).
Post operative patient assessment ( Doenges , 1999) are included:
1 ) . Circulation Symptoms : a history of heart problems, GJK, pulmonary edema, vascular disease peripheral or vascular stasis ( increased risk of formation thrombus ).
2 ) . ego integrity Symptoms : feelings of anxiety , fear , anger , apathy ; stress factor multiple , such as financial , relationship , lifestyle .Mark : can not break , increasing tension / sensitive excitatory ;sympathetic stimulation .
3 ) . Food / fluid Symptoms : pancreatic insufficiency / DM , ( predisposition to hypoglycemia /ketoacidosis ), malnutrition ( including obesity ) ; mucous membranedry ( restriction intake / preoperative fasting period
4 ) . breathing Symptoms : infection , chronic conditions / cough , smoking .
5 ) . security Symptoms : allergic / sensitive to medications , foods , plasters , and solutions ; Immune deficiency ( risk of systemic infection and delay shealing ) ; emergence of cancer / latest cancer therapies ; History family of malignant hyperthermia reaction / anesthesia ; Historyhepatic disease ( effect of detoxification of drugs and canchange coagulation ) ; history of blood transfusion / transfusion reactions .Signs : infection exhausting process ; fever.
6 ) . Counseling / Learning Symptoms : anticoagulation , steroids , antibiotics , antihypertensives ,cardiotonic glokosid , antidisritmia , bronchodilator , diuretic ,decongestants , analgesics , anti-inflammatory , anticonvulsant or tranquilizers and also the-counter medicines or drugs recreational. Alcohol use ( risk of kidney damage ,affecting coagulation and anesthesia options , and also potential for postoperative withdrawal ) .
I. Nursing Diagnoses
that appear in patients post Operative include :
1. Breathing pattern , ineffective related to neuromuscular , imbalanceperceptual / cognitive , increased lung expansion , tracheobronchial obstruction .
2. Changes in thought processes associated with chemical changes such as the use of pharmaceutical drugs , hypoxia ; limited therapeutic environment for example excessive sensory stimuli ; physiological stress.
3. Fluid volume deficiency , associated with a high risk of restrictions oral fluid intake , loss of body fluids is not normal , blood vessel integrity expenditures .4 . Acute pain associated with disorders of the skin , tissue and integrittas muscle , trauma muskuloskletal , appearance and hose lines ( Doenges , 1999) .
J. Intervention and Implementation
Intervention is planning nursing actions that will be implemented to tackle the problem in accordance with the nursing diagnoses ( Boedihartono ,1994). Implementation is the realization of the plan of management and nursing have been prepared at the planning stage ( Effendi , 1995). Nursing interventions in post- operative patients ( Doenges , 1999) include :
- DP 1 :Goals : establish a normal breathing pattern / effective and free of cyanosis or other signs of hypoxia. Expected outcomes : no change in the frequency and depth of breathing .
- Maintain patient's airway by tilting the head , jaw hyperextension ,oral pharyngeal airflow
R : prevent airway obstruction .
- Auscultation of breath sounds . Listen to the presence / absence of breath sounds .
R : lack of breath sounds is an indication of obstruction by mucus orthe tongue and can be addressed by changing the position or suction .
- Observation of the frequency and depth of breathing , use of auxiliary musclesbreathing , chest expansion , retraction or nostril breathing ,skin color , and the air flow
R : is done to ensure that the effectiveness of respiratory effortsegerra can be done to fix it
- Place the patient in the appropriate position , depending on the power of breathingand type of surgery
R : elevation head and tilted position will prevent the occurrence of aaspirasivomiting , the correct position will encourage ventilation on lung lobe sectionsdown and reduce pressure on the diaphragm
- motion exercises as soon as possible in patients with reactive and continuein the postoperative period
R : active ventilation opening in the alveoli , issued secretion ,increase oxygen transport , dispose of anesthetic gases ; cough assistissued secretion of the respiratory system
- Perform suctioning if necessary
R : airway obstruction may occur due to the presence of blood or mucus inthroat or trachea
- Collaboration , giving oxygen as needed
R : is done to improve or maximize the uptake of oxygenwill be bound by the hemoglobin in the place of anesthetic gases and encourageterssebut gas expenses substances through inhalation
- DP 2 :Goals : increasing the level of awareness. Outcomes: the patient is able to recognize one's limitations and seek sourcesassistance as needed.
- Orient the patient continuously back after being out of the influenceanesthesia ; stated that the operation had been completed
R : because patients have increased awareness , support and guarantee it willhelp eliminate anxiety
- Talk in patients with jelaas and normal voice without yelling , consciousfull of what was said
R : can not be determined when the patient fully conscious , but sensoryhearing is the first time the ability to recover
- Evaluation of sensation / movement of the extremities and the corresponding trachea
R : return of function after spinal nerve block or localdepends on the type or amount of drug used and the duration of the procedureperformed
- Use the pads on the edge of the bed, do binding if necessary
R : provide security for the patient during the emergency phase , preventinginjury to the head and extremities when patients take the fight forperiod of disorientation
- Test the infusion , endotracheal tube , catheter , when installed and make surekepatenannya
R : in patients who experienced disorientation may occur damthe infusion flow system and other expenses , regardless , or kinked
- Maintain a calm and comfortable environment
R : external stimulus may cause abrasion psychic when it occursdissociative anesthetic drugs that have been given
- DP 3 :Objectives : adequate fluid balance .Criteria results : no no signs of dehydration ( stable vital signs ,good pulse quality , normal skin turgor , mucous membranesmoist and corresponding expenditures urine )
- Measure and record income and expenditure . Review the operation of intra records .
R : Accurate documentation will help in identifying expenditureliquid / replacement requirements and the choices that affectintervention .
- Assess urinary spending , especially for the type of surgical procedure performed .
R : may be a decrease or elimination of the procedures setelahaor genitourinary system and adjacent structures indicatemalfunction or obstruction of the urinary system .
- Monitor vital signs .
R : hypotension , tachycardia , increased breathing indicates lacklack of fluids .
- Place the patient in the appropriate position , depending on the power of breathingand type of surgery .
R : elevation head and tilted position will prevent the occurrence of aaspirasivomiting , the correct position will encourage ventilation on lung lobe sectionsdown and reduce pressure on the diaphragm.
- Check pads , appliance drain at regular intervals . Assess the wound for theswelling .
R : excessive bleeding can refer to hypovolemia / hemorrhage .
- Monitor the temperature of the skin , palpation of peripheral pulses .
R : skin cold / damp , weak pulse indicates a decreaseperipheral circulation and extra fluid needed for replacement .
- Collaboration , give parenteral fluids , blood products and plasma expanders oras directed . Increase speed IV if large is .
R : replace fluid losses have been documented . Record timepenggangtian circulation volume potential for the reduction of complications ,such imbalances
Intervention
- Evaluation regular seccara pain , note the characteristics , location andintensiitas ( 0-10 ) .
R : provide information about the need / effectiveness of the intervention .
- Note the emergence of anxiety / fear and connect with the environment and preparationfor the procedure .
R : consider the things that are unknown and / or inadequate preparationapendikstomi eg emergency ) can worsen the patient's perception would tastesick .
- Assess vital signs , note tachycardia , hypertension and increasedbreathing , even if the patient denied any pain .
R : can indicate acute pain and discomfort .
- Provide information on the nature of discomfort , as needed .
R : understand the cause of discomfort , provide emotional security .
- Do repositioning as directed , such as semi - Fowler ; skewed .
R : may reduce pain and improve circulation . Position semi -Fowler can reduce abdominal muscle tension and muscle pungguungarthritis , while reducing pressure dorsal oblique .
- Observation of analgesic effect .
R : respiration may be decreased in the administration of narcotics , and may causesynergistic effects with anesthetic agents .
- Collaboration , IV administration of analgesics as needed .
R : IV analgesic with pain by immediately reach the center , raisesbusting drug is more effective in small doses .
R : Accurate documentation will help in identifying expenditureliquid / replacement requirements and the choices that affectintervention .
- Assess urinary spending , especially for the type of surgical procedure performed .
R : may be a decrease or elimination of the procedures setelahaor genitourinary system and adjacent structures indicatemalfunction or obstruction of the urinary system .
- Monitor vital signs .
R : hypotension , tachycardia , increased breathing indicates lacklack of fluids .
- Place the patient in the appropriate position , depending on the power of breathingand type of surgery .
R : elevation head and tilted position will prevent the occurrence of aaspirasivomiting , the correct position will encourage ventilation on lung lobe sectionsdown and reduce pressure on the diaphragm.
- Check pads , appliance drain at regular intervals . Assess the wound for theswelling .
R : excessive bleeding can refer to hypovolemia / hemorrhage .
- Monitor the temperature of the skin , palpation of peripheral pulses .
R : skin cold / damp , weak pulse indicates a decreaseperipheral circulation and extra fluid needed for replacement .
- Collaboration , give parenteral fluids , blood products and plasma expanders oras directed . Increase speed IV if large is .
R : replace fluid losses have been documented . Record timepenggangtian circulation volume potential for the reduction of complications ,such imbalances
- DP 4 :Purpose: The patient said that the pain has been controlled or missing .Outcomes: the patient seemed to relax , to rest / sleep and domovement which means the corresponding tolerance .
Intervention
- Evaluation regular seccara pain , note the characteristics , location andintensiitas ( 0-10 ) .
R : provide information about the need / effectiveness of the intervention .
- Note the emergence of anxiety / fear and connect with the environment and preparationfor the procedure .
R : consider the things that are unknown and / or inadequate preparationapendikstomi eg emergency ) can worsen the patient's perception would tastesick .
- Assess vital signs , note tachycardia , hypertension and increasedbreathing , even if the patient denied any pain .
R : can indicate acute pain and discomfort .
- Provide information on the nature of discomfort , as needed .
R : understand the cause of discomfort , provide emotional security .
- Do repositioning as directed , such as semi - Fowler ; skewed .
R : may reduce pain and improve circulation . Position semi -Fowler can reduce abdominal muscle tension and muscle pungguungarthritis , while reducing pressure dorsal oblique .
- Observation of analgesic effect .
R : respiration may be decreased in the administration of narcotics , and may causesynergistic effects with anesthetic agents .
- Collaboration , IV administration of analgesics as needed .
R : IV analgesic with pain by immediately reach the center , raisesbusting drug is more effective in small doses .
J. Evaluation Evaluation is the stage at which the level of success of the nursing process in achievement of nursing assessed and the need to modify the destination or a nursing intervention defined ( Brooker , 2001)
Evaluation of the expected post- operative patients included :
1 . Establish a normal breathing pattern / effective and free of cyanosis or other signs of hypoxia .
2 . Increase the level of awareness .
3 . Adequate body fluid balance .
4 . The patient said that the pain has been controlled or missing .
REFERENCES
Brooker, Christine. 2001. Kamus Saku Keperawatan. Jakarta : EGC.
http://arifs45.multiply.com/journal/item/8
http://kamus.landak.com/cari/cholecystectomy
http://www.mamashealth.com/stomach/cholecy.asp
http://www.medicastore.com/index.php?mod=penyakit&id=607
http://www.medicastore.com/index.php?mod=penyakit&id=608
Sloane, Ethel. 2004. Anatomi dan Fisiologi Untuk Pemula, Edisi I. Jakarta : EGC.
Syaifudin, H, B.Ac, Drs. 1997. Anatomi Fisiologi Untuk Siswa Perawat, Edisi 2.
Jakarta: EGC.
Evaluation of the expected post- operative patients included :
1 . Establish a normal breathing pattern / effective and free of cyanosis or other signs of hypoxia .
2 . Increase the level of awareness .
3 . Adequate body fluid balance .
4 . The patient said that the pain has been controlled or missing .
REFERENCES
Brooker, Christine. 2001. Kamus Saku Keperawatan. Jakarta : EGC.
http://arifs45.multiply.com/journal/item/8
http://kamus.landak.com/cari/cholecystectomy
http://www.mamashealth.com/stomach/cholecy.asp
http://www.medicastore.com/index.php?mod=penyakit&id=607
http://www.medicastore.com/index.php?mod=penyakit&id=608
Sloane, Ethel. 2004. Anatomi dan Fisiologi Untuk Pemula, Edisi I. Jakarta : EGC.
Syaifudin, H, B.Ac, Drs. 1997. Anatomi Fisiologi Untuk Siswa Perawat, Edisi 2.
Jakarta: EGC.
Definition
Intussusception is the inclusion of part of the intestine into the
border or the more distal parts of the intestine (general, ileal
invagination into the descending colon). (Nettina, 2002)
Invagination or intussusception occurs when some gastrointestinal
driven such that a portion of it will cover most of the other to shrink
or retracts fully into a segment that is located next to the caudal.
(Nelson, 1999).
An intussusception is a medical condition in which a part of the
intestine has invaginated into another section of intestine, similar to
the way in which the parts of a collapsible telescope slide into one
another. This can often result in an obstruction. The part that
prolapses into the other is called the intussusceptum, and the part that
receives it is called the intussuscipiens. (wikipedia)
Clinical Manifestations
Early symptoms can include nausea, vomiting (sometimes bile stained
(green color)), pulling legs to the chest area, and intermittent
moderate to severe cramping abdominal pain. Pain is intermittent not
because the intussusception temporarily resolves, but because the
intussuscepted bowel segment transiently stops contracting. Later signs
include rectal bleeding, often with “red currant jelly” stool (stool
mixed with blood and mucus), and lethargy. Physical examination may
reveal a “sausage-shaped” mass felt upon palpation of the abdomen.
In children or those too young to communicate their symptoms
verbally, they may cry, draw their knees up to their chest or experience
dyspnea (difficult or painful breathing) with paroxysms of pain.
Fever is not a symptom of intussusception. However, intussusception
can cause a loop of bowel to become necrotic, secondary to ischemia due
to compression to arterial blood supply. This leads to perforation and
sepsis, which causes fever.
Nursing Care Plan for Intussusception
Nursing Assessment – Nursing Care Plan for Intussusception
1. Assessment of general physical
2. Medical history
3. Observation stool patterns and behavior before and after surgery
4. Observations of behavior of children / infants
5. Observation manifestations occur intussusception:
- Paroxysmal abdominal pain.
- Children screamed and fold knees toward your chest.
- Children seem normal and comfortable during the interval between episodes of pain.
- Vomiting.
- Lethargy.
- Currant jelly-like stool containing blood and mucus, hemocculi test positive.
- Feces no increase.
- Abdominal distention and tenderness.
- Palpable mass in the abdomen are like sausages.
- The anus that looks unusual, it can seem like a rectal prolapse.
- Dehydration and fever to rise 41 0C.
- Things like shock with rapid pulse, pale and sweating a lot.
6. Observation of the chronic manifestations of intussusception:
- Diarrhea.
- Anorexia.
- Losing weight.
- Sometimes vomiting.
- Periodic pain.
- Pain without other symptoms.
7. Assess the diagnostic procedures and tests such as plain abdominal examination, barium enema and ultrasonogram.
Nursing Diagnosis – Nursing Care Plan for Intussusception
1. Acute Pain related to bowel invagination.
2. Ineffective Tissue Perfusion: shock hipolemik related to vomiting, bleeding and accumulation of fluid and electrolytes in the lumen.
3. Anxiety related to lack of knowledge, foreign environment.
4. Ineffective Thermoregulation related to the process of inflammation, fever.
5. Acute Pain related to surgical incision.
Definition of Nasopharyngeal Carcinoma
Nasopharyngeal carcinoma is a malignant tumor that grows in the
nasopharynx with a predilection in Rossenmuller fossa and roof of the
nasopharynx.
Etiology of Nasopharyngeal Carcinoma
High incidence of nasopharyngeal carcinoma is associated with eating
behavior, environment and Epstein-Barr virus. Besides geographic
factors, racial, gender, genetics, occupation, habits of life, culture,
socio-economic, bacteria or parasite infections also affect the
likelihood of this tumor.
Signs and Symptoms of Nasopharyngeal Carcinoma
Symptoms of nasopharyngeal carcinoma can be divided into 4 sections, which include:
1. Symptoms of nasopharyngeal
Nasopharyngeal Symptoms can be mild epistaxis or nasal obstruction.
2. Disorders of the ear
An early warning because the place of origin of the tumor near the mouth
of the Eustachian tube (Rosenmuller fossa). Disruption resulting from
blockage of the Eustachian tube, such as tinnitus, deafness, ear
discomfort until the pain in the ear.
3. Eye and neurological disorders
Because of the proximity to the cranial cavity, then there is spreading
through the foramen lacerum, which will hit the brain to nerves III, IV,
VI thus encountered diplopia, squint, exoftalmus, and nerves to the V
form of motor and sensory disturbances.
4. Metastasis to the cervical lymph
Namely in the form of lump medial to the sternocleidomastoid muscular that eventually form large masses to the skin shiny.
Nursing Assessment – Nursing Care Plan for Nasopharyngeal Carcinoma
1. Hereditary factors or a history of cancer in the family eg mother or grandmother with a history of breast cancer.
2. Spheres of influence, such as chemical irritants, smoke a certain kind of wood.
3. The habit of cooking with certain ingredients or spices and eating
foods that are too hot and preserved foods (meat and fish).
4. Low socioeconomic classes will also be related to the environment and living habits.
5. Signs and symptoms:
Activity
Weakness or fatigue. Changes in the patterns of rest; presence of factors that affect sleep such as pain, anxiety.
Circulation
As a result of tumor metastases are palpitations, chest pain, decreased blood pressure, epistaxis / nose bleeding.
Ego integrity
Stress factors, concerns about appearance changes, deny the diagnosis,
feelings of helplessness, loss of control, depression, withdrawal,
anger.
Elimination
Changes in bowel habit constipation or diarrhea, urinary elimination alteration, change of bowel sounds, abdominal distension.
Food / fluid
Poor dietary habits (low fiber, additives, preservatives), anorexia,
nausea / vomiting, mouth dryness, food intolerance, weight changes,
cachexia, changes in humidity / skin turgor.
Neuro-sensory
Headache, tinnitus, deafness, diplopia, squint, eksoftalmus
Pain / comfort
Discomfort in the ear to ear pain (otalgia), stiffness in the neck area due to tissue fibrosis caused by radiation
Breathing
Smoking (tobacco, marijuana, living with someone who smokes), exposure
Security
Exposure to toxic chemicals, carcinogens, exposure to the sun old / redundant, fever, skin rash.
Sexuality
Sexual problems such as the impact of the relationship, changes in the level of satisfaction.
Social interaction
Inadequate / support system weaknesses
DEFINITION
Bladder cancer is a cancer that starts in the bladder. The bladder is the body part that holds and releases urine. It is in the center of the lower belly area.
The World Health Organization, In 2004, developed a new grading system for bladder cancer. This system divides bladder cancers into the following groups.
1. Risk for injury related to radiation therapy and chemotherapy.
Expected outcomes:
Intervention:
Expected outcomes:
Intervention:
Expected outcomes:
Expected outcomes:
Intervention:
Bladder cancer is a cancer that starts in the bladder. The bladder is the body part that holds and releases urine. It is in the center of the lower belly area.
The World Health Organization, In 2004, developed a new grading system for bladder cancer. This system divides bladder cancers into the following groups.
- Urothelial papilloma – noncancerous (benign) tumor
- Papillary urothelial neoplasm of low malignant potential (PUNLMP) – slow growing and unlikely to spread
- Low-grade papillary urothelial carcinoma – slow growing and unlikely to spread
- High-grade papillary urothelial carcinoma – more quickly growing and more likely to spread
- Blood in your urine
- A frequent urge to urinate
- Pain when you urinate
- Low back pain
- Ask clients about changes in urination, note the color change, the frequency and amount of urine.
- Hematuria with pain is the first sign of cancer blader, usually intermittent which often leads to barriers in the search for diagnostic services.
- Due to disease progression, clients experience iritable bladder, with dysuria. Finally gross hematuria, obstruction or vistula encourage clients to seek treatment.
1. Risk for injury related to radiation therapy and chemotherapy.
Expected outcomes:
- Clients do not develop problems associated with radiation therapy and chemotherapy
Intervention:
- Giving anti-spasmodic.
- Increased fluid intake.
- Provision for cystitis urinary tract antiseptic.
- Clients with proctitis, requires a low-fiber diet and agents to reduce intestinal motility.
Expected outcomes:
- Clients understand the diagnostic, surgical and treatment of urinary diversion.
Intervention:
- Prepare preoperatively, clients who experience urinary diversion.
- Education about urinary diversion.
- Encourage acceptance of the facts and results of urinary elimination through the skin of the rectum or stoma special.
- Prepare general physical and emotional.
- Note the gastrointestinal tract: non residue diet for a few days, intestinal sterilization, enema.
- Advise clients to prevent skin contact with urine, to prevent skin irritation due to urinary diversion.
- Clean the stoma with soap and water and then dried at any urine bag replacement.
Expected outcomes:
- Clients will be diagnosed early to eliminate dysuria.
- Installation of indwelling catheters.
- CBI to prevent blood clot
- Intervention in TUR – P (input fluids, analgesics and antispasmodics as needed)
Expected outcomes:
- Clients will not thrive on disruption of skin integrity, or peristomal irritation.
Intervention:
- Check the pH of the urine
- Check the bag of urine to leak and whether the skin sensitive to the material.
- Change bags for not leaking (too often replaced cause irritation).
- During replaced bags allow contact with air as possible.
- Give nystatin at around stoma.
Nasopharyngeal angiofibroma or juvenile nasopharyngeal
angiofibroma is a histologically benign but locally aggressive vascular
tumor that grows in the back of the nasal cavity, usually found in
adolescent boys.
Diagnosis
If nasopharyngeal angiofibroma is suspected based on physical exam (a smooth submucosal mass in the posterior nasal cavity), imaging studies such as CT or MRI should be performed. Biopsy can lead to extensive bleeding since the tumor is composed of blood vessels without a muscular coat.
Nursing Assessment
1. Hereditary factors or a history of cancer in the family eg mother or grandmother with a history of breast cancer.
2. Spheres of influence, such as chemical irritants, smoke a certain kind of wood.
3. The habit of cooking with certain ingredients or spices and eating foods that are too hot and preserved foods (meat and fish).
4. Low socioeconomic classes will also be related to the environment and living habits. (Efiaty & Nurbaiti, 2001 case 146)
5. Signs and symptoms:
Activity
Weakness or fatigue. Changes in the patterns of rest; presence of factors that affect sleep such as pain, anxiety.
Circulation
As a result of tumor metastases are palpitations, chest pain, decreased blood pressure, epistaxis / nose bleeding.
Ego integrity
Stress factors, concerns about appearance changes, deny the diagnosis, feelings of helplessness, loss of control, depression, withdrawal, anger.
Elimination
Changes in bowel habit constipation or diarrhea, urinary elimination alteration, change of bowel sounds, abdominal distension.
Food / fluid
Poor dietary habits (low fiber, additives, preservatives), anorexia, nausea / vomiting, mouth dryness, food intolerance, weight changes, cachexia, changes in humidity / skin turgor.
Neuro-sensory
Headache, tinnitus, deafness, diplopia, squint, exophthalmos.
Pain / comfort
Discomfort in the ear to ear pain (otalgia), stiffness in the neck area due to tissue fibrosis
Breathing
Smoking (tobacco, marijuana, living with someone who smokes)
Security
Exposure to toxic chemicals, carcinogens, exposure to the sun old / redundant, fever, skin rash.
Social interaction
Inadequate / support system weaknesses
(Doenges, 2000)
Diagnosis
If nasopharyngeal angiofibroma is suspected based on physical exam (a smooth submucosal mass in the posterior nasal cavity), imaging studies such as CT or MRI should be performed. Biopsy can lead to extensive bleeding since the tumor is composed of blood vessels without a muscular coat.
Nursing Assessment
1. Hereditary factors or a history of cancer in the family eg mother or grandmother with a history of breast cancer.
2. Spheres of influence, such as chemical irritants, smoke a certain kind of wood.
3. The habit of cooking with certain ingredients or spices and eating foods that are too hot and preserved foods (meat and fish).
4. Low socioeconomic classes will also be related to the environment and living habits. (Efiaty & Nurbaiti, 2001 case 146)
5. Signs and symptoms:
Activity
Weakness or fatigue. Changes in the patterns of rest; presence of factors that affect sleep such as pain, anxiety.
Circulation
As a result of tumor metastases are palpitations, chest pain, decreased blood pressure, epistaxis / nose bleeding.
Ego integrity
Stress factors, concerns about appearance changes, deny the diagnosis, feelings of helplessness, loss of control, depression, withdrawal, anger.
Elimination
Changes in bowel habit constipation or diarrhea, urinary elimination alteration, change of bowel sounds, abdominal distension.
Food / fluid
Poor dietary habits (low fiber, additives, preservatives), anorexia, nausea / vomiting, mouth dryness, food intolerance, weight changes, cachexia, changes in humidity / skin turgor.
Neuro-sensory
Headache, tinnitus, deafness, diplopia, squint, exophthalmos.
Pain / comfort
Discomfort in the ear to ear pain (otalgia), stiffness in the neck area due to tissue fibrosis
Breathing
Smoking (tobacco, marijuana, living with someone who smokes)
Security
Exposure to toxic chemicals, carcinogens, exposure to the sun old / redundant, fever, skin rash.
Social interaction
Inadequate / support system weaknesses
(Doenges, 2000)
Assessment for Peptic Ulcer
Patient history acts as an important basis for diagnosis. Patients were asked to describe the pain and the methods used to eliminate them. Peptic ulcer pain is usually described as a burning or gnawing and occurs approximately occurs after 2 hours after meals. This pain often awakens the patient hours of midnight and 3 am. The patient stated that the pain is only removed by antacids, eating or vomiting.
Patients were asked when vomiting occurs. If so, how much? Is vomit bright red or coffee color. Does the patient have a bowel movement with bloody stool? During the history taking, the nurse asked the patient to write the input of food, usually a period of 72 hours and include all eating habits (eating speed, regular meals, a fondness for spicy food, use herbs, use of beverages containing caffeine).
The level of tension and nervousness of patients studied. Does the patient smoke? If yes, how much? How patients express anger, especially in the context of work and family life? Is there or is there job stress with family problems? Is there a family history of ulcer disease?
Vital signs assessed for indicators of anemia (tachycardia, hypotension), fecal occult blood checked against. Physical examination and abdominal palpation performed to localize tenderness.
4 Nursing Diagnosis and Interventions for Peptic Ulcer
1. Acute pain related to irritation of the mucosa and muscle spasms.
Goal: Client expressed pain diminished or disappeared.
Intervention:
1. Give drug therapy according to the program:
2. Instruct to avoid drugs are sold freely, especially those containing salicylates.
R /: Medicines containing salicylates may irritate the gastric mucosa.
3. Encourage clients to avoid foods / drinks that irritate the gastric mucosa: caffeine and alcohol.
R /: to stimulate the secretion of hydrochloric acid.
4. Encourage clients to use the meals and snacks at regular intervals.
R /: Schedule regular eating helps retain food particles in the stomach that helps neutralize the acidity of gastric secretions.
5. Instruct patient to stop smoking
R /: Smoking can stimulate ulcer recurrence.
2. Anxiety related to the nature of the disease and long-term management.
Goal: Decrease anxiety.
Intervention:
1. Encourage clients to express their problems and fears and ask questions as needed.
R /: Open communication helps clients develop trusting relationships that help reduce anxiety and stress.
2. Explain the reasons for the planned treatment schedule obey, such as pharmacotherapy, dietary restrictions, modification of activity levels, reduce or stop smoking.
R /: Knowledge reduce anxiety appears to be a sense of fear due to ignorance. Knowledge can have a positive effect on behavior change.
3. Assist clients to identify situations that cause anxiety.
R /: stressors need to be identified before it can be overcome.
4. Teach stress management strategies: eg drugs, distraction, and imagination.
R /: decrease anxiety decrease the secretion of hydrochloric acid.
3. Imbalanced Nutrition, Less Than Body Requirements related to pain, which is related to food.
Goal: Getting optimal nutrition.
Intervention:
1. Encourage eating foods and drinks that do not irritate.
R /: Food and drinks are not irritating to help reduce epigastric pain.
2. Encourage eating on a regular schedule, avoid snacks before bedtime.
R /: Eating regularly helps neutralize gastric acid secretion; snack before bedtime increases the secretion of gastric acid.
3. Encourage eating food in a relaxed environment
R /: less relaxed environment cause anxiety. Decreased anxiety helps reduce the secretion of hydrochloric acid.
4. Knowledge Deficit: the prevention and treatment of symptoms related to the condition of inadequate information.
Goal: Clients gain knowledge about prevention and management.
Intervention:
1. Assess the level of knowledge and readiness to learn from clients.
R /: Desire to learn depends on the physical condition of the client, the level of anxiety and mental readiness.
2. Teach the required information: Use words that correspond with the level of knowledge of the client. Choose a time when most convenient and interested clients. Limit counseling sessions to 30 minutes or less.
R /: Individualization counseling improve learning.
3. Assure the client that the disease can be overcome.
R /: Gives confidence can have a positive influence on behavior change.
Patient history acts as an important basis for diagnosis. Patients were asked to describe the pain and the methods used to eliminate them. Peptic ulcer pain is usually described as a burning or gnawing and occurs approximately occurs after 2 hours after meals. This pain often awakens the patient hours of midnight and 3 am. The patient stated that the pain is only removed by antacids, eating or vomiting.
Patients were asked when vomiting occurs. If so, how much? Is vomit bright red or coffee color. Does the patient have a bowel movement with bloody stool? During the history taking, the nurse asked the patient to write the input of food, usually a period of 72 hours and include all eating habits (eating speed, regular meals, a fondness for spicy food, use herbs, use of beverages containing caffeine).
The level of tension and nervousness of patients studied. Does the patient smoke? If yes, how much? How patients express anger, especially in the context of work and family life? Is there or is there job stress with family problems? Is there a family history of ulcer disease?
Vital signs assessed for indicators of anemia (tachycardia, hypotension), fecal occult blood checked against. Physical examination and abdominal palpation performed to localize tenderness.
4 Nursing Diagnosis and Interventions for Peptic Ulcer
1. Acute pain related to irritation of the mucosa and muscle spasms.
Goal: Client expressed pain diminished or disappeared.
Intervention:
1. Give drug therapy according to the program:
2. Instruct to avoid drugs are sold freely, especially those containing salicylates.
R /: Medicines containing salicylates may irritate the gastric mucosa.
3. Encourage clients to avoid foods / drinks that irritate the gastric mucosa: caffeine and alcohol.
R /: to stimulate the secretion of hydrochloric acid.
4. Encourage clients to use the meals and snacks at regular intervals.
R /: Schedule regular eating helps retain food particles in the stomach that helps neutralize the acidity of gastric secretions.
5. Instruct patient to stop smoking
R /: Smoking can stimulate ulcer recurrence.
2. Anxiety related to the nature of the disease and long-term management.
Goal: Decrease anxiety.
Intervention:
1. Encourage clients to express their problems and fears and ask questions as needed.
R /: Open communication helps clients develop trusting relationships that help reduce anxiety and stress.
2. Explain the reasons for the planned treatment schedule obey, such as pharmacotherapy, dietary restrictions, modification of activity levels, reduce or stop smoking.
R /: Knowledge reduce anxiety appears to be a sense of fear due to ignorance. Knowledge can have a positive effect on behavior change.
3. Assist clients to identify situations that cause anxiety.
R /: stressors need to be identified before it can be overcome.
4. Teach stress management strategies: eg drugs, distraction, and imagination.
R /: decrease anxiety decrease the secretion of hydrochloric acid.
3. Imbalanced Nutrition, Less Than Body Requirements related to pain, which is related to food.
Goal: Getting optimal nutrition.
Intervention:
1. Encourage eating foods and drinks that do not irritate.
R /: Food and drinks are not irritating to help reduce epigastric pain.
2. Encourage eating on a regular schedule, avoid snacks before bedtime.
R /: Eating regularly helps neutralize gastric acid secretion; snack before bedtime increases the secretion of gastric acid.
3. Encourage eating food in a relaxed environment
R /: less relaxed environment cause anxiety. Decreased anxiety helps reduce the secretion of hydrochloric acid.
4. Knowledge Deficit: the prevention and treatment of symptoms related to the condition of inadequate information.
Goal: Clients gain knowledge about prevention and management.
Intervention:
1. Assess the level of knowledge and readiness to learn from clients.
R /: Desire to learn depends on the physical condition of the client, the level of anxiety and mental readiness.
2. Teach the required information: Use words that correspond with the level of knowledge of the client. Choose a time when most convenient and interested clients. Limit counseling sessions to 30 minutes or less.
R /: Individualization counseling improve learning.
3. Assure the client that the disease can be overcome.
R /: Gives confidence can have a positive influence on behavior change.
A small PDA may not cause any symptoms. However, some infants may have symptoms such as: fast breathing, poor feeding habits, rapid pulse, shortness of breath, sweating while feeding, tiring very easily, poor growth.
Nursing Diagnosis for Patent Ductus Arteriosus (PDA)
- Decreased Cardiac Output related to malformations of the heart.
- Impaired Gas Exchange related to pulmonary congestion.
- Activity Intolerance related to imbalance between oxygen consumption by the body and oxygen supply to the cells.
- Delayed Growth and Development related to an inadequate supply of oxygen and nutrients to the tissues.
- Imbalanced Nutrition Less than Body related to fatigue at mealtime and increased caloric needs.
- Risk for Infection related to decreased health status.
Nursing Interventions for Patent Ductus Arteriosus (PDA)
1. Maintain adequate cardiac output:
- Observation of the quality and strength of heart rate, peripheral pulses, skin color and warmth.
- Enforce the degree of cyanosis (circumoral, mucous membranes, clubbing).
- Monitor signs of CHF (restlessness, tachycardia, tachypnea, spasms, fatigue, periorbital edema, oliguria, and hepatomegaly).
- Collaboration of drugs in accordance with the order, using toxicity hazard prevention techniques.
- Provide treatment to reduce afterload.
- Give diuretics as indicated.
- Monitor the quality and rhythm of breathing.
- Adjust the position of the child with Fowler position.
- Avoid children from an infected person.
- Give adequate rest.
- Provide optimal nutrition.
- Give oxygen if indicated.
- Allow the child to rest frequently, and avoid disturbances during sleep.
- Encourage to engage in play and light activity.
- Help child to choose activities appropriate to the age, condition and abilities.
- Avoid the ambient temperature is too hot or too cold.
- Avoid the things that cause fear / anxiety in children.
- Assess the level of development of the child.
- Give the stimulation of growth and development, play activities, gaming, watching TV, puzzles, drawing, and others according to the condition and age of the child.
- Involve the family in order to continue to provide stimulation during care.
- Provide a balanced diet, high nutrients for adequate growth.
- Monitor height and weight, documented in the form of graphs to determine the trend of growing children.
- Measure weight every day with the same weight and the same time.
- Record intake and output correctly.
- Provide food with small portions but often to avoid fatigue during meals.
- Children who receive diuretics are usually very thirsty, and therefore not restricted fluid.
- Avoid contact with infected individuals.
- Give adequate rest.
- Provide optimal nutritional needs.
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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