肿瘤(英文版).ppt

Tumor outline PathophysiologyRiskfactorsSymptomsStageandgradeoftumorDiagnosisTreatmentNursingcare Cancer Lymphomas ininfection fightingorgans lymphatictissue Leukemias inblood formingorgans spleen bonemarrow Sarcomas inconnectivetissue bone Carcinomas inepithelialtissue RiskFactors 1 EnvironmentFactors2 LifestyleFactors a Tobaccob Radiationc Occupationalhazardsa Tobaccob Sunexposurec Alcohold Diet 3 GeneticFactors4 ViralFactors5 Precancerouslesions6 Stress7 Drugs RiskFactors Symptoms 1 Specificsymptomsdependontheanatomicalandfunctionalcharacteristicsoftheorganorstructureinvolved 2 Mechanicaleffects a Pressureb Obstructionc Interruptionsofbloodsupply3 Systemiceffects a anorexia weakness weightloss b Metabolicdisturbances malabsorptionsyndrome c Fluidandelectrolyteimbalances d Hormonalimbalances StagingofTumors TNMsystem T theanatomicalsizeoftheprimarytumorsN theextentoflymphnodeinvolvementM thepresenceorabsenceofmetastasisStagingisessentialas 1 anindicationofprognosis 2 anaidintheplanningoftreatmentandevaluationofresults 3 ameansofcomparingtheresultsofdifferenttreatments GradingofTumors Differentiation Normalbodycellshaveindividualcharacteristicsthatallowthemtoperformdifferentbodyfunctions Well differentiated Tumorcellsthatretainmanyoftheidentifiabletissuecharacteristicoftheoriginalcell Undifferentiated Tumorcellshavinglittlesimilaritytothetissueoforigin Diagnostictests 1 Biopsy excisionofpartoftumormass 2 Needlebiopsy aspirationofcellsfromsubcutaneousmassesororganssuchasliver 3 Exfoliativecytology scrapingofanyendothelium cervix mucousmembranes skin andapplyingtoslide 4 X rays detecttumorgrowthinGI respiratory andrenalsystems 5 Endoscopy visualizationofbodycavitythroughendoscope 6 Computedtomography CT visualizationofabodypartwherebylayersoftissuecanbeseenutilizingtheverynarrowbeamsofthistypeofx rayequipment 7 Magneticresonanceimaging MRI ascanningdeviceusingamagneticfieldforvisualization 8 Labdata assistantdiagnosis Treatment Surgery1 Curativeoperation removealloftumor surroundingtissueandtheoriginallymphnodes breastcancer 2 Palliativeoperation relievesymptomsorcomplications3 Reconstructiveoperation reestablishfunctionorabettercosmeticeffect Radiationtherapy 1 Goal eradicatemalignantcellswithoutcausingharmtohealthytissues 2 Preoperativeradiation reducethetumormass3 Postoperativeradiation decreasetheriskoflocalrecurrence4 Sideeffects nausea vomiting stomatitis esophagitis drymouth diarrhea depressionofbonemarrow suppressionofimmuneresponse decreasedlifespan andsterility Chemotherapy 1 Goal cure increasesurvivaltime ordecreasespecificlife threateningcomplications 2 Majorproblem lacksspecificity thusaffectingnormalaswellasmalignantcells 3 Majorsideeffects bonemarrowdepression stomatitis nauseaandvomiting gastrointestinalulcerations diarrhea andalopecia 4 Routesofadministration oral intramuscular intravenous subclavianlines peripheral intra arterial mayhaveinfusionpumpforcontinuousorintermittentflowrate intracavity Analysis nursingdiagnosis 1 Painrelatedtodiagnosticprocedures pressure obstruction interruptionofbloodsupply orpotentialsideeffectsofdrugs 2 Anxietyrelatedtofearofdiagnosisordiseaseprogression treatment anditsknownorexpectedsideeffects 3 Alterednutrition lessthanbodyrequirements relatedtoanorexia 4 Riskforinfectionrelatedtoimmunosuppressionfromradiationandchemotherapy5 Bodyimagedisturbancerelatedtolossofbodyparts changeinappearanceasaresultoftherapy 6 Powerlessnessrelatedtodiagnosisandownperceptionofitsmeaning Nursingcareplan implementationpreoperative A Goal preventrespiratorycomplications 1 Coughinganddeep breathingtechniques 2 Nosmokingfor1wkbeforesurgery B goal counteractnutritionaldeficiencies 1 Diet a Highprotein highcarbohydratefortissuerepair b Vitaminandmineralsupplements c Hyperalimentationasordered 2 Bloodtransfusionsmaybeneededifcountsarelow C Goal reduceapprehension 1 Clarifypostoperativeexpectations 2 Explaincareoftubes 3 Answerpatient squestionshonestly Postoperative A Goal preventcomplications 1 Monitorrespiratorystatusandhemodynamicstatus 2 Woundcare activeandpassiveexercisesasallowed respiratoryhygiene coughing deepbreathing andturning fluids B Goal alleviatepainanddiscomfort 1 Encourageearlyambulation dependingonsurgicalprocedure 2 Administerprescribedmedicationsasneeded 3 Administerstoolsoftenersandenemasasordered C Goal promotepsychosocialcomfort 1 Assistwithdiagnosticworkupbyprovidingpsychologicalsupportandinformationaboutspecificdisease diagnostictests diagnosis andtreatmentoptions 2 Reduceanxietybylistening makingreferralsforspecialproblems peersupportgroups self helpgroupssuchasReachtoRecovery supplyinginformation orcorrectingmisinformation asappropriate d Goal healthteaching 1 Involvepatient significantothers andfamilymembersinrehabilitationprogram 2 Prepareforfurthertherapies suchasradiationorchemotherapy 3 Developskillstodealwithdiseaseprogressionifcurenotrealisticormetastasisevident Nursingcareplan implementation radiotherapy 1 Goal preventtissuebreakdown a Donotwashoffsite identificationmarks tattooscannotberemoved dosageareaiscarefullycalculatedandmustbeexactforeachtreatment b Assessskindailyandteachpatienttodosame mostradiationtherapyisdoneonoutpatientbasis sopatientneedsskillstomanageindependently c Keepskindry cornstarchusuallytheonlytopicalapplicationallowed d Contraindications i Talcumpowders duetopotentialradiationdosagealteration ii Lotions duetoincreasedmoisteningofskin e Reduceskinfrictionbyavoidingconstrictingbedclothesorclothingandbyusingelectricshaver 2 Goal decreasesideeffectsoftherapy a Providemeticulousoralhygiene b Ifdiarrheaoccurs mayneedIVinfusions antidiarrhealmedications monitorbowelmovements possibleadhesionsfromsurgeryandradiationtreatments c Monitorvitalsigns particularlyrespiratoryfunction andBP sloughingoftissueputspatientatriskforhemorrhage d Monitorhematologicalstatus bonemarrowdepressioncancausefataltoxicosisandsepsis e Institutereverseisolationasnecessarytopreventinfections reverseisolationusuallyinstitutediflessthan50 neutrophils 3 Goal healthteaching a Instructpatienttoavoid i Strongsunlight mustwearsunblocklotion protectiveclothingoverradiationsite ii Extremesintemperaturetothearea hot waterbottles icecaps iii Synthetic nonporousclothesortightconstrictiveclothingoverarea iv Eating2 3hrbeforetreatmentand2hrafter todecreasenausea givesmall frequentmealshighinproteinandcarbohydratesandlowinresidue v Strongalcohol basemouthwash usedailysaltandsodamouthwash vi Fatigue anoverwhelmingproblem Needtopacethemselves nap mayneedsomeonetodrivethemtotherapy cancontinuewithusualactivitiesastolerated vii Crowdsandpersonswithupperrespiratoryinfectionsoranyotherinfections b Provideappropriatebirthcontrolinformationforpatientsofchildbearingage Nursingcareplan implementationChemotherapy A goal assistwithtreatmentofspecificsideeffects 1 Nauseaandvomiting antiemeticdrugsasorderedandscheduled small frequent high calorie high potassium high proteinmeals choppedorblendedfoodsforeaseinswallowing includemilkandmilkproductswhentoleratedforincreasedcalcium carbonateddrinks frequentmouthcare antacidtherapyasordered restaftermeals avoidfoododorsduringpreparationofmeals pleasantenvironmentduringmeals appropriatedistractions IVtherapy nasogastrictubeforcontrolofseverenauseaorasroutefortubefeedingifunabletotakefoodbymouth hyperalimentation 2 Diarrhea low residuediet increasedpotassium increasedfluids avoidhotorcoldfoods liquids 3 Stomatitis painfulmouth softtoothbrushesorsponges toothettes mouthcareq2 q4 Oralsaltandsodamouthrinses avoidcommercialmouthwashesthatcontainhighlevelofalcohol whichcouldbeveryirritatingtomucousmembranes Avoidhotfoods liquids includeblandfoodsatcooltemperatures removedenturesifsoresareunderdentures moistenlipswithlubricant 4 Skincare monitor woundsthatdonotheal infections patientreceivesfrequentsticksforbloodtestsandtherapy avoidsunlight usesunblock especiallyifreceivingdoxorubicin Adriamycin 5 Alopecia begentlewhencombingorlightlybrushinghair usewigs nightc