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Cancer of the Lungs (Bronchogenic Cancer) -refer to malignant tumors of the lung arising within the wall or epithelial

lining of the bronchus. The lung is also a common site of metastasis from cancer elsewhere in the body via the venous circulation or lymphatic spread. Risk Factors Tobacco smoke, Occupational exposure, atmospheric pollution Warning signals of Lung Cancer

-Chest X-Ray -Cytologic Exam -Fiberoptic Bronchoscopy -CT Scan -Lymph node biopsy Nursing Diagnoses 1. Ineffective breathing pattern related to obstructive and restrictive respiratory processes associated with lung cancer 1. Promotive Nursing Intervention 2. 1. 2. 3. Elevate the head of bed to promote gravity drainage and prevent fluid collection in upper body Teach breathing retraining exercises to increase diaphragmatic excursion Encourage energy conservation through decreasing activities Curative Nursing Intervention 1. Prepare patient physically, emotionally, and intellectually for prescribed therapeutic regimen Augment the patients ability to cough effectively -splint chest manually with hands -instruct patient to inspire fully and cough 2-3 times in one breath -provide humidifier/vaporizer to provide moisture to loosen secretions 1. 1.

c. Allow patient to sleep in a reclining chair if he is severely dyspneic d. Give prescribed treatment for productive cough to prevent inspissated secretions and subsequent dyspnea

Pain related to tumor effects; invasion of adjacent structures Curative Nursing Intervention Consider alternative methods: cognitive and behavioral training feedback, relaxation to increase patients sense of control Administer prescribed drug, usually starting with NSAIDs and progressing to adjuvant analgesics and narcotic agents Administer regularly to maintain pain at tolerable level Titrate to achieve pain control

       

Any change in respiratory pattern Persistent cough Sputum streaked with blood Frank Hemoptysis Rust colored or purulent sputum Chest, shoulder, or arm pain Recurring episodes of pleural effusion , pneumonia, or bronchitis Dyspnea, unexplained or out of proportion

Anxiety related to uncertain outcome and fear of recurrence Curative Nursing Intervention

Assessment -cough, specially a new type of changing cough -dyspnea -chest pain -repeated Upper Respiratory infection -hemoptysis -malaise, fever, weight loss, fatigue, anorexia Diagnostic Evaluation

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Try to have the patient express any concerns, share these concerns with the physician Encourage the patient to communicate feeling to significant persons in his life Encourage the patient to keep busy and remain in mainstream Secure services of a trained counselor if emotional stresses become overwhelming

6. Cancer of the Breast Is a disease of the breast tissue but can progress to systemic involvement. The cause is unknown, however several factors appear to influence its occurrence. 7.

Alteration in contour of the breast (elevation of the affected breast) Pain (late sign), burning, stinging, aching

2. quadrantectomy or wedge resection- resection of the involved quadrant and dissection of axillary lymph nodes and irradiation 3. Simple (total) mastectomy 4. Modified radical mastectomy and dissection of lymph nodes

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RISK FACTORS Genetic- strongest factor; women of succeeding generations are not only predisposed but develop 10-12 years earlier than women without history of breast cancer Menarche- before the age 11, menopause after age 50. No Children- or first child after age 30. Chronic Irritation- fibrocystic disease Previous breast cancer Uterine cancer

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NURSING DIAGNOSES Knowledge Deficit of breast cancer and mastectomy Anxiety related to diagnosis and treatment -discuss her concerns about breast cancer -explain the type of surgical procedure chosen -inquire about support system -discuss patients usual coping mechanisms -arrange for the patient to have a visitor who has undergone mastectomy 3. Body Image disturbance related to lost of breast -discuss patients view on how her body image has been altered -suggest clothing adjustments to camouflage lost of breast -provide information about breast prosthesis as desired by the patient 4. INTERVENTIONS a. Preventive -BSE every month (20s) -BSE and consulation (30s) -BSE, consultation and mammogram (40s) b. Curative -Surgical Interventios 1. Simple excision (lumpectomy) followed by irradiation of remaining tumor

Cancer of the Colon and Rectum (Colorectal Cancer) -A neoplasm in the colon characterized by uncontrolled growth of anaplastic cells that tend to invade surrounding tissues and metastasize to other body tissues. -Develop from adenomatous polyps and bacterial end products that are carcinogens and constipation allows longer contact with bowel walls. Incidence: 1. 2. 1. 2. 3. 4. 1. 2. 3. Highest incidence occurs in persons above 50 years of age Potentially curable in 80%-90% of patients if early diagnosis has been made before node involvement RISK FACTORS Familial polyposis Chronic ulcerative colitis Unabsorbable fiber deficits appears to be related to intestinal transit time, stool bulk and consistency ASSESSMENT Change in bowel habits most common presenting symptom Blood (occult) in stool

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ASSESSMENT TUMOR LOCATED MOST FREQUENTLY INN THE UPPER OUTER QUADRANT OF THE BREAST

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Non-tender lump which may be movable at the UOQ of the breast Dimpling of the skin Retraction of the nipple Change in skin color Change in skin texture (orange peel)

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Partial obstruction causing constipation alternating with diarrhea, lower abdominal plans (crampy) Progressive weakness, fatigue, anorexia, weight loss, shortness of breath, angina, pain, anemia, pallor, cachexia, ascites, hepatomegaly and other signs of obstruction. DIAGNOSTIC EVALUATION Digital rectal examination d. stool exam for blood Endoscopy e. hemoglobin for anemia Barium enema f. hemoquant test NURSING DIAGNOSES Altered Nutrition (less than body requirements related to malignant tumor effects Curative Intervention

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Pain related to spread of malignancy and inflammation Curative Intervention

-is a malignant tumor of the prostate gland. It arises from the parenchyma of the prostate, usually in the most posterior part; therefore, most prostatic cancers are palpable on rectal examination

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Relieving pain Relaxation techniques, repositioning, imaging, laughter, music, reading and touch for control or relief of pain Administer prescribed analgesics

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ASSESSMENT Symptoms due to obstruction of urinary flow Hesitancy and straining on voiding, frequency and nocturia Diminution in size and force of urinary stream Symptoms due to metastasis Pain in lumbosacral area radiating to hips and down the legs Perineal and rectal discomfort Anemia, weight loss, weakness, nausea, oliguria (from uremia) Hematuria (from urethral or bladder invasion) Lower extremity edema

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Knowledge Deficit related to diagnosis and treatment Make specific plans for the patients understanding and acceptance of colostomy Show the patient the intended appliance and have him try it on Arrange a preoperative visit by one who has undergone the same surgery

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Achieve adequate nutrition -serve high calorie, low residue diet before surgery if constipation permits -observe and record fluid losses (vomiting and diarrhea) -maintain hydration by assisting with prescribed IV infusion and observing and recording urinary output - assist patent during nasoenteral feeding Treatment -Resection of the tumor and Colostomy Cancer of the Prostate 1. 1. 2. 3. 4. Impaired Skin Integrity related to suregery, colostomy Inspect stoma area each pouch change Empty, irrigate and cleanse ostomy pouch on a routine basis using appropriate equipment Investigate reports of burning/itching/blistering around stoma Evaluate adhesive product and appliance fit on ongoing basis

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DIAGNOSTIC EXAMINATION/EVALUATION Digital Rectal Examination- will reveal stony hard and fixed prostate Needle biopsy- through anterior rectal wall for histologic and cytologic studies Serologic markers of prostate cancer

Prostate-specific antigen (PSA) protein found on prostate cells (normal and malignant), sensitive in detection of prostate cancer and in staging and follow up treatment Prostatic Acid phospatase - elevated in patients with prostatic cancer

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3. 4. 1. 2. NURSING DIAGNOSES Pain related to metastases Curative Intervention

Radical Prostatectomy including seminal vesicles Orchiectomy lowers plasma testosterone level this result in completely removing he testicular stimulus required for continued prostatic growth. Prostatic atrophy occurs after this procedure. Radiation- curative in the early stage and palliation for patients with late stage disease Hormone therapy- is a method control rather than cure. The rational underlying hormone treatment is that prostatic epithelium become atrophied or inactivated when androgen hormones are greatly reduced or inactivated. Diabetes Mellitus

A pancreatic hormone called glucagon (secreted by the alpha cells of the islets of Langerhans) is released when blood glucose levels decrease and stimulate the liver to release stored glucose. The insulin and the glucagon together maintain a constant level of glucose in the blood by stimulating the release of glucose from the liver through glycogenolysis.

FORMS Primary Forms:   Type 1 (previously called insulin-dependent diabetes mellitus) Type 2 (previously called non-insulin dependent diabetes mellitus) Secondary Forms:  Diabetes mellitus associated with other conditions or syndromes (pancreatic disease, hormonal or genetic syndromes, ingestion of certain drugs or chemicals)  PREVALENCE

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Support patient undergoing chemotherapy Monitor catheter drainage via either suprapubic or urethral catheter Administer medication for pain

  1. 2. 3. 4. Anxiety related to impact with living in uncertainty Develop a trusting relationship with patient. Avoid displaying value judgments regarding feelings. Be able to acknowledge the impact of disease on the patients existence Give repeated explanations with nurturing voice, touch, eye contact and expert physical

It is a syndrome of insulin deficiency or resistance. Its characterized by disturbances in carbohydrate, protein, and fat metabolism. Insulin deficiency compromises the body tissues ability to access essential nutrients for fuel and storage. INSULIN is secreted by beta cells in the islets of Langerhans in the pancreas. It:

Accelerates transport of amino acids (derived from dietary protein) into cells Transports and metabolizes glucose for energy Enhances storage of dietary fat in adipose tissue Signals the liver to stop the release of glucose Inhibits the breakdown of stored glucose, protein, and fat. Stimulates storage of glucose in the liver and muscle (in the form of glycogen)

Type 2 diabetes mellitus is particularly prevalent, affecting approximately 18.4% of people over age 65.

CAUSES

MEDICAL/SURGICAL INTERVENTION

  

Increased insulin resistance (reducing the older adults ability to metabolize glucose) Impaired insulin secretion (the release of insulin from the pancreatic beta cells is reduced and delayed) Faulty hepatic gluconeogenesis

  

Random plasma glucose concentrations 200mg/dl or greater with symptoms of diabetes on two different occasions Fasting blood glucose concentrations 126mg/dl or greater; fasting is defined as no caloric intake for at least 8 hours Two-hour plasma glucose concentrations after oral glucose intake 200mg/dl or greater during an oral glucose tolerance test using a glucose load of 75g

If oral anti diabetic drugs are unsuccessful in controlling blood glucose levels, insulin may be used alone or with oral drugs. COMPLICATIONS  Hypoglycemia (slow cerebration, dizziness, weakness, pallor, tachycardia, diaphoresis, seizures, coma), a potential complication for patients with insulin or oral anti diabetic drugs. Diabetic ketoacidosis, characterized by severe hyperglycemia, acidosis and dehydration, usually occurs in people with type 1 diabetes but may occasionally affect people with type 2 diabetes who are under extreme stress Hyperglycemic Nonketotic Syndrome, characterized by severe hyperglycemia, hyperosmolality and severe dehydration from osmotic diuresis and neurologic manifestations. The most common chronic complications include peripheral and autonomic neuropathy, cardiovascular disease, retinopathy, and neuropathy. Hypertension, which results in a greatly increased risk of transient ischemic attacks and cerebrovascular accident. Skin and urinary tracy infections and vaginitis

RISK FACTORS      Obesity Reduced physical activity Co-existing illnesses Poor eating habits  Nutrition Therapy The diet should meet nutritional guidelines, control blood glucose levels, decrease risk factors (elevated serum lipids) and maintain appropriate body weight.  Exercise Therapy Physical activity increases insulin sensitivity, improves glucose tolerance, and promotes weight control.  Oral anti diabetic agents If blood glucose levels cant be controlled with lifestyle modifications, pharmacotherapy is added which include one oral anti diabetic agent or combined oral agents (alpha-glucosidase inhibitors, biguanides, sulfonylureas, etc.)  Insulin Therapy 

ASSESSMENT FINDINGS The patient or caregiver may report: Appetite loss Weight loss Unexplained fatigue Slow wound healing Mental status changes Incontinence Decreased vision DIAGNOSIS 2-hour postprandial serum glucose test and the oral glucose tolerance test are more helpful in diagnosing diabetes in older adults. Diagnosis is usually made when one of the following criteria is met:

 

NURSING INTERVENTIONS  Older people are likely to resist drastic lifestyle changes. You may need to adapt your interventions to the individual or alter them to achieve treatment goals. Initially, you'll need precise records of vital signs, weight, fluid intake, urine output, and calorie intake.

Monitor for acute complications of diabetes therapy, especially hypoglycemia which requires that you give the patient carbohydrates immediately in the form of fruit juice, hard candy, honey or, if he's unconscious, glucagon or I.V. Dextrose. Also be alert for signs of HHNS. Provide meticulous skin care, especially to the feet and legs. Treat all injuries, cuts, and blisters promptly. Avoid constricting hose, slippers, or bed linens. Refer the older adult to a podiatrist for regular foot and nail care if needed. Offer emotional support and a realistic assessment of his condition. Explain that with proper treatment, he can have a nearnormal lifestyle and life expectancy. Teach the patient and family members to use a home glucose monitor of prescribed. Have them give a return demonsatration of the procedure to confirm that they understand it.

*Eye examination by an ophthalmologist at least once per year for early detection of damage that could cause blindness before symptom appear.  Care for your teeth *Schedule regular dental check ups and follow good home care to minimize dental problems related to diabetes, such as gum disease and abscesses. *Report for bleeding, pain, or soreness in the gums or teeth. *Brush teeth after every meal and floss daily. *Clean dentures thoroughly everyday and make sure they fit properly.  Care for your skin *Check skin daily for cuts and irritated areas and see doctor if necessary. *Bathe daily with warm water and mild soap and pat skin dry thoroughly. *Always wear cotton underwear to allow moisture to evaporate and help prevent skin breakdown. PREVENTING DIABETIC COMPLICATIONS Care for your skin *Check skin daily for cuts and irritated areas and see doctor if necessary. *Bathe daily with warm water and mild soap and pat skin dry thoroughly. *Always wear cotton underwear to allow moisture to evaporate and help prevent skin breakdown.

PREVENTING DIABETIC COMPLICATIONS  Care for your feet *Diabetes can reduce blood flow to your feet and dull their ability to feel heat, cold, or pain. *Wash feet daily, carefully dry between toes and inspect for corns, calluses, redness, swelling, bruises, and breaks in skin. PREVENTING DIABETIC COMPLICATIONS   Wear comfortable, nonconstricting shoes and never to walk barefoot. Exercise feet daily to improve circulation. Sitting on the edge of bed, point toes upward and then downward 10 times. Then make a circle with each foot 10 times. PREVENTING DIABETIC COMPLICATIONS  Check your urine. *Have routine checks of urine for protein which can signal kidney disease. Report immediately symptoms of urinary tract infection (burning, painful or difficult urination or blood or pus in the urine).  Get regular check ups *See the doctor regulary for detection of early signs of complications and start treatment promptly.

PREVENTING DIABETIC COMPLICATIONS  Care for your heart *Maintain normal weight. *Exercise regularly, following the doctor's recommendations. *Eat a low-fat, low sodium, high-fiber diet as prescribed to help control blood pressure and cholesterol levels  Care for your eyes

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