肿瘤(英文版).ppt

TumoroutlinePathophysiologyRisk factorsSymptomsStage and grade of tumorDiagnosisTreatmentNursing careBenign neoplasmNot cancerous harmlessGrow slowlyEncapsulated,well-definedNot spreadMalignant neoplasmharmfulMultiply quicklyIrregular-shapedSpread;metastasisCancerLymphomas:in infection-fighting organs(lymphatic tissue)Leukemias:in blood-forming organs(spleen,bone marrow)Sarcomas:in connective tissue(bone)Carcinomas:in epithelial tissueRisk Factors1.Environment Factors2.Life style Factors a.Tobacco b.Radiation c.Occupational hazards a.Tobacco b.Sun exposure c.Alcohol d.Diet3.Genetic Factors4.Viral Factors5.Precancerous lesions6.Stress7.DrugsRisk FactorsSymptoms1.Specific symptoms depend on the anatomical and functional characteristics of the organ or structure involved.2.Mechanical effects:a.Pressure b.Obstruction c.Interruptions of blood supply3.Systemic effects:a.anorexia,weakness,weight loss.b.Metabolic disturbances-malabsorption syndrome.c.Fluid and electrolyte imbalances.d.Hormonal imbalancesStaging of Tumors(TNM system)T:the anatomical size of the primary tumorsN:the extent of lymph node involvementM:the presence or absence of metastasisStaging is essential as (1)an indication of prognosis (2)an aid in the planning of treatment and evaluation of results (3)a means of comparing the results of different treatmentsGrading of TumorsDifferentiation:Normal body cells have individual characteristics that allow them to perform different body functions.Well-differentiated:Tumor cells that retain many of the identifiable tissue characteristic of the original cell.Undifferentiated:Tumor cells having little similarity to the tissue of origin.Diagnostic tests:(1)Biopsy-excision of part of tumor mass.(2)Needle biopsy-aspiration of cells from subcutaneous masses or organs such as liver.(3)Exfoliative cytology-scraping of any endothelium(cervix,mucous membranes,skin)and applying to slide.(4)X-rays-detect tumor growth in GI,respiratory,and renal systems.(5)Endoscopy-visualization of body cavity through endoscope.(6)Computed tomography(CT)-visualization of a body part whereby layers of tissue can be seen utilizing the very narrow beams of this type of x-ray equipment.(7)Magnetic resonance imaging(MRI)-a scanning device using a magnetic field for visualization.(8)Lab data-assistant diagnosis.Treatment Surgery1.Curative operation:remove all of tumor,surrounding tissue and the original lymph nodes(breast cancer)2.Palliative operation:relieve symptoms or complications3.Reconstructive operation:reestablish function or a better cosmetic effect.Radiation therapy:1.Goal:eradicate malignant cells without causing harm to healthy tissues.2.Preoperative radiation:reduce the tumor mass3.Postoperative radiation:decrease the risk of local recurrence4.Side effects:nausea,vomiting,stomatitis,esophagitis,dry mouth,diarrhea,depression of bone marrow,suppression of immune response,decreased life span,and sterilityChemotherapy1.Goal:cure,increase survival time,or decrease specific life-threatening complications.2.Major problem:lacks specificity,thus affecting normal as well as malignant cells.3.Major side effects:bone marrow depression,stomatitis,nausea and vomiting,gastrointestinal ulcerations,diarrhea,and alopecia.4.Routes of administration:oral,intramuscular,intravenous,subclavian lines,peripheral,intra-arterial(may have infusion pump for continuous or intermittent flow rate),intracavity.Analysis/nursing diagnosis:1.Pain related to diagnostic procedures,pressure,obstruction,interruption of blood supply,or potential side effects of drugs.2.Anxiety related to fear of diagnosis or disease progression,treatment,and its known or expected side effects.3.Altered nutrition,less than body requirements,related to anorexia.4.Risk for infection related to immunosuppression from radiation and chemotherapy5.Body image disturbance related to loss of body parts,change in appearance as a result of therapy.6.Powerlessness related to diagnosis and own perception of its meaning.Nursing care plan/implementationpreoperativeA.Goal:prevent respiratory complications.(1)Coughing and deep-breathing techniques.(2)No smoking for 1 wk before surgery.B.goal:counteract nutritional deficiencies.(1)Diet:(a)High protein,high carbohydrate for tissue repair.(b)Vitamin and mineral supplements.(c)Hyperalimentation as ordered.(2)Blood transfusions may be needed if counts are low.C.Goal:reduce apprehension.(1)Clarify postoperative expectations.(2)Explain care of tubes.(3)Answer patients questions honestly.Postoperative:A.Goal:prevent complications:(1)Monitor respiratory status and hemodynamic status.(2)Wound care;active and passive exercises as allowed;respiratory hygiene;coughing,deep breathing,and turning;fluids.B.Goal:alleviate pain and discomfort.(1)Encourage early ambulation,depending on surgical procedure.(2)Administer prescribed medications as needed.(3)Administer stool softeners and enemas as ordered.C.Goal:promote psychosocial comfort.(1)Assist with diagnostic workup by providing psychological support and information about specific disease,diagnostic tests,diagnosis,and treatment options.(2)Reduce anxiety by listening,making referrals for special problems(peer support groups,self-help groups such as Reach to Recovery),supplying information,or correcting misinformation,as appropriate.d.Goal:health teaching(1)Involve patient,significant others,and family members in rehabilitation program.(2)Prepare for further therapies,such as radiation or chemotherapy(3)Develop skills to deal with disease progression if cure not realistic or metastasis evident.Nursing care plan/implementation:radiotherapy(1)Goal:prevent tissue breakdown.(a)Do not wash off site-identification marks(tattoos cannot be removed);dosage area is carefully calculated and must be exact for each treatment.(b)Assess skin daily and teach patient to do same(most radiation therapy is done on outpatient basis,so patient needs skills to manage independently).(c)Keep skin dry;cornstarch usually the only topical application allowed.(d)Contraindications:(i)Talcum powders,due to potential radiation dosage alteration.(ii)Lotions,due to increased moistening of skin.(e)Reduce skin friction by avoiding constricting bedclothes or clothing and by using electric shaver.(2)Goal:decrease side effects of therapy(a)Provide meticulous oral hygiene.(b)If diarrhea occurs,may need IV infusions,antidiarrheal medications;monitor bowel movements,possible adhesions from surgery and radiation treatments.(c)Monitor vital signs,particularly respiratory function,and BP(sloughing of tissue puts patient at risk for hemorrhage).(d)Monitor hematological status;bone marrow depression can cause fatal toxicosis and sepsis.(e)Institute reverse isolation as necessary to prevent infections(reverse isolation usually instituted if less than 50%neutrophils).(3)Goal:health teaching(a)Instruct patient to avoid:(i)Strong sunlight;must wear sunblock lotion,protective clothing over radiation site.(ii)Extremes in temperature to the area(hot-water bottles,ice caps)(iii)Synthetic,nonporous clothes or tight constrictive clothing over area.(iv)Eating 2-3 hr before treatment and 2 hr after,to decrease nausea;give small,frequent meals high in protein and carbohydrates and low in residue.(v)Strong alcohol-base mouthwash;use daily salt and soda mouthwash.(vi)Fatigue,an overwhelming problem.Need to pace themselves,nap;may need someone to drive them to therapy;can continue with usual activities as tolerated.(vii)Crowds and persons with upper respiratory infections or any other infections.(b)Provide appropriate birth control information for patients of childbearing age.Nursing care plan/implementation ChemotherapyA.goal:assist with treatment of specific side effects(1)Nausea and vomiting-antiemetic drugs as ordered and scheduled;small,frequent,high-calorie,high-potassium,high-protein meals;chopped or blended foods for ease in swallowing;include milk and milk products when tolerated for increased calcium;carbonated drinks;frequent mouth care;antacid therapy as ordered;rest after meals;avoid food odors during preparation of meals;pleasant environment during meals;appropriate distractions;IV therapy;nasogastric tube for control of severe nausea or as route for tube feeding if unable to take food by mouth;hyperalimentation.(2)Diarrhea-low-residue diet;increased potassium;increased fluids;avoid hot or cold foods/liquids.(3)Stomatitis(painful mouth)-soft toothbrushes or sponges(toothettes):mouth care q2-q4;Oral salt and soda mouth rinses;avoid commercial mouthwashes that contain high level of alcohol,which could be very irritating to mucous membranes.Avoid hot foods/liquids;include bland foods at cool temperatures;remove dentures if sores are under dentures;moisten lips with lubricant.(4)Skin care-monitor:wounds that do not heal,infections(patient receives frequent sticks for blood tests and therapy);avoid sunlight;use sunblock,especially if receiving doxorubicin(Adriamycin).(5)Alopecia-be gentle when combing or lightly brushing hair;use wigs,night caps,scarves;provide frequent linen changes.Advise patient to have hair cut short before treatment with drugs known to cause alopecia.Other techniques may be used,depending on patients age and protocol in clinical agency.(6)Extravasation-infiltration of chemotherapeutic agents into surrounding tissues.Document and treat according to agency protocols for administered drug.b.Goal:health teaching(1)Orient patient and family to purpose of proposed drug regimen and anticipated side effects.(2)Advise that frequent checks on hematological status will be necessary(patient will receive frequent IV sticks,lab tests).(3)Advise patient/family on increased risk for infection(avoid uncontrolled crowds and individuals with upper respiratory tract infections or childhood diseases).(4)Monitor injection site for signs of extravasation(infiltration);site must be changed if leakage suspected,and guidelines to neutralize must be followed according to drug protocol.Thank You Thank You！