NURSING CARE PLAN

PATIENT
WITH GYNECOLOGY CHEMOTHERAPY
Ni Ketut Alit A
Nursing Faculty Airlangga University
Surabaya East Java
REFERENCES
Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care, The
Nurse and The Family 5
th
ed , St Luis : CV Mosby Company.

Black, J.M. & Matassarin E, (1997). Medical Surgical Nursing:
Clinical Management for continuity of care. J.B. Lippincott.co.

Smeltzer, S.C., & Bare, B. (2003). Brunner and Suddarth's Textbook
of Medical-Surgical Nursing (10
th
ed.). Philadelphia: Lippincott
Williams & Wilkins.

Ignativicius & Bayne. (2001). Medical and Surgical Nursing.
Philadelphia: W.B. Saunders Company.

Luckman & Sorensen. (2000). Medical Surgical Nursing. Philadelphia:
W.B. Saunders Company.

Journals and article related to..

TERMINOLOGY
Neoplasm
new plasmaabnormal tissue growth with rapid
growth
Benign
no metastasis
Malignant
local invasion and destructive growthwicked
Metastasis
spread form primary via lymphatic and/or circulatory
system


DEFINITIONS
1. Cancer is a disease of the cell

2. Large group of diseases characterized by:
a. Abnormal cell structure (no differentiation)

b. Uncontrolled growth (proliferation)

c. Ability to spread (metastasis)

d. Ability to invade normal tissue (lack contact inhibition)

SURGERY
Curative

Prophylactic

Diagnostic

Staging

Palliative

Adjuvant or Supportive

Reconstructive/Rehabilitative

RADIATION
Highest energy rays that can kill any cell or tissue
May be external source (brachytherapy)
Curative
Palliative
60% will receive XRT
Divided into doses or fractions
(Preserve normal cellular growth)

CHEMOTHERAPY
Cytotoxic drugs that destroy cancer cells or prevent
cellular replication by interfering with DNA and RNA
and vital cellular proteins

Goal is to reduce the number of cells to a small
number that can be (theoretically) handled by the
immune system

PRINCIPLES OF CANCER
TREATMENT
CURE

CONTROL

PALLIATION

GENITAL CANCER
Cervical
Endometrial
Ovarian
Testicular
Breast

CANCER BACKGROUND


1. Family of complex diseases
2. Affect different organs and organ systems
3. Normal cells mutate into abnormal cells
4. Eventually harm and destroy host
5. Historically, cancer is a dreaded disease
6. Cancer accounts for about 25% of death.


SIDE EFFECT OF CHEMOTHERAPY
MYELOSUPPRESSION
NEUTROPENIA

THROMBOCYTOPENIA

ANEMIA
NEUTROPENIA/LEUKOPENIA
Assess risk factors
(Age, renal and liver function, nutrition, bone marrow, other
medications, prior chemotherapy and/or radiation)
Manifestations include
fever >38 C or 100.4F (no classic signs)
cough, SOB
skin redness or tenderness, (mouth, perianal, rectal)
urinary symptoms (dysuria frequency, hematuria,
hesitancy)
indwelling devices (VADs, pain, edema, swelling,
induration at site)
sepsis (hypotension, agitation, decreased urine)

PREVENTION
No fresh fruits or vegetables, no pepper, live
plants or potting soil
No exposure to live vaccines or pet excreta
Avoid others with colds
Strict hand washing and personal hygiene
Mouth care at least 4 times daily
No trauma or invasive procedures
Prevent constipation and pressure sores

Management:
BC lines and peripheral, urine, sputum
Good physical assessment
Antibiotics immediately (broad spectrum coverage)
Patient education
Vital signs at least every 4 hours or more
Assess for chills, cough, pain
THROMBOCYTOPENIA
Assess risk factors
chemotherapy / radiation
DIC
disease infiltration
NSAID's
petechaie
hemorrhage (skin, GI, GU)
headaches, confusion, somnolence

Management
Institute bleeding precautions <50,000/mm3
Decrease activity and no lifting or straining/Valsalva
High fiber, increase fluids, stool softeners
No razors, nail clippers, douching, tampons, water-
soluble lubricants, no flossing, guiac/hemocult, pad
counts
Maintain SBP <140mm/Hg
No IM injections, apply pressure to all sites, no
NSAIDS, administer platelets per protocol
Educate patients signs and symptoms

ANEMIA=DECREASED RED BLOOD CELLS
Assess for
chemotherapy
kidney damage
tumor infiltration
bleeding, hemorrhage
age, appetite


Management:
Rest, slow position changes
Oxygen
Iron
Transfusion
Patient education on signs and symptoms
GI SYMPTOM
60% patients experience nausea and
vomiting, etc..

Patterns
Anticipatory (starts and may last several hours to days)
Acute (0-24 hours)
Delayed (1-4 days)

medications, stress management
Assess for weight loss, albumin, hydration

OTHER NOTABLE SIDE EFFECTS
Up to 80% develop mouth sores

Skin reaction : hypersensitivity, hyper pigmentation,
photo sensitivity, Ulceration
Hair loss : damage is to shaft (thinning and breakage),
damage to roots (complete alopecia), loss begins about
2 weeks after treatment, regrowth may take up to 3-5
months after treatment



NURSING CARE- NURSING DIAGNOSIS
Anxiety
1. Therapeutic interactions with client and family.
2. Availability of community resources for terminally ill.

B. Disturbed Body Image
1. Includes loss of body parts ; loss of energy, ability to be productive
2. Fear of rejection, stigma

C. Anticipatory Grieving
1. Facing death and making preparations for death.
2. Offer realistic hope that cancer treatment may be successful

NURSING CARE- NURSING
DIAGNOSIS
D. Risk for Infection
E. Risk for Injury
F. Altered Nutrition: less than body requirements
G. Impaired Tissue Integrity