Asuhan Keperawatan pada

pasien Ca Serviks
Anggorowati
Departemen Keperawatan FK UNDIP
 INTRODUCTION

 Malignant neoplasm of cervix uteri.

 Occur in younger women in child
bearing age.
 The most common genital cancer
in India (80%)
 She may have no symptom, or
present with
 Irregular bleeding,
 Post coital bleeding
 Leucorrhoea
 Blood stained or offensive
discharge.
 High Risk Features
 Coitus before 18 yrs.
 Multiple sexual partners.
 Delivery before the age of 20 yrs.
 Multiparity with poor birth spacing.
 Poor personal hygiene.
 Poor socioeconomic status.
 Exposure to smegma from uncircumscribed partners.
 smoking., drug abuse, alcohol.
 Women with STD, HIV,HS virus 2 infection, HPV infection or
condylomata, or both.
 Immunosuppressed individuals.
 h/o pre invasive lesion.
 COC, and progestogens use over long periods
 Pathology
EPIDERMOID CARCINOMA
80% of CA CX
Arise from stratified squamous epithelium
of cervix

ENDOCERVICAL CA
20% of CA CX
Arise from mucus membrane of
endoceeervical canal
 Cin/cervical intra epithelial
neoplasia/pre invasive ca/stage 0
 CIN refers to the histopathological description in which a part or the full
thickness of the stratified squamous epithelium replaced by cells showing
varying degrees of dysplasia , but basement membrane intact
 Mild dysplasia – CIN I
• Undifferentiated cells are confined to lower 1/3 of epithelium
 Moderate dysplasia – CIN II
• Undifferentiated cells occupy lower 50 to75 % of epithelial thickness.
 Severe dysplasia & CA insitu – CIN III
• Entire thickness replaced by abnormal cells, but basement membrane
intact
 CIN –II ,III :HSIL/high grade squamous intra epithelial lesions
 Clinical Features
 She may have no symptom or present with
 Irregular menses.
 Menometrorrhagia.
 Continuous bleeding.
 post coital bleeding.
 Leucorrhoea.
 Blood stained or offensive discharge.
 The cx reveals a growth, which bleeds on touch,
 Or an ulcer with edges that bleed on touch.
 Cervical cancers usually do not spread early.
 They tend to be slow growing and cause most of their
problems in the pelvis.
Staging of ca Cervix
 Staging
 Stage I - limited to the cervix.

 IA - Diagnosed only by microscopy; no visible lesions

 IA1 -Stromal invasion less than 3 mm in depth and
7 mm or less in horizontal spread.
 IA2 - Stromal invasion between 3 and 5 mm with
horizontal spread of 7 mm or less.

 IB - visible lesion or a microscopic lesion with more

than 5 mm of depth or horizontal spread of more than
7 mm
 IB1 - visible lesion 4 cm or less in greatest
dimension
 IB2 - visible lesion more than 4 cm
Staging of ca Cervix
 Stage II - Invades beyond cervix.
 IIA - Without parametrial invasion, but involve
upper 2/3 of vagina.
 IIB - With parametrial invasion.

 Stage III - Extends to pelvic wall or lower third of the

vagina
 IIIA - Involves lower third of vagina
 IIIB - Extends to pelvic wall and/or
causes hydronephrosis or non-functioning
kidney

 Stage IV - Extends outside the vagina

 IVA - Invades mucosa of bladder or rectum and/or
extends beyond true pelvis
 Mode of Spread

 Continuity :Involves vagina, parametrium & uterine body.

 Contiguity :Urinary bladder & bowel.

 Lymphatic spread.

 Vascular embolisation to distant sites like lung & liver.

 Pre Invasive ca in Pregnancy
 Symptoms :
Bleeding during pregnancy.
Post coital bleeding.
 Sign :
CX appear normal or show chronic cervix or
erosion.
 Diagnosis :
Pap smear.
Colposcopy directed biopsy.
 Management :
Woman allowed a vaginal delivery if invasive leision
excluded.6wks postpartum another papsmear
followed by colposcopy will confirm diagnosis.
 Invasive ca Cervix & Pregnancy
 Symptoms :
Antipartum bleeding.
Cervix presents similar picture as in non pregnant
condition.
 Diagnosis :
Multiple biopsy or colposcopy directed biopsy.
 Management :
If pregnancy approaching term wait until foetus is
viable.
Elective classical caesarean delivery followed 4weeks
later by surgery or radiotherapy.
 Diagnosis

 Pap test.
 Tissue biopsy.
 Cervicography.
 Colposcopy.
 Schiller’s iodine test.
Rentang perawatan klien Ca Serviks

Penegakan Selama Pasca

Diagnosa Terapi Terapi
Selama pemeriksaan diagnostik
Klien Harap cemas
perawat
dengan hasil
Bersikap Empati
setiap
pemeriksaan

Kecemasan
Memberi
menjalani
pendidikan
prosedur
kesehatan
pemeriksaan

Kurang
Berperilaku
pengetahuan
altruistik
akan prosedur

Tidak terjaganya
privacy selama
tindakan
pemeriksaan
 Perawatan selama penegakan
diagnosa
• Pendekatan spiritual selama menunggu hasil
pemeriksaan (masa ketidakpastian)
• Sistematis dalam pemeriksaan sehingga waktu
penegakan diagnosa efektif
• Penjelasan alur dan prosedur diagnostik
• Tindakan mengurangi kecemasan
Respon klien dengan Kanker
• Kehilangan pekerjaan
• Ketakutan memanage
kondisi fisik
• Masalah
seksual/emosional
 Setelah diagnosis ditegakkan
• Proses penerimaan=== diawali dengan
berduka
• Treatmen tergantung tahap kanker yang
diderita klien
• Pembedahan, Stadium II a ke bawah
• Kombinasi kemoterapi dan radiasi, tahap
lanjut
 Perawatan perioperative (1)
• Evaluasi preoperative
– Mengkaji risiko pembedahan
– Mengkaji riwayat pengobatan, riwayat
pembedahan, riwayat ginekologi, riwayat keluarga,
riwayat sosial, dokumentasi obat-obatan, alergi
obat, kebiasaan
– Pemeriksaan fisik lengkap
– Status nutrisi (infeksi, tromboemboli, risiko
perdarahan)
 Perawatan perioperative (2)
• Persiapan preoperative
– Menyiapkan pembedahan:
• Puasa
• Mencukur rambut area operasi
• Antibiotik
• Persiapan bowel
• Profilaksis Tromboembolik
– Memberi penjelasan prosedur
– Pendidikan kesehatan post operatsi: cairan IV,
managemen nyeri, drainase, perawatan luka, latihan
nafas, batuk, pergerakan, ambulasi dini
 Perawatan perioperative (3)
• Intraoperative
– Posisi klien
– Kehilangan darah selama operasi
– Drainase (lymph nodes disection)
– Blader drainage
– Pencegahan surgical adhesion
 Perawatan perioperative (4)
• Postoperative
– Managemen post operasi tergantung dari luas, lama dan
jenis operasi
– Evaluasi laboratorium
– Aktivitas
• Statis vena, atelektasis, ileus
• Ambulasi dini
• Posisi kepala lebih tinggi menghindari aspirasi
– Intake dan output
– Diit
– Perawatan pulmonari, risiko pneumonia
– Perawatan luka
 Perawatan perioperative (5)
• Komplikasi pembedahan
– Disfungsi blader
– Fungsi seksual
– Komplikasi urologi lain
– Limfedema
– Emboli pulmoner
 Radiasi
• Komplikasi:
– Cystitis, proctitis
– Fistula vaginal, intestinal
– Obtruksi bowel
– Fibrosis, kerusakan kulit
 Perawatan stadium lanjut
• Stadium IV---Angka harapan hidup kecil
• Fokus perawatan palliative—menghadirkan
kebutuhan psikologis, sosial, kultural dan
spiritual
• Therapi Komplementer--- meningkatkan
kenyamanan
• Ases sumber finansial yang memadai
• Meningkatkan nilai
 PERAWATAN PALIATIF
TUJUAN :
• MENINGKATKAN RASA NYAMAN
• MENINGKATKAN RASA PERCAYA DIRI
• MEMPERTAHANKAN /
MENINGKATKAN KUALITAS HIDUP

FOKUS PERAWATAN:
MENGONTROL GEJALA YANG
DITIMBULKAN AKIBAT KANKER
 Kondisi Psikologis dan Sosial
• Gangguan body image • Perasaan Bersalah
• Denial • Kesulitan komunikasi
• Depresi • Hubungan tdk harmonis dgn
• Takut mati / kehilangan keluarga
• Rasa bersalah berlebihan • Isolasi sosial
• Rasa percaya diri menurun • Kebutuhan penjelasan
• Malu
• Penolakan diri
 Diagnosa Keperawatan
• Defisit pengetahuan
• Takut/ kecemasan
• Pembatasan sensori
• Gangguan integritas kulit
• Risiko injury
• Nyeri
• Gangguan fungsi seksual
 Lingkungan Selama Terapi
• Lingkungan yang terapeutik (Venolia,1988)
– When you are in a healing environment, you know it; no
analysis is required. You should some how feel welcome,
balanced and at one with yourself and the world.You are
both relaxed and stimulated, reassured and invited to
expand. You feel at home.
• Penting: hubungan terapeutik (Reilly, 1995)
– the question of intention and integrity; the quality of the
meeting; the trust;the relationship; the shared walk
together of the person and the carer is where the magic
really happens, where things really move and people
experienc eradical changes in how they are coping or not
coping, and in the quality of their life, and where
transformations occur.
 Perawatan selama treatmnet
• Penyembuhan Fisik
– Managemen nyeri
– Meningkatkan imunitas
– Nutrisi
• Penyembuhan Emosional
• Meningkatkan support system
– Dukungan keluarga, kelompok sebaya
 Intervensi mandiri selama terapi
• Massage
Fisik — efek mekanik, psikologis dan relaksasi
Emosional — melalui sentuhan
Mental — meningkatkan perasaan dari
kesejahteraan
Spiritual/energi — melalui pertukaran energi
antara praktisi dan klien
Meningkatkan Imunitas: Booster imun
system
Mengurangi risiko kanker
Inactivating radikal bebas
Mencegah kanker berulang
 Bosster system imun
Tidur dengan kualitas yang baik secara teratur
Latihan setiap hari
Diit rendah lemak tinggi sayur dan buah2an
Mengurangi stress
Berhubungan dengan orang lain yg mencintai
dan mendukung
Mengembangkan kehidupan spiritual
 Pasca Therapy
 Pernyataan Klien kanker :
‘We didnot choose cancer, cancer choose us’
 Comprehensive therapeutic approach
 Pasca terapi

Recovery
Membangun
mimpi
Self Healing
 Self Healing
• Latihan secara teratur
• Makanan diit yang sehat
• Istirahat siang (pacing yourself) dan malam
(sleeping well)
 Pemulihan penyembuhan fisik
• Mengurangi nyeri
• Menghindari kecemasan atau depresi yang
memanjang
• Membuat kondisi spiritual yang berdampak
terhadao kesehatan dan penyembuhan
• Mempertahankan hubungan dengan dunia
luar dan orang yang dicintai
 Bangkit dari ketidakberdayaan
• Melawan powerlessness (Lee Jampolsky)
• - positive action
• - positive direction
• === Pemulihan fisik===
 Membangun mimpi
• Keluar dari fase krisis
• Setback (setback mrp kondisi normal, tidak
gagal, dan dapat diatasi)
• Menyusun tujuan pemulihan
 Penutup
• Harapan hidup kanker serviks tergantung
stadium kanker
• Penting meningkatkan kualitas hidup
• Modifikasi lingkungan menjadi lingkungan
yang terapeutik