home Audience 6 Nursing activities for breast cancer. Caring for patients undergoing breast surgery. Central and internal localization

Nursing activities for breast cancer. Caring for patients undergoing breast surgery. Central and internal localization

Nursing process

breast cancer.

Epidemiology

· The incidence of breast cancer in Russia, as in most countries of Europe and North America, is growing.
· In the structure of cancer incidence in Russia, cancer of this localization has held first place since 1985.

Worldwide, in 2000, more than 796,000 cases of breast cancer were newly diagnosed: - in the United States of America - more than 183,000; – in the UK – about 26,000.

In 2001, 45,257 patients with malignant neoplasms of the mammary glands were identified in Russia.
·Over the past 10 years, the annual increase in incidence is 5.8%, amounting to a total of 31.2%.
In 17.8% of cases, detection is associated with preventive examinations.

In Russia, 60.0% of breast cancer was detected in stages 1-11, in 26.1% - in stage 111, and in 12.5% - in stage 1V of the disease.

The highest incidence rates and growth rates were observed in the age groups 60-64 years (136.5 per 100,000 population) and 65-69 years (133.2 per 100,000 population).
· At younger ages: 20-24, 25-29, 30–34, 35-39 – incidence rates have stabilized, amounting to: 0.59 and 0.67; 3.42 and 3.9; 13.12 and 13.5; 31.59 and 32.5 per 100,000 population, respectively.
· The highest standardized incidence rates were registered in the Khabarovsk Territory - 49.7, St. Petersburg - 48.3 and Moscow - 46.4.
· Malignant neoplasms of the mammary glands have the largest share in the mortality structure - 16.5%.
· In 2000, approximately 312,000 patients died from breast cancer worldwide.
· Every year in the United States, 2,000–3,000 women die from breast cancer.
· In Russia, 13,000 patients died from breast cancer in 2000.
· The highest age-specific mortality rate occurs in those aged 75 and over – 86.2 and in those aged 70-74 – 75.8 per 100,000 population.
· The highest mortality rates in 2001 were characteristic of St. Petersburg - 23.0, Moscow - 22.6 and the Kamchatka region - 22.8.
· More than 66% of women with breast cancer did not have the most important risk factors for the disease.
· Of the 367,632 breast cancer patients under observation in Russia in 2001, 199,408 women were observed for 5 or more years.

Average survival rate for this pathology in Russia.

Risk factors

About 66% of women with breast cancer are unaware of the existence of risk factors.

Factors increasing risk:

The ratio of sick women to men is 135:1.

Age.

– the age group 55-65 years old has the highest risk of developing breast cancer,

– only about 10% of patients are under 30 years of age.

Menstrual status:

Early menarche (before 13 years) – the risk increases by 2-2.5 times; – late menopause (after 55 years);

– long period of menopause (78% of patients have various menopausal disorders.

State of the reproductive sphere:

– late first birth (the risk increases by 40% in the group where the first pregnancy and childbirth were after the age of 25);

– a history of abortion, especially before the first birth.

Hormonal factors:

– use of hormonal drugs during pregnancy, especially estrogen ones;

– the use of hormone replacement therapy in the postmenopausal period is a controversial risk factor

Hormone replacement therapy slightly increases the risk of developing breast cancer only during its use (approximately 2.1 times);
upon completion of its use, the risk decreases;

Duration of use with minimal risk – 2 years; – oral contraceptives:

the risk is minimal;
a slight increase in the percentage of women with breast cancer is observed with continuous use of contraceptives for 6 more than 10 years.

Mastopathy:

– the risk of increased morbidity is minimal with low proliferative activity; – increases more than 3 times with atypical epithelial proliferation.

Anamnestic data on other oncological pathology:

– 2 times higher risk of developing breast cancer among patients suffering from endometrial or ovarian carcinoma;

– an exposure dose of 100 rad increases the risk of breast cancer by 3 times; -radiation therapy used in the treatment of Hodgin's lymphomas increases the risk of breast cancer, especially in young patients, with a tendency towards bilateral lesions.

· Alcohol:

– drinking alcohol in a dose of 50 ml daily increases the risk of developing breast cancer by 1.4 – 1.7 times.

Genetic factor:
· An assumption was made about the hereditary nature of breast cancer after studying the clinical features of the occurrence of breast cancer:

– the average age of hereditary forms of cancer is 44 years, which is approximately 10-16 years higher than in the population;

The cumulative risk of second breast cancer over a 20-year follow-up period for the hereditary form reaches 46%;

– hereditary breast cancer can be combined with other types of tumors (integral specific hereditary breast cancer syndrome).

· The genetic substrate has now been identified – the BRCA-1 and BACA-2 genes.

– BRCA-1 is a cytosomal dominant gene localized on chromosome 17:

Its expression increases the overall risk to 85%, with 33-50% under the age of 50 years and 56-87% under the age of 70 years. The overall risk in the population for the corresponding ages is 2% and 7%, respectively;

increases the risk of cancer by 28-44%

– BCRA-2 is localized on chromosome 13:

· its expression increases the risk to 85%;
· expression of this gene is a risk factor for the development of highly differentiated

breast cancer with low mitotic index; – genetically determined syndromes:

· breast cancer + brain tumor;
· breast cancer + sarcoma;
breast cancer + lung cancer + laryngeal cancer + leukemia;

SBLA syndrome + sarcoma + breast cancer + leukemia + adrenal cortex carcinoma;

GOWDEN disease + thyroid cancer + adenomatous polyp + colon cancer + breast cancer;

BLOOM disease + breast cancer;
ataxia-teriangiectasia + breast cancer.

– examination by a specialist starting from the age of 20;

Annual mammography from the age of 25-35 years;

Use of ultrasound CT, pelvic Dopplerography and examination for CA 125,

– the use of prophylactic mastectomy can be recommended if certain principles are followed:

This is not an emergency event;
possibly at menopausal age or in a nursing woman with a child;
Prophylactic mastectomy reduces, but does not completely eliminate, the risk of developing breast cancer. The most significant studies:

Potential Risk Factors

Diet:

– between a low-calorie diet and a low risk of developing breast cancer.

Obesity:

– is more of a risk factor in the group of postmenopausal patients.

· Hypothyroidism.
· 3 liver diseases.
· Hypertonic disease.

Diabetes.

Factors that reduce the risk of morbidity breast cancer

· Early first birth: the birth of the first child before the age of 18 years.
· Active circulation:

37% had a reduced risk of breast cancer with regular examinations

from specialists.

Lactation:

– breastfeeding at a young age reduces the risk of developing breast cancer

glands during menopause.

LECTURE 8.2

LECTURE PLAN:

1. DEFINITION OF BREAST CANCER.

2. ETIOLOGY.

3. PATHOGENESIS.

4. CLINICAL MANIFESTATIONS.

5. INSPECTION AND DIAGNOSTICS.

6. TREATMENT AND REHABILITATION.

Breast cancer belongs to the group of diseases that includes mastopathy (hormonal hyperplasia).

Mastopathy- a large group of hyperplastic conditions of different morphological structure, obviously with a common pathogenesis, but different etiology. The common link for all mastopathy is a hormonal imbalance. A relationship has been established between dysfunction of the gonads and the development of mastopathy in the mammary glands.

The likelihood of developing breast cancer is closely related to a woman’s constitution, the time of onset of menstruation, the rhythm and duration of the menstrual cycle, the intensity and nature of menstrual bleeding, the onset of sexual activity and its nature, the use of drugs to prevent pregnancy, the time of menopause and climacteric disorders of the vegetative, metabolic-endocrine and neuropsychic order. An important role is played by the number of births and abortions, the number of lactations, their intensity and duration, diseases of the female reproductive system, primarily the breast, and the presence of breast cancer in the past.

Currently, the incidence and mortality of women from breast cancer ranks high among all cancer diseases. Despite the development and improvement of surgical, radiation, medicinal, and immunological treatment methods, the mortality rate from breast cancer can only be reduced by improving the state of early diagnosis.

The development of breast cancer, like tumors of other localizations, is subject to general laws that influence the growth rate of the tumor.

Clinical forms Breast cancers are diverse. Depending on the nature of growth, all breast cancers are divided into two main groups - nodular, growing in the form of a more or less delimited node, and diffuse, growing infiltratively. The following independent forms are distinguished:

1) mast-like cancer, in which reactive inflammation dominates with hyperemia, infiltration and swelling of the skin, local and general increase in temperature;

2) erysipelas-like cancer, characterized by extensive hyperemia of the skin;

3) armored cancer, in which the skin over a significant area turns into a thick layer;

4) Paget's cancer (cancer of the nipple and areola);

5) cancer of the excretory ducts (intraductal cancer, comedocarcinoma).

In 1956, the Ministry of Health proposed a clinical classification providing for four stages of disease development. The international TNM classification, based on the clinical assessment of local tumor spread (T), involvement of regional lymph nodes (N) and the presence of distant metastases, has also become widespread.

Breast cancer develops asymptomatically for a long time. Pain is not typical for the initial period. Small and deeply located tumors do not cause changes in the appearance of the breast.

When the tumor is located in the superficial layers, especially with infiltrative growth, due to lymphangitis and lymphostasis, swelling of the skin develops, in which it takes on the appearance of a “lemon peel”. The skin over the tumor becomes dry, flaky and dull. As cancer progresses, it leads to deformation of the breast, nipple and areola.

A cancerous tumor, as a rule, is palpated in the form of a node, an irregularly shaped compaction with unclear contours and a bumpy surface. The consistency of the tumor is very dense, sometimes reaching the density of cartilage. Characteristic is an increase in density from the periphery to the center. Disintegrating cancerous tumors have a soft consistency.

In areas of regional metastasis (axillary, subclavian and supraclavicular areas), the lymph nodes enlarge, become very dense, and take on a rounded shape.

The examination must be carried out correctly. Women are examined in a standing position (hands on head) and lying on their back. Attention is paid to the symmetry of the mammary glands, their size, shape, the presence of deformations, the condition of the skin and its color, the condition of the areolas and nipples (is there any discharge), check for retractions, ulcerations, and swelling. First, one mammary gland is palpated, then the other, comparing symmetrical areas. When a compaction is identified, its size, shape, consistency, mobility, and connection with the skin are determined. Next, bilateral palpation of the muscular, sub- and supraclavicular lymph nodes is performed.

The most optimal and timely diagnostic complex for examining patients with suspected breast cancer is palpation - mammography - puncture. Thermography and echography methods have also gained great recognition.

The choice of treatment method depends primarily on the stage of the disease. In stages I and partially II, surgical intervention is indicated without the use of any additional specific treatment methods.

The main operation for breast cancer is radical mastectomy. In older women, the Patey procedure can be used to preserve the pectoralis major muscle.

In later stages, combined treatment is used - radical mastectomy with preoperative radiation therapy or cytostatic chemotherapy, hormone therapy.

For stage IV breast cancer, especially in the presence of multiple metastases, treatment includes hormonal and chemotherapy with cytostatics.

Contraindications to chemotherapy: leukopenia below 3000, thrombocytopenia below 100,000, sharply weakened general condition of the patient, cachexia, severe impairment of liver and kidney function due to concomitant diseases or massive metastasis. During drug treatment, you should remember the myelosuppressive properties of most antitumor drugs; systematically, at least 2 times a week, monitor the number of leukocytes (especially lymphocytes) and blood platelets.

Of particular importance is the maximum use of therapeutic measures aimed at improving the general condition of the patient and increasing the body's defenses. Medications that normalize hematopoiesis, a complex of vitamins, blood transfusions and, if necessary, antibiotics are prescribed. In addition to conventional treatments, immunotherapy may be used.

It can be said without exaggeration that the treatment of breast cancer, like other malignant tumors, is a problem of early diagnosis, since a very clear dependence of the long-term prognosis on the duration of the disease and the degree of its prevalence has been established.

For breast cancer, the prognosis depends on the stage of the disease, the morphological type of tumor growth and the histological structure. Infiltrative and poorly differentiated tumors give worse treatment results. According to the St. Petersburg Institute of Oncology, about 65% lived 10 years after treatment at stage I, about 35% at stage II, and 10% at stage III. The use of combination therapy including hormonal and chemotherapy treatment in advanced conditions gave up to 65% of the objectively recorded effect (reduction or disappearance of the tumor or metastases). In half of the treated patients, the average life expectancy is about 2 years. The effectiveness of breast cancer treatment has increased in recent years due to the widespread use of a complex method.

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Course work

Topic: "Nursing process for breast cancer"

INTRODUCTION
1. BREAST CANCER
1.1. Risk factors for breast cancer
1.2. Forms and stages of breast cancer
1.3. Pathogenesis, clinical picture, diagnosis of breast cancer
1.4. Breast cancer treatment, prognosis
1.5. Breast self-examination techniques
2. NURSING PROCESS FOR BREAST CANCER
2.1. Nursing process for breast cancer
2.2. Features of nursing care in the preoperative period for breast cancer
2.3.Nursing care in the early postoperative period for breast cancer
2.4. Features of nursing care in the late postoperative period for breast cancer
3. PRACTICAL PART
3.1. Case Study 1
3.2. Case Study 2
3.3. conclusions
4.CONCLUSION
5. LITERATURE
6.APPLICATIONS

INTRODUCTION

Breast cancer is one of the most common forms of malignant tumors in women. The relevance of this problem lies in the fact that in terms of frequency this localization ranks first among cancers in women, and second in mortality. Moreover, recently there has been an increasing increase in the incidence of breast cancer, which can be explained by improved diagnosis and recording, as well as the growth of the medical culture of the population. 80% Patients themselves accidentally discover a tumor, which in almost half of the cases, unfortunately, belongs to an already advanced stage. Only 20% patients are actively identified by medical workers, but at an earlier stage.

The majority of actively identified patients undergo individual preventive examinations by doctors of various specialties. A significantly smaller number of patients are identified during mass preventive examinations.

The outpatient doctor is not required to establish an accurate diagnosis of breast disease. But doctors of any specialty - gynecologists, therapists, surgeons, neurologists, dermatologists and others - must exercise oncological vigilance and, if possible, examine the mammary glands when seeing patients.

If any pathology of the mammary glands is suspected, the doctor should refer the patient to an oncologist, who will conduct further examination and establish an accurate diagnosis. Therefore, all general practitioners should be sufficiently familiar with the pathology of the mammary glands.

Object of study: nursing process.

Subject of study: Nursing process in breast cancer.

Purpose of the study: studying the nursing process in breast cancer.

Tasks:

To achieve this research goal it is necessary to study:

etiology of breast cancer;
features of pathogenesis at different stages;
clinical picture of breast cancer;
methods of diagnosis, self-diagnosis of breast cancer;
principles of breast cancer treatment;
stages of the nursing process;
features of care for patients with breast cancer in the pre- and postoperative periods;
clinical cases from practice.

Research methods:

scientific and theoretical analysis of medical literature on this topic;
empirical - observation, additional research methods:
organizational method;
subjective method of clinical examination of the patient (history collection);
objective methods of examining the patient (physical, instrumental, laboratory);
biographical (analysis of anamnestic information, study of medical documentation);
psychodiagnostic (conversation)...................

This is a common form of malignant tumors, ranking 3rd after stomach and uterine cancer in women. Breast cancer usually occurs between the ages of 40 and 50, although approximately 4% of patients are women under 30 years of age. Breast cancer is rare in men.

In the development of breast cancer, previous pathological processes in its tissues play a significant role. Mainly………………..hyperplasia

(fibroadenomatosis). The reasons for these changes in breast tissue are a number of endocrine disorders, often caused by concomitant ovarian diseases, repeated abortions, improper feeding of the child, etc.

Anatomical and embryological abnormalities are known to play a role in the development of breast cancer - the presence of accessory mammary glands and dystonia of the lobules of glandular tissue, as well as previous benign tumors - breast fibroadenoma.

All these formations, regardless of their tendency to malignant transformation, must be immediately removed, because they are often difficult to confidently distinguish from cancer.

The localization of cancerous tumors in the mammary glands is very different. Both the right and left mammary glands are equally often affected; in 2.5% there are bilateral mammary gland cancers, either as a metastasis or as an independent tumor.

Breast cancer appearance:

1.may be a small, very sweaty cartilaginous tumor without clear boundaries

2.it’s a bit soft

3. test leathery node of a round shape with fairly clear boundaries, with a smooth or bumpy surface, sometimes reaching significant sizes (5-10 cm)

4. unclear compaction without clear boundaries

The local spread of breast cancer to the skin depends on the proximity of its location to the integument and on the infiltrating nature of growth.

One of the typical symptoms of cancer is fixation, wrinkling and retraction of the skin over the tumor with the transition of 1 later stages to ………………………….. (the “orange peel” symptom) and ulcerations.

Deeply located tumors quickly grow together with the underlying fascia and lipids.

By lymph flow, which is very developed in breast tissue, tumor cells are transported to the lymph nodes and give initial metastases. The axillary, subclavian and subscapular groups of nodes are primarily affected, and if the tumor is located in the slow quadrants of the glands, the chain of parasterial nodes is affected.

In some cases, metastases in the axillary lymph nodes appear earlier than a tumor is detected in the mammary gland.

Hematogenously, metastases occur in the lungs, pleura, liver, bones and brain. Bone metastases are characterized by damage to the spine, pelvic bones, ribs, skull, femur and humerus, which is manifested at the beginning by intermittent aching pain in the bones, which later becomes persistently painful.

A tumor-like node or compaction appears in the mammary gland with blurred boundaries. In this case, a change in the position of the gland is observed - it, together with the nipple, is pulled up, or is swollen and lowered down.

A thickening or umbilical retraction of the skin is noted above the location of the tumor, sometimes an orange peel symptom, and subsequently an ulcer appears.

Typical symptoms:

Flattening and retraction of the nipple, as well as bloody discharge from it. Painful sensations are not a diagnostic sign; they may be absent in cancer and at the same time greatly bother patients with mastopathy.

Forms of cancer:

1. Mastitis-like form - characterized by a rapid course with a sharp enlargement of the mammary gland, its swelling and pain. The skin is tense, hot to the touch, and reddish. The symptoms of this form of cancer are similar to acute mastitis, which in young women, especially against the background of…………….., entails severe diagnostic errors.

2. The erysipelas-like form of cancer is characterized by the appearance of sharp redness on the skin of the glands, sometimes spreading beyond its boundaries, with uneven jagged edges, sometimes with a high rise in T0. This form can be mistaken for ordinary erysipelas, with the corresponding prescription of various physiotherapeutic procedures and medications, which leads to a delay in proper treatment.

3. …………. Cancer occurs due to cancerous infiltration through the lymphatic vessels and crevices of the skin, which leads to a lumpy thickening of the skin. A kind of dense shell is formed, wrapping half, and sometimes the entire chest. The course of this form is extremely malignant.

4. Paget's cancer - general form…………. lesions of the nipple and areola; in the initial stages, peeling and scalyness of the nipple appears, which is often mistaken for eczema. Subsequently, the cancerous tumor spreads deep into the ducts of the mammary gland, forming a typical cancerous node with metastatic lesions in the tissue.

Paget's cancer progresses relatively slowly, sometimes over several years, limited only to damage to the nipple.

The course of breast cancer depends on many factors: primarily on the hormonal status and age of the woman. In young people, especially during pregnancy and lactation, it occurs very quickly, …………., distant metastases. At the same time, in old women, breast cancer can exist for up to 8-10 years without a tendency to metastasize.

Inspection and feeling

First, the examination is performed while standing with arms lowered and then with arms raised, after which examination and palpation are continued with the patient in a horizontal position on the couch.

Typical symptoms of cancer:

Presence of a tumor

Its density, blurred boundaries

Merging with skin

Gland asymmetry

Nipple retraction

Be sure to examine the second mammary gland in order to identify an independent tumor or metastasis in it, and also palpate both axillary and supraclavicular areas. Due to the frequency, metastases in ...... are also palpable.

Interdependent interventions

R-scopy of the lungs

Mammography,

Biopsy: puncture with cytological examination (sector resection)

In the initial stages, with a small size, deep location of the tumor and the absence of certain metastases.

Surgical (no mts)

Halstead mastectomy

If the tumor exceeds 5 cm in diameter with pronounced skin-like symptoms and infiltration of the surrounding tissue, with palpable mts in the axilla

l\u - combined treatment.

Stage 1 – radiation therapy

Stage 2 – surgical treatment

Approximate standard of physiological problems in breast cancer.

(before surgery)

1. A lump or thickening in or near the mammary gland, or in the armpit area.

2.Changes in breast size or shape

3.Nipple discharge

4. Changes in the color or texture of the skin of the breast, areola or nipple (retraction, wrinkles, scaliness)

5. Pain, discomfort

6.violation…….

7.Decreased ability to work

8.Weakness

Psychological problems of the patient

1. Feeling of fear due to an unfavorable outcome of the disease

2. Anxiety, fear when visiting a doctor “oncologist”

3. Increased irritability

4.Lack of knowledge about upcoming procedures, manipulations, and the possibility of pain in the process.

5. Feeling of hopelessness, depression, fear for your life.

6.Feeling of fear of death

Physiological problems

1. Changes in a woman’s weight or disturbances in weight distribution during breast removal, which leads to

2.discomfort in the back and neck

3. Skin tightness in the chest area

4.Numbness of the chest and shoulder muscles

After a mastectomy, some patients lose strength in these muscles permanently, but most often the decrease in muscle strength and mobility is temporary.

5. Slowing down the flow of lymph if the axillary lymph node is removed. In some patients, lymph accumulates in the upper arm and hand, causing lymphedema.

6.Lack of appetite

Potential problems

1.Nerve Damage – A woman may experience numbness and tingling in her chest, armpit, shoulder and arm. This usually goes away within a few weeks or months, but some numbness may remain permanent.

2.Risk of developing various infectious complications. It becomes difficult for the body to cope with the infection, so a woman should protect the arm on the affected side from damage throughout her life. In case of cuts, scratches, or insect bites, be sure to treat them with antiseptics, and in case of complications, consult a doctor immediately.

3. Risk of complications from the respiratory system due to pain.

4. Limitations of self-service – the inability to do laundry and wash your hair.

Violated needs

3. work hard

4. communicate

5. have no discomfort

6. be healthy

8. be safe

These operations do not require any special preoperative preparation. It is necessary to monitor active aspiration from the wound, carried out for 3-4 days, to monitor the performance of therapeutic exercises to develop hand movements from the side of the operation.

When cancer spreads, both by local manifestations and by the degree of damage to the lymphatic system, especially in young menstruating women, a complex treatment method is used, combining radiation therapy and surgery with hormonal treatment and chemotherapy. Hormone therapy includes bilateral...ectomy (...radiation ovarian suppression), andogen therapy and corticoid therapy to suppress adrenal function.

Forecast – life expectancy 2.5-3 years

Prevention - timely relief of patients from precancerous lumps in the mammary glands, as well as compliance with the normal physiological rhythm of a woman’s life (pregnancy, lactation) while reducing the number of abortions to a minimum.

Prostate cancer

This is a rare form, the incidence rate is 0.85%, most often at the age of 60-70 years.

Problems

Increased frequency of urination at night

Difficulty urinating, first at night and then during the day.

Feelings of incomplete emptying of the bladder

Increase in the amount of residual urine

These problems are similar to those in patients with prostatic hypertrophy. Later, with cancer, the following appear:

Hematuria

Pain resulting from tumor invasion of the bladder and pelvic tissue

Prostate cancer often metastasizes, showing a particular tendency to involve multiple bones (spine, pelvis, hip, ribs), in addition to the lungs and pleura.

D: Rectal examination, enlargement, density, lumpiness, biopsy

In the early stages - surgical

- ……… i.m. – relieves pain and diuretic disorders (hormone therapy)

Radiation therapy

If there is severe compression of the urethra, the bladder is released through a catheter, and if catheterization is impossible, a suprapubic fistula is applied.

The prognosis is unfavorable due to the early occurrence of metastases.

Esophageal carcinoma

It is one of the most common forms of malignant tumors, accounting for 16-18%, and occurs much more often in men, mainly in adulthood and old age. Most often it affects the lower and middle sections of the esophagus.

External factors that contribute to the development of esophageal cancer include poor nutrition, in particular the abuse of very hot foods, as well as alcohol.

Patient problems

Quite bright. The patient's first complaint is a feeling of difficulty passing rough food through the esophagus. This symptom, called dysphagia, is initially mildly expressed and therefore the patient and doctors do not attach due importance to it, attributing its appearance to injury to the esophagus with a lump of rough food or a bone. And unlike other diseases of the esophagus caused by its spasm, dysphagia in cancer is not intermittent in nature and, once it appears, begins to bother the patient again and again. Substernal pain occurs, sometimes of a burning nature. Less often, pain precedes dysphagia.

Having difficulty passing food through the esophagus, patients first begin to avoid particularly coarse foods (bread, meat, apples, potatoes), resort to pureed, ground food, and then are forced to limit themselves only to liquid foods - milk, cream, broth.

Progressive weight loss begins, often reaching complete cachexia.

Subsequently, complete obstruction of the esophagus occurs, and everything that the patient takes is thrown back through regurgitation.

Violated needs

Adequate nutrition, drinking

Highlight

Sleep, rest

Discomfort

Communication

Interdependent interventions

They do not play a big role in recognizing the esophagus, because anemia usually occurs late. A false increase in hemoglobin content is observed due to blood thickening due to malnutrition and dehydration of the patient.

R-examination, which reveals a narrowing of the lumen of the esophagus with uneven contours and rigid, infiltrated walls. Above the narrowing, the esophagus is usually somewhat dilated. Sometimes the degree of narrowing is so great that even liquid barium in a very thin stream has difficulty passing into the stomach.

Esophagoscopy makes it possible to visually see a bleeding tumor protruding into the lumen of the esophagus or a narrowed area with dense, inelastic, hyperemic or whitish walls, through which it is impossible to pass through the esophagoscope tube. The stability of the X-ray esophagoscopic picture makes it possible to distinguish esophageal cancer from its spasm, in which the narrowing disappears spontaneously or after the administration of antiseptics and the normal lumen and patency of the esophagus is restored.

The final stage of diagnosis is a biopsy with special forceps or taking smears from the surface of the tumor for cytological examination, carried out under the control of an esophagoscope.

Radical treatment can be carried out using 2 methods. Pure radiation treatment using the method of remote gamma therapy in a certain percentage of cases gives a satisfactory result. The same applies to purely surgical treatment.

However, observations in a number of patients …….. prompted …… ………………………… to resort to combination treatment. There are 2 types of operations.

For cancer of the lower part, the affected area is removed and resected, retreating down and up from the edges of the tumor up and down at least 5-6 cm. In this case, the upper part of the stomach is often taken away, and then the esophagogastric ……… are created. , sewing the proximal end of the esophagus into the stump of the stomach.

The second type of operation is called the Torek operation, which is most often performed for cancer of the middle esophagus. The patient is first given a gastrostomy tube for nutrition, and then the esophagus is completely removed and its upper end is brought out to the neck.

Patients live by feeding through a tube inserted into the gastrostomy opening,

And only after 1-2 years, provided that no metastases are detected, the normal passage of food is restored, replacing the missing esophagus with the small or large intestine.

The division of these operations into several stages is necessary. Because patients with esophageal cancer are extremely weakened, they cannot tolerate single-stage complex interventions.

Particular attention is paid to the preparation and management of these patients.

From the moment the patient is admitted to the hospital, he receives intravenous

Administration of fluids (saline solutions, or Ringer's, glucose), vitamins, protein preparations, native plasma and blood. By mouth, if possible, give frequent small portions of high-calorie protein foods and various juices.

Care during the period depends on the nature of the interventions. Thus, the application of a gastrostomy is not a difficult operation, but it is necessary to receive instructions from the doctor about the timing of feeding, which until his strength is restored, is carried out by honey. sister. To do this, a thick gastric tube is inserted into the openings of the gastrostomy tube, directing it to the left, into the body of the stomach and trying to insert it deeper, but without force. Putting a funnel on the probe, slowly, in small portions, introduce mixtures prepared in advance:

From milk or cream

BROTH

butter

Sometimes diluted alcohol is added.

In the future, the diet is expanded, but the food always remains liquid and pureed.

Patients eat frequently and in small portions up to 5-6 times a day.

The postoperative period is much more difficult after such complex interventions as Thorek’s surgery performed in the chest cavity and esophageal plastic surgery. In these patients, a complex of anti-shock measures is carried out - blood transfusions, blood substitutes, fluids, etc. Cardiovascular drugs, oxygen and, as after all thoracic operations, active aspiration from drains left in the chest cavity are used.

Nutrition after plastic replacement of the esophagus remains through a gastrostomy and stops only after complete fusion along the line of connection of the displaced intestine with the esophagus and stomach, when there is no fear of feeding the patient through the mouth. The gastrostomy subsequently heals on its own.

A common form of esophageal cancer with invasion of surrounding tissues or the presence of distant metastases is classified as inoperable. These patients, if their general condition allows, are subject to palliative radiation treatment and also, for palliative purposes, a gastrostomy tube for nutrition.

Esophageal cancer metastasizes both by the lymphatic route - to the lymph nodes of the mediastinum and in the left supraclavicular region, and through the bloodstream, most often affecting the liver.

Metastasis rarely plays a role in the causes of death; the main effect of tumors is progressive general exhaustion due to the spread of the primary tumor.

For esophageal cancer, radically treated patients have a poor prognosis.

Persistent cure is observed in 30-35%.

studfiles.net

NURSING CARE FOR BREAST CANCER

LECTURE 8.2

LECTURE PLAN:

1. DEFINITION OF BREAST CANCER.

2. ETIOLOGY.

3. PATHOGENESIS.

4. CLINICAL MANIFESTATIONS.

5. INSPECTION AND DIAGNOSTICS.

6. TREATMENT AND REHABILITATION.

Breast cancer belongs to the group of diseases that includes mastopathy (hormonal hyperplasia).

Mastopathy is a large group of hyperplastic conditions with different morphological structure, obviously with a common pathogenesis, but different etiology. The common link for all mastopathy is a hormonal imbalance. A relationship has been established between dysfunction of the gonads and the development of mastopathy in the mammary glands.

The development of breast cancer, like tumors of other localizations, is subject to general laws that influence the growth rate of the tumor.

The clinical forms of breast cancer are diverse. Depending on the nature of growth, all breast cancers are divided into two main groups - nodular, growing in the form of a more or less delimited node, and diffuse, growing infiltratively. The following independent forms are distinguished:

1) mast-like cancer, in which reactive inflammation dominates with hyperemia, infiltration and swelling of the skin, local and general increase in temperature;

2) erysipelas-like cancer, characterized by extensive hyperemia of the skin;

3) armored cancer, in which the skin over a significant area turns into a thick layer;

4) Paget's cancer (cancer of the nipple and areola);

5) cancer of the excretory ducts (intraductal cancer, comedocarcinoma).

Breast cancer develops asymptomatically for a long time. Pain is not typical for the initial period. Small and deeply located tumors do not cause changes in the appearance of the breast.

In areas of regional metastasis (axillary, subclavian and supraclavicular areas), the lymph nodes enlarge, become very dense, and take on a rounded shape.

The main operation for breast cancer is radical mastectomy. In older women, the Patey procedure can be used to preserve the pectoralis major muscle.

In later stages, combined treatment is used - radical mastectomy with preoperative radiation therapy or cytostatic chemotherapy, hormone therapy.

For stage IV breast cancer, especially in the presence of multiple metastases, treatment includes hormonal and chemotherapy with cytostatics.

Contraindications to chemotherapy: leukopenia below 3000, thrombocytopenia below 100,000, severely weakened general condition of the patient, cachexia, severe impairment of liver and kidney function due to concomitant diseases or massive metastasis. During drug treatment, you should remember the myelosuppressive properties of most antitumor drugs; systematically, at least 2 times a week, monitor the number of leukocytes (especially lymphocytes) and blood platelets.

mykonspekts.ru

Nursing care for patients with tumor diseases of the mammary gland (mastopathy, breast cancer).

Historical sketch.

The problem of breast tumors is as ancient as the entire history of medicine. Women's attitude towards the mammary gland as an attribute of femininity carries her through all the years. This feeling determines her consent to see a doctor, her readiness to undergo the surgical treatment he recommends, up to complete removal of the breast, or, conversely, her refusal of any type of treatment.

Breast cancer has been encountered since time immemorial; preserved relics, ancient bones, and paleontological remains indicate that cancer is widespread and affects all living things.

The earliest document related to the history of medicine is the ancient surgical papyrus of Edwin Slifa, dating back to the times of the Egyptian pyramids (2.5 - 3 thousand years BC). The name of the author is reliably known, the text is attributed to the doctor of the ancient world, Imhotep. The papyrus describes 8 cases of breast cancer. Tumors are divided into cold (convex) with swelling of the mammary gland and inflammatory, most likely abscesses. For the treatment of the latter, coagulation is recommended. If a cold tumor (cancer) was detected, no treatment was recommended.

The ancient Greek historian Herodotus (500 BC), 100 years before Hippocrates, tells a story about Princess Atossa, who suffered from a breast tumor. She turned to the famous physician Democedes (525 BC) for help only when the tumor reached a large size and began to bother her. Out of false modesty, the princess did not complain while the tumor was small. This case shows the attitude of a woman to her mammary glands in that very long period of history. The type of treatment is not specified, but the princess was cured.

The famous physician Hippocrates (400 BC) points out that it is better not to treat “deeply located” tumors, because it can hasten the patient's death, and refusal of treatment can prolong life.

The famous physician Galen (131 - 200), perhaps the first to propose surgical treatment of breast cancer while preserving the pectoralis major muscle. He also legitimized the term “cancer” by describing a tumor that looked like a crab. Galen was an adherent of the “humoral” theory of cancer, caused, in his opinion, by “black bile” - a theory that dominated medicine for a whole millennium.

The first surgeon who began to remove not only the mammary gland, but also the axillary lymph nodes for cancer, was Severinus (1580-1656)

In the 19th century principles of breast cancer treatment were formed. In 1882, Halsted, and in 1894, independently of him, Meyer, used the radical mastectomy method in clinical practice, which became a classic method and is currently used.

Later, by studying the pathways of lymphatic drainage, they began to offer extended operations with the removal of axillary, subclavian and parasternal lymph nodes.

These were very mutilating operations, and the results were not satisfactory.

In recent years, extended mastectomies have been abandoned because... Additional treatment methods have appeared in the arsenal of doctors: radiation, chemotherapy, and hormone therapy.

In the last decade, organ-saving operations have been performed in combination with modern treatment methods. The result of this treatment was a significant increase in life expectancy and a decrease in the number of complications and disability.

Anatomy and physiology of the mammary gland.

In their development, the mammary glands are a homologue of the sweat and sebaceous glands, they are formed in the ectoderm and in the first stages of embryonic development they do not differ in men and women.

Sizes M.F. very diverse. On average, the transverse size of M.J. 10-12 cm, longitudinal 10 cm, thickness from 4 to 6 cm. Right M.F. slightly larger than the left in right-handed people. The weight of one gland in girls is 150 - 400 g, in nursing women - 500 - 800 g.

The body of the M.J., or the glandular tissue itself, is embedded in fatty tissue, which is a direct continuation of the subcutaneous fatty layer of neighboring areas. The supporting and strengthening apparatus of the breast is the superficial thoracic fascia, which is attached along the entire length of the clavicle; going down, it is divided into 2 leaves, which cover the gland and form a capsule.

Between the deep layer of fascia and the aponeurosis of the pectoralis major muscle there is a retromammary space filled with loose fatty tissue. This creates a condition for significant mobility of the gland and determines the course of pathological processes.

M.Zh. It is customary to divide into 4 quadrants: upper-outer and lower-outer, upper-inner and lower-inner. M.Zh. consists of 15-20 alveolar tubular glands (lobules), surrounded by loose connective tissue with a small amount of fatty tissue. Each lobe has its own excretory duct with a diameter of 1 to 2 mm with an opening on the nipple of 0.2 to 0.3 mm. The excretory duct near the external opening expands spindle-shaped, forming the milk sinus. Deep in the tissue, the ducts branch, moving to the so-called alveolar ducts. On average, there are from 7 to 30 milk ducts on the surface of the nipple.

Arterial blood supply to M.Zh. receives from 3 branches, all of them anastomose with each other and surround the glandular lobules and ducts with an arterial network. Venous vessels follow the paths of the arterial vessels and flow into the axillary, subclavian, internal mammary and superior vena cava.

Given the venous outflow, cancer emboli penetrate the lungs, pelvic bones and spine.

The lymphatic network consists of superficial and deep plexuses of vessels. The main directions of lymph outflow are the axillary and subclavian lymph nodes. From the central and medial parts of the gland, the lymphatic vessels go deep, accompanying the branches of the internal thoracic artery and vein, and go to the posterior sternal mediastinal lymph nodes. From the lower internal section of M.Zh. the lymphatic pathways are directed to the epigastrum and anastomose with the lymphatic pathways of the pleura of the subdiaphragmatic space and the liver. There are many anastomoses between the superficial and deep lymphatic networks, and there are also many between the mammary glands.

Starting from 10-12 years of age, the growth of the ducts and surrounding stroma increases in girls. At the age of 13-15 years, the development of the final glandular elements of the alveoli begins. By the age of 16-18 M.Zh. reach normal size. Maximum development occurs between the ages of 25-28 and 33-40 years. During this period, there is a lobulated, alveolar-tubular gland with a well-developed and clearly distinguishable supporting stroma.

At the age of 45-55 lei, involution of the glandular elements and stroma of the breast occurs. In women 60-80 years old, the structure of the mammary gland is characterized by a predominance of subcutaneous fatty tissue, and the gland’s own tissue has the appearance of narrow, coarse fibrous layers.

Development and functioning of M.Zh. depends on neurohumoral regulations, the influence of hormones of the sex glands, adrenal glands and pituitary gland. Regulation of various endocrine functions and metabolic processes is carried out by the cerebral cortex through the diencephalic zone of the hypothalamus.

MASTOPATHY

This disease has other names: Reclus disease, Shimelbusch disease, cystic disease, fibroadenomatosis, sclerosing adenomatosis, etc. Dishormonal hyperplasia in the mammary gland develops under the influence of many factors: impaired childbirth, ovarian-menstrual function, endocrine disorders, social and everyday conflicts (stress) , sexual disorders, liver dysfunction.

Mastopathy is characterized by the proliferation of connective tissue in the form of whitish strands, in which gray-pink areas and cysts with clear liquid are noted.

A number of features should be noted in the etiology of this disease. Firstly, it is important to take into account social and living characteristics. Thus, 1.5 times more often are tumors of M.Zh. found in cities than in rural areas. Persons with higher education are 1.7 times more likely than unskilled workers. Mastopathy occurs with frequent negative stress. Conflict is the main cause of strong emotions. Therefore, it is important to identify its sources. These sources can be divided into several groups:

1. Dissatisfaction with marital status.

2. Domestic conflicts.

3. Conflict situations at work.

4. Mental stress.

5. Adverse sexual factors.

If these factors are not resolved, malignancy is possible.

Secondly, reproductive dysfunction. This function is closely related to complex rhythmic processes in the nervous and endocrine systems.

The risk group includes people with early onset of menstruation and late menopause, as well as people who experience anovulatory cycles during the reproductive period. To reduce the risk, especially in youth, it is recommended to increase physical activity, play sports, and dance. Thirdly, these are diseases of the genital organs. First of all, these are inflammatory diseases of the appendages and uterus. Fourthly, these are sexual factors. When discussing sexual problems, it is important to find out the regularity and emotionality (dissatisfaction, oppression, depression) of sexual life. If a significant role of sexual factors in the occurrence and development of mastopathy is established, the patient must be treated together with a sex therapist or psychotherapist. Fifthly, a violation of the inactivating ability of the liver plays a certain role. Treatment of hepatitis and cholecystitis leads to the elimination of mastopathy. Patients with somatic pathology that provokes mastopathy should undergo treatment under the supervision of a mammologist and therapist.

You should pay attention to external signs of endocrine imbalance: constitution (asthenic unfavorable), signs of hypoestrogenism (male type of hair growth, hirsutism, hypoplasia of the external genitalia), obesity after 45 years, as well as dysfunction of the thyroid gland.

People who have relatives with mastopathy need to know that only a predisposition to tumors is inherited, and not a symptom. The realization of a predisposition is possible under unfavorable conditions. Eliminating the causes and changing lifestyle prevents the development of the disease.

The nurse should actively identify women with mastopathy, carry out preventive measures, conversations, recommend them examination, form them into risk groups, monitor their health and teach them self-examination techniques.

The disease manifests itself in two forms: diffuse and nodular.

With mastopathy, pain in the gland is noted in the middle of the menstrual cycle and before menstruation. Patients complain of thickening of the gland and sometimes discharge from the nipple. The pain is characterized as stabbing, shooting, sharp, radiating to the back and neck.

Upon palpation, compactions of a lobular nature with an uneven surface, heaviness of the tissue, and moderate pain are determined. After menstruation, with diffuse mastopathy, the gland is evenly compacted, heavy, the pain may be insignificant. In the nodular form, painless single or multiple foci of compaction are determined. They are not fused to the skin, nipple, surrounding tissues, are mobile, and are not palpable in the supine position (Koenig's sign is negative). No enlarged lymph nodes are observed.

Fibroadenoma. The age of the patients is young, from 15 to 35 years. After 40, malignancy is possible. The tumor is usually solitary. The size of the tumor varies. It has a round shape, clear contours, is painless on palpation, and has a positive Koenig sign.

Leaf-shaped. This tumor has a layered structure, is clearly demarcated from the surrounding tissues, quickly increases in size, and does not have a capsule. It most often becomes malignant and then metastasizes to the bones, lungs and other organs.

A peculiarity in the clinic is exhaustion, cyanosis of the skin in the projection of the tumor.

DIAGNOSTICS.

Palpation examination by a mammologist.
In accordance with age and recommendations of the mammologist, non-contrast mammography or ultrasound of the breast.
Needle biopsy.

Diffuse forms are treated conservatively. Patients should be referred to a specialist, undergo a full examination, after which adequate treatment is prescribed. Nursing staff can recommend proper nutrition and general strengthening activities.

Patients are advised to reduce their weight to normal. Reduce the consumption of animal fats to 30% in calorie content (butter no more than 75 grams per day). It is advisable to strictly limit the use of pickled, smoked and dried foods, fatty meats and whole milk. And eating eggs favorably improves intestinal flora and reduces the possibility of developing a tumor. There is evidence that if coffee, tea, chocolate and tonic drinks are excluded from the diet, after 2-6 months. Pathological changes of a fibrocystic nature disappear.

It is recommended to include liver, fish, vegetables especially with dark green leaves, tomatoes, carrots, sweet potatoes and corn in the diet. There is also a beneficial effect when consuming fruits, especially citrus fruits, vegetables rich in carotene, the cabbage family, and whole grain products. To strengthen the body's defense mechanisms and prevent the occurrence of tumors, it is necessary to introduce vitamins into the diet. The main antitumor vitamins are A, C, E.

Among the methods of surgical intervention, sectoral resection of the mammary gland is used.

Ministry of Health Republic of Tatarstan

State autonomous educational institution

secondary vocational education of the Republic of Tatarstan

"NIZHNEKAMSK MEDICAL COLLEGE"

Specialty General Medicine

ADMISSION TO PROTECTION

Deputy Director for SD

O.V.Sizova

"__"_________________20__

Patrakova Alina Sergeevna

Course work

"Analysis of the nursing process in the treatment of breast cancer"

Head: Gaisin Radik Masgutovich

Nizhnekamsk 2016-17

Introduction 3

1. THEORETICAL PART 4

1.2. Principles of breast cancer treatment 5

1.3. Stages of the nursing process 6

1.4. Features of preoperative patient care 9

1.5. Features of postoperative patient care 11

2. PRACTICAL PART 13

2.1. Stage one. 13

2.2. Stage two. 15

2.3. Stage three. 19

Conclusion 30

Application 31

List of used literature 42

Introduction

Breast cancer is one of the forms of malignant tumors, which is the most common among cancers in women, rarely in men.

Recently, with improved diagnosis and recording, in 90% of cases, cancer is cured completely, but only in the early stages. However, the problem is that many women ignore the recommendations of oncologists and mammologists in their annual breast examination and turn to specialists too late, when the disease is much more difficult to cure.

The relevance of this work lies: firstly, in increasing the number of patients with breast cancer; secondly, in the influence of heredity; thirdly, the importance of the nursing role.

Purpose of the study:studying the features of care for breast cancer.

Tasks:

Consider the causes of malignant neoplasms;
Describe the common clinical signs of breast cancer;
Get acquainted with modern principles of breast cancer treatment;
To determine the features of care for patients with breast cancer in the pre- and postoperative period.

Hypothesis: Nursing process is hypothesized to play a major role in the care of patients with breast cancer.

Object of study : nursing process.

Subject of study: Nursing process in breast cancer.

1. THEORETICAL PART

1.1. Clinic of breast cancer and the causes of its occurrence.

The causes of breast cancer are the following factors: gender; heredity; a woman has a history of an ovarian or other breast tumor; age factor; increased ionizing radiation (MRI, CT); increased body weight; early (before 11 years) first menstruation; refusal of breastfeeding; late first pregnancy (over 30 years of age) or no pregnancies at all; abortions; immunodeficiencies for various reasons; menopause (occurring after the age of 55 years); smoking, excessive alcohol consumption; history of breast trauma; diabetes mellitus, arterial hypertension.