Lectures on the cycle of nursing care for cancer patients. Nursing care. Caring for dentures

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NURSING CARE FOR CANCER PATIENTS

Introduction

Conclusion

Literature

Introduction

Primary malignant tumors of the central nervous system account for about 1.5% of the total cancer incidence.

In children, tumors of the central nervous system are much more common (? 20%) and are second only to leukemia. In absolute terms, the incidence increases with age. Men get sick 1.5 times more often than women, whites - more often than representatives of other races. For every spinal cord tumor there are over 10 brain tumors. Metastatic tumors of the central nervous system (mainly the brain) develop in 10-30% of patients with malignant tumors of other organs and tissues.

They are thought to be even more common than primary CNS tumors. The most common cancers that metastasize to the brain are lung cancer, breast cancer, skin melanoma, kidney cancer, and colorectal cancer.

The vast majority (more than 95%) of primary CNS tumors occur for no apparent reason. Risk factors for the development of the disease include radiation and family history (I and II). The influence of mobile communications on the occurrence of central nervous system tumors has not yet been proven, but monitoring of the impact of this factor continues.

1. Features of caring for cancer patients

What are the characteristics of a nurse working with cancer patients? A feature of caring for patients with malignant neoplasms is the need for a special psychological approach. The patient should not be allowed to find out the true diagnosis. The terms “cancer” and “sarcoma” should be avoided and replaced with the words “ulcer”, “narrowing”, “induration”, etc.

In all extracts and certificates handed out to patients, the diagnosis should also not be clear to the patient.

You should be especially careful when talking not only with patients, but also with their relatives. Cancer patients have a very labile, vulnerable psyche, which must be kept in mind at all stages of care for these patients.

If you need consultation with specialists from another medical institution, then a doctor or nurse who transport documents.

If this is not possible, then the documents are sent by mail to the head physician or given to the patient’s relatives in a sealed envelope. The actual nature of the disease can only be communicated to the patient’s closest relatives.

What are the features of patient placement in the oncology department? We must try to separate patients with advanced tumors from the rest of the patient population. It is advisable that patients with initial stages There were no patients with malignant tumors or precancerous diseases who had relapses and metastases.

In an oncology hospital, newly arrived patients should not be placed in wards where there are patients with late stages diseases.

How are cancer patients monitored and cared for? When monitoring cancer patients great importance has regular weighing, since a drop in body weight is one of the signs of disease progression. Regular measurement of body temperature allows us to identify the expected disintegration of the tumor and the body’s reaction to radiation.

Body weight and temperature measurements should be recorded in the medical history or in the outpatient card.

For metastatic lesions of the spine, which often occur with breast or lung cancer, bed rest is prescribed and a wooden shield is placed under the mattress to avoid pathological bone fractures. When caring for patients suffering from inoperable forms of lung cancer, exposure to air, non-tiring walks, and frequent ventilation of the room are of great importance, since patients with limited respiratory surface of the lungs need an influx of clean air.

How are sanitary and hygienic measures carried out in the oncology department?

It is necessary to train the patient and relatives in hygienic measures. Sputum, which is often secreted by patients suffering from cancer of the lungs and larynx, is collected in special spittoons with well-ground lids. Spittoons need to be washed daily hot water and disinfect with a 10-12% bleach solution. To destroy the foul odor, add 15-30 ml to the spittoon. turpentine. Urine and feces for examination are collected in an earthenware or rubber vessel, which should be regularly washed with hot water and disinfected with bleach.

What is the diet for cancer patients?

Proper diet is important.

The patient should receive food rich in vitamins and proteins at least 4-6 times a day, and attention should be paid to the variety and taste of the dishes. You should not adhere to any special diets, you just need to avoid excessively hot or very cold, rough, fried or spicy foods.

What are the features of feeding patients with stomach cancer? Patients with advanced forms of stomach cancer should be fed more gentle foods (sour cream, cottage cheese, boiled fish, meat broths, steamed cutlets, crushed or pureed fruits and vegetables, etc.).

During meals, it is necessary to take 1-2 tablespoons of a 0.5-1% solution of hydrochloric acid. Severe obstruction of solid food in patients with inoperable forms of cancer of the cardial part of the stomach and esophagus requires the administration of high-calorie and vitamin-rich liquid food (sour cream, raw eggs, broths, liquid porridges, sweet tea, liquid vegetable puree and etc.). Sometimes the following mixture helps improve patency: rectified alcohol 96% - 50 ml., glycerin - 150 ml. (one tablespoon before meals).

Taking this mixture can be combined with the administration of a 0.1% atropine solution, 4-6 drops per tablespoon of water, 15-20 minutes before meals. If there is a threat of complete obstruction of the esophagus, hospitalization for palliative surgery is necessary. For a patient with a malignant tumor of the esophagus, you should have a sippy cup and feed him only liquid food. In this case, it is often necessary to use a thin gastric tube passed into the stomach through the nose.

2. Features of organizing nurse care for cancer patients

2.1 Organization medical care to the population according to the profile “oncology”

Medical care is provided to patients in accordance with the “Procedure for providing medical care to the population”, approved by order of the Ministry of Health Russian Federation dated November 15, 2012 No. 915n. Medical assistance is provided in the form of:

Primary health care;

Ambulance, including specialized emergency medical care;

Specialized, including high-tech, medical care;

Palliative care.

Medical assistance is provided in the following conditions:

Outpatient;

In a day hospital;

Stationary.

Medical care for cancer patients includes:

Prevention;

Diagnosis of oncological diseases;

Treatment;

Rehabilitation of patients of this profile using modern special methods and complex, including unique, medical technologies.

Medical care is provided in accordance with the standards of medical care.

2.1.1 Providing primary health care to the population in the field of oncology

Primary health care includes:

Primary pre-hospital health care;

Primary medical care;

Primary specialized health care.

Primary health care involves the prevention, diagnosis, treatment of cancer and medical rehabilitation according to the recommendations of a medical organization providing medical care to patients with cancer.

Primary pre-hospital health care is provided medical workers with average medical education on an outpatient basis.

Primary medical care is provided on an outpatient basis and in day hospital local therapists, general practitioners (family doctors) on a territorial-precinct basis.

Primary specialized health care is provided in a primary oncology office or in a primary oncology department by an oncologist.

If an oncological disease is suspected or detected in a patient, general practitioners, local therapists, general practitioners (family doctors), specialist doctors, paramedical workers in the prescribed manner refer the patient for consultation to the primary oncology office or the primary oncology department of a medical organization for providing him with primary specialized health care.

An oncologist at a primary oncology office or primary oncology department refers a patient to an oncology clinic or to medical organizations that provide medical care to patients with cancer to clarify the diagnosis and provide specialized, including high-tech, medical care.

2.1.2 Providing emergency, including specialized, medical care to the population in the field of oncology

Emergency medical care is provided in accordance with the order of the Ministry of Health and social development Russian Federation dated November 1, 2004 No. 179 “On approval of the Procedure for the provision of emergency medical care” (registered by the Ministry of Justice of the Russian Federation on November 23, 2004, registration No. 6136), as amended by orders of the Ministry of Health and Social Development of the Russian Federation dated August 2, 2010 of the year No. 586n (registered by the Ministry of Justice of the Russian Federation on August 30, 2010, registration No. 18289), dated March 15, 2011 No. 202n (registered by the Ministry of Justice of the Russian Federation on April 4, 2011, registration No. 20390) and dated January 30, 2012 No. 65n ( registered by the Ministry of Justice of the Russian Federation on March 14, 2012, registration No. 23472).

Emergency medical care is provided by paramedic visiting ambulance teams, medical visiting ambulance teams in an emergency or emergency form outside a medical organization.

Also in outpatient and inpatient settings for conditions requiring urgent medical intervention.

If an oncological disease is suspected and (or) detected in a patient during the provision of emergency medical care, such patients are transferred or referred to medical organizations providing medical care to patients with oncological diseases, to determine management tactics and the need to additionally use other methods of specialized antitumor treatment.

2.1.3 Providing specialized, including high-tech, medical care to the population in the field of oncology

Specialized, including high-tech, medical care is provided by oncologists, radiotherapists in an oncology clinic or in medical organizations providing medical care to patients with oncological diseases, having a license, the necessary material and technical base, certified specialists, in inpatient conditions and day hospital conditions and includes the prevention, diagnosis, treatment of oncological diseases requiring the use of special methods and complex (unique) medical technologies, as well as medical rehabilitation. The provision of specialized, including high-tech, medical care in an oncology clinic or in medical organizations providing medical care to patients with cancer is carried out in the direction of an oncologist of the primary oncology office or primary oncology department, a specialist doctor in case of suspicion and (or) detection in a patient with cancer during emergency medical care. In a medical organization providing medical care to patients with cancer, tactics medical examination and treatment is established by a council of oncologists and radiotherapists, with the involvement of other medical specialists if necessary. The decision of the council of doctors is documented in a protocol, signed by the participants of the council of doctors, and entered into the patient’s medical documentation.

2.1.4 Providing palliative medical care to the population in the field of oncology

Palliative care is provided by medical workers trained in palliative care in outpatient, inpatient, and day hospital settings and includes a complex medical interventions aimed at relieving pain, including using narcotic drugs, and relief of other severe manifestations of cancer.

The provision of palliative medical care in an oncology clinic, as well as in medical organizations with palliative care departments, is carried out on the direction of a local physician or general practitioner ( family doctor), an oncologist at a primary oncology office or primary oncology department.

2.1.5 Follow-up of cancer patients

Patients with cancer are subject to lifelong dispensary observation in the primary oncology office or primary oncology department of a medical organization, oncology clinic or in medical organizations providing medical care to patients with cancer. If the course of the disease does not require a change in patient management tactics, clinical examinations after treatment are carried out:

During the first year - once every three months;

During the second year - once every six months;

In the future - once a year.

Information about a newly diagnosed case of cancer is sent by a medical specialist from the medical organization in which the corresponding diagnosis was established to the organizational and methodological department of the oncology dispensary for registering the patient with the dispensary. If the patient is confirmed to have cancer, information about the patient’s updated diagnosis is sent from the organizational and methodological department of the oncology clinic to the primary oncology office or the primary oncology department of a medical organization providing medical care to patients with cancer, for subsequent follow-up of the patient.

2.2 Organization of activities of the oncology clinic

The registry office of the dispensary's clinic is responsible for registering patients for appointments with an oncologist, a gynecologist-oncologist, an oncologist, and a hematologist-oncologist. The registry keeps records of those admitted for inpatient and outpatient examinations for the purpose of consultation.

Confirmation or clarification of the diagnosis, consultation: surgeon-oncologist, gynecologist-oncologist, endoscopist, hematologist. The treatment plan for patients with malignant neoplasms is decided by the CEC. Clinical laboratory where clinical, biochemical, cytological, hematological studies are carried out.

X-ray diagnostic room performs examinations of patients to clarify the diagnosis and further treatment in the oncology clinic (fluoroscopy of the stomach, radiography chest, radiography of bones, skeleton, mammography), special studies for treatment (marking the pelvis, rectum, bladder).

The endoscopic room is designed for endoscopic therapeutic and diagnostic procedures (cystoscopy, sigmoidoscopy, endoscopy).

The treatment room is used to carry out medical appointments for outpatients.

Rooms: surgical and gynecological, in which outpatients are received and consultations are carried out by oncologists.

At an outpatient appointment with patients, after their examination, the issue of confirming or clarifying this diagnosis is decided.

2.3 Features of nurse care for cancer patients

Modern treatment of cancer patients is a complex problem, in which doctors of various specialties take part: surgeons, radiation specialists, chemotherapists, psychologists. This approach to treating patients also requires the oncology nurse to solve many different problems. The main areas of work of a nurse in oncology are:

Administration of medications (chemotherapy, hormone therapy, biotherapy, painkillers, etc.) according to medical prescriptions;

Participation in the diagnosis and treatment of complications arising during the treatment process;

Psychological and psychosocial assistance to patients;

Educational work with patients and their family members;

Participation in scientific research.

2.3.1 Features of the work of a nurse during chemotherapy

Currently, in the treatment of oncological diseases at the Nizhnevartovsk Oncology Dispensary, preference is given to combination polychemotherapy.

The use of all antitumor drugs is accompanied by the development adverse reactions, since most of them have a low therapeutic index (the interval between the maximum tolerated and toxic dose). The development of adverse reactions when using anticancer drugs creates certain problems for the patient and medical personnel caring for them. To one of the first side effects refers to a hypersensitivity reaction, which can be acute or delayed.

An acute hypersensitivity reaction is characterized by the appearance in patients of shortness of breath, wheezing, a sharp drop in blood pressure, tachycardia, a feeling of heat, hyperemia skin.

The reaction develops already in the first minutes of drug administration. Actions of the nurse: immediately stop administering the drug, immediately inform the doctor. In order not to miss the onset of these symptoms, the nurse constantly monitors the patient.

At certain intervals, she monitors blood pressure, pulse, respiratory rate, skin condition and any other changes in the patient’s well-being. Monitoring should be performed whenever anticancer drugs are administered.

A delayed hypersensitivity reaction is manifested by persistent hypotension and the appearance of a rash. Actions of the nurse: reduce the rate of drug administration, immediately inform the doctor.

From others side effects occurring in patients receiving antitumor drugs, it should be noted neutropenia, myalgia, arthralgia, mucositis, gastrointestinal toxicity, peripheral neutropathy, alopecia, phlebitis, extravasation.

Neutropenia is one of the most common side effects, which is accompanied by a decrease in the number of leukocytes, platelets, neutrophils, is accompanied by hyperthermia and, as a rule, the addition of some infectious disease.

It usually occurs 7-10 days after chemotherapy and lasts 5-7 days. It is necessary to measure body temperature twice a day, and perform a CBC once a week. To reduce the risk of infection, the patient should refrain from excessive activity and remain calm, avoid contact with sick people respiratory infections, do not visit places with large crowds of people.

Leukopenia is dangerous for the development of severe infectious diseases, depending on the severity of the patient’s condition, requiring the administration of hemostimulating agents, the prescription of broad-spectrum antibiotics, and placement of the patient in a hospital.

Thrombocytopenia is dangerous due to the development of bleeding from the nose, stomach, and uterus. If the number of platelets decreases, immediate blood transfusion, platelet mass, and the prescription of hemostatic drugs are necessary.

Myalgia, arthralgia (pain in muscles and joints), appear 2-3 days after chemotherapy infusion, pain can be of varying intensity, last from 3 to 5 days, often do not require treatment, but in case of severe pain, the patient is prescribed non-steroidal PVP or non-narcotic analgesics .

Mucositis and stomatitis are manifested by dry mouth, a burning sensation when eating, redness of the oral mucosa and the appearance of ulcers on it.

Symptoms appear on the 7th day and persist for 7-10 days. The nurse explains to the patient that he must examine the oral mucosa, lips, and tongue every day.

When stomatitis develops, it is necessary to drink more fluids, rinse your mouth often (necessarily after eating) with a furacillin solution, brush your teeth with a soft brush, and avoid spicy, sour, hard and very hot foods. Gastrointestinal toxicity is manifested by anorexia, nausea, vomiting, and diarrhea.

Occurs 1-3 days after treatment and can persist for 3-5 days. Almost all cytostatic drugs cause nausea and vomiting. Patients may experience nausea just at the thought of chemotherapy or at the sight of a pill or a white coat.

When solving this problem, each patient needs an individual approach, a doctor’s prescription of antiemetic therapy, and the sympathy of not only relatives and friends, but primarily medical personnel.

The nurse provides a calm environment and, if possible, reduces the influence of factors that can provoke nausea and vomiting.

For example, does not offer the patient food that makes him sick, feeds him in small portions, but more often, does not insist on eating if the patient refuses to eat. Recommends eating slowly, avoiding overeating, resting before and after meals, not turning over in bed or lying on your stomach for 2 hours after eating.

The nurse makes sure that there is always a container for vomit next to the patient, and that he can always call for help. After vomiting, the patient should be given water so that he can rinse his mouth.

It is necessary to inform the doctor about the frequency and nature of vomiting, about the presence of signs of dehydration in the patient (dry, inelastic skin, dry mucous membranes, decreased diuresis, headache). The nurse teaches the patient the basic principles of oral care and explains why it is so important.

Peripheral nephropathy is characterized by dizziness, headache, numbness, muscle weakness, impairment motor activity, constipation.

Symptoms appear after 3-6 courses of chemotherapy and may persist for about 1-2 months. The nurse informs the patient about the possibility of the above symptoms and recommends that they urgently contact a doctor if they occur.

Alopecia (baldness) occurs in almost all patients, starting from 2-3 weeks of treatment. The hairline is completely restored 3-6 months after completion of treatment.

The patient must be psychologically prepared for hair loss (convinced to buy a wig or hat, use a headscarf, teach some cosmetic techniques).

The nurse regularly examines the patient and evaluates venous access, choose the appropriate medical instruments for administering chemotherapy (butterfly needles, peripheral catheters, central venous catheters).

It is better to use a vein with the widest diameter possible, which ensures good blood flow. If possible, alternate veins of different limbs, unless anatomical reasons prevent this (postoperative lymphostasis).

Extravasation (getting under the skin medicine) is a technical error by medical personnel.

Also, the reasons for extravasation may be anatomical features patient's venous system, fragility of blood vessels, vein rupture during high speed administration of drugs. Contact of drugs such as adriamicide, farmorubicin, mitomycin, and vincristine under the skin leads to necrosis of the tissue around the injection site.

At the slightest suspicion that the needle is outside the vein, the administration of the drug should be stopped without removing the needle, try to aspirate the contents, the drug substance that has got under the skin, inject the affected area with an antidote, and cover it with ice.

General principles for the prevention of infections associated with peripheral venous access:

1. Follow the rules of asepsis during infusion therapy, including installation and care of the catheter;

2. Carry out hand hygiene before and after any intravenous manipulation, as well as before putting on and after taking off gloves;

3. Check the expiration dates of medications and devices before performing the procedure. Do not use drugs or devices with expired suitability;

4. Treat the patient’s skin with a skin antiseptic before installing the PVC;

5. Rinse the PVC regularly to maintain patency. The catheter should be flushed before and after infusion therapy to prevent mixing of incompatible drugs. For rinsing, it is allowed to use solutions drawn into a 10 ml disposable syringe. from a disposable ampoule (NaCl 0.9% ampoule 5 ml. or 10 ml.). In the case of using a solution from large volume bottles (NaCl 0.9% 200 ml., 400 ml.), it is necessary that the bottle is used only for one patient;

6. Secure the catheter after installation with a bandage;

7. Replace the bandage immediately if its integrity is damaged;

8. In a hospital setting, inspect the catheter installation site every 8 hours.

On an outpatient basis once a day. More frequent inspection is indicated when irritating drugs are administered into a vein.

Assess the condition of the catheter insertion site using the phlebitis and infiltration scales and make appropriate notes on the palliative care observation sheet.

2.3.2 Nutritional features of an oncology patient

Dietary nutrition for an oncology patient should solve two problems:

Protecting the body from food intake of carcinogenic substances and factors that provoke the development of a malignant tumor;

Saturation of the body with nutrients that prevent the development of tumors - natural anti-carcinogenic compounds.

Based on the above tasks, the nurse gives recommendations to patients who want to adhere to an antitumor diet:

1. Avoid excess fat intake. The maximum amount of free fat is 1 tbsp. a spoonful of vegetable oil per day (preferably olive). Avoid other fats, especially animal fats;

2. Do not use fats that are reused for frying or that have been overheated during cooking. When cooking foods, it is necessary to use fats that are resistant to heat: butter or olive oil. They should be added not during, but after cooking food;

3. Cook with little salt and do not add salt to food;

4. Limit sugar and other refined carbohydrates;

5. Limit your meat intake. Replace it partially with vegetable proteins (legumes), fish (small deep-sea varieties are preferred), eggs, and low-fat dairy products. When eating meat, proceed from its “value” in descending order: lean white meat, rabbit, veal, free range chicken (not broiler), lean red meat, fatty meat. Eliminate sausages, sausages, as well as charcoal-grilled meats, smoked meats and fish;

6. Steam, bake or simmer foods over low heat with a minimum amount of water. Don't eat burnt food;

7. Eat whole grain cereals and baked goods enriched with dietary fiber;

8. Use spring water for drinking, settle the water or purify it in other ways. Drink herbal infusions and fruit juices instead of tea. Try not to drink carbonated drinks with artificial additives;

9. Don't overeat, eat when you feel hungry;

10. Don't drink alcohol.

2.3.3 Carrying out pain relief in oncology

The likelihood of pain and its severity in cancer patients depends on many factors, including the location of the tumor, the stage of the disease and the location of metastases.

Each patient perceives pain differently, and this depends on factors such as age, gender, pain threshold, history of pain, and others. Psychological characteristics, such as fear, anxiety and certainty of imminent death can also influence the perception of pain. Insomnia, fatigue and anxiety lower the pain threshold, while rest, sleep and distraction from the disease increase it.

Treatment methods for pain syndrome are divided into medicinal and non-medicinal.

Drug treatment of pain syndrome. In 1987, the World Health Organization determined that "analgesics are the mainstay of cancer pain treatment" and proposed a "three-step approach" for the selection of analgesic drugs.

At the first stage, a non-narcotic analgesic is used with the possible addition additional drug.

If the pain persists or intensifies over time, the second stage is used - a weak narcotic drug in combination with a non-narcotic and possibly an adjuvant drug (an adjuvant is a substance used in combination with another to increase the activity of the latter). If the latter is ineffective, the third stage is used - a strong narcotic drug with the possible addition of non-narcotic and adjuvant drugs.

Non-narcotic analgesics are used to treat moderate cancer pain. This category includes non-steroidal anti-inflammatory drugs - aspirin, acetaminophen, ketorolac.

Narcotic analgesics are used to treat moderate to severe cancer pain.

They are divided into agonists (completely imitating the effect of narcotic drugs) and agonist-antagonists (imitating only part of their effects - providing an analgesic effect, but without affecting the psyche). The latter include moradol, nalbuphine and pentazocine. For the effective action of analgesics, the mode of their administration is very important. In principle, two options are possible: reception at certain hours and “as needed”.

Studies have shown that the first method for chronic pain syndrome more effective, and in many cases requires a lower dose of drugs than with the second regimen.

Non-drug treatment of pain. Nurse to combat painful sensations can use physical methods and psychological (relaxation, behavioral therapy).

Pain can be significantly reduced by changing the patient’s lifestyle and the environment that surrounds him. Activities that provoke pain should be avoided and, if necessary, use a support collar, surgical corset, splints, walking aids, wheelchair, or lift.

When caring for a patient, the nurse takes into account that discomfort, insomnia, fatigue, anxiety, fear, anger, mental isolation and social abandonment exacerbate the patient's perception of pain. Empathy for others, relaxation, the possibility of creative activity, and good mood increase the cancer patient’s resistance to the perception of pain.

A nurse caring for a patient with pain:

Acts quickly and compassionately when patient requests for pain relief;

Observes non-verbal signs of the patient’s condition (facial expressions, forced posture, refusal to move, depressed state);

Educates and explains to patients and their caring relatives medication regimens, as well as normal and adverse reactions when taking them;

Shows flexibility in approaches to pain relief, and does not forget about non-medicinal methods;

Takes measures to prevent constipation (advice on nutrition, physical activity);

Provides psychological support to patients and their

relatives, uses measures of distraction, relaxation, shows care;

Conducts regular assessments of the effectiveness of pain relief and promptly reports to the doctor about all changes;

Encourages the patient to keep a diary of changes in his condition.

Relieving cancer patients of pain is the fundamental basis of their treatment program.

This can only be achieved through the joint actions of the patient himself, his family members, doctors and nurses.

2.3.4 Palliative care for cancer patients

Palliative care for a seriously ill patient is, first of all, the highest quality care possible.

The nurse must combine her knowledge, skills and experience with caring for the person.

Creating favorable conditions for an oncological patient, a delicate and tactful attitude, and a willingness to provide assistance at any moment are mandatory - prerequisites for quality nursing care.

Modern principles of nursing care:

1. Safety (prevention of patient injury);

2. Confidentiality (details of the patient’s personal life, his diagnosis should not be known to outsiders);

3. Respect for dignity (performing all procedures with the patient’s consent, ensuring privacy if necessary);

4. Independence (encouraging the patient when he becomes independent);

5. Infection safety.

The cancer patient has impaired satisfaction of the following needs: movement, normal breathing, adequate nutrition and drinking, excretion of waste products, rest, sleep, communication, overcoming pain, and the ability to maintain one’s own safety. In this regard, the following problems and complications may arise: the occurrence of bedsores, respiratory disorders (congestion in the lungs), urinary disorders (infection, formation of kidney stones), the development of joint contractures, muscle wasting, lack of self-care and personal hygiene, constipation, disorders sleep, lack of communication. The content of nursing care for a seriously ill patient includes the following points:

1. Ensuring physical and psychological peace - to create comfort, reduce the effect of irritants;

2. Monitoring compliance with bed rest - to create physical rest and prevent complications;

3. Changing the patient’s position after 2 hours - to prevent bedsores;

4. Ventilation of the ward, room - to enrich the air with oxygen;

5. Control of physiological functions - for the prevention of constipation, edema, and the formation of kidney stones;

6. Monitoring the patient’s condition (temperature measurement, blood pressure, pulse counting, respiratory rate) - for early diagnosis complications and timely provision of emergency care;

7. Measures to maintain personal hygiene to create comfort and prevent complications;

8. Skin care - for the prevention of bedsores, diaper rash;

9. Change of bed and underwear - to create comfort and prevent complications;

10. Feeding the patient, assistance with feeding - to ensure vital important functions body;

11. Training relatives in care activities - to ensure the patient’s comfort;

12. Creating an atmosphere of optimism - to ensure the greatest possible comfort;

13. Organization of the patient’s leisure time - to create the greatest possible comfort and well-being;

14. Training in self-care techniques - for encouragement and motivation to action.

Conclusion

In this work, the features of nurse care for cancer patients were studied.

The relevance of the problem under consideration is extremely great and lies in the fact that, due to the increasing incidence of malignant neoplasms, there is a growing need to provide cancer patients with specialized assistance, Special attention is given to nursing care, since a nurse is not just a doctor’s assistant, but a competent, independently working specialist.

Summarizing the work done, we can draw the following conclusions:

1) We carried out an analysis of risk factors for cancer. Common Clinical signs, modern methods of diagnosis and treatment of malignant neoplasms have been studied; medical oncology hospital

2) During the work, the organization of medical care was reviewed;

3) The activities of the nurse were analyzed;

4) A survey of patients was conducted;

5) During the study, statistical and bibliographic methods were used.

An analysis of twenty literary sources on the research topic was carried out, which showed the relevance of the topic and possible ways solving problems in caring for cancer patients.

Literature

1. M.I. Davydov, Sh.Kh. Gantsev., Oncology: textbook, M., 2010, - 920 p.

2. Davydov M.I., Vedsher L.Z., Polyakov B.I., Gantsev Zh.Kh., Peterson S.B., Oncology: modular workshop. Tutorial/ 2008. - 320 p.

3. S.I. Dvoinikov, Fundamentals of Nursing: Textbook, M., 2007, p. 298.

4. Zaryanskaya V.G., Oncology for medical colleges - Rostov n/d: Phoenix / 2006.

5. Zinkovich G.A., Zinkovich S.A., If you have cancer: Psychological help. Rostov n/d: Phoenix, 1999. - 320 pp., 1999.

6. Kaprin A.D., The state of oncological care for the population of Russia / V.V. Starinsky, G.V. Petrova. - M.: Ministry of Health of Russia, 2013.

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INTRODUCTION

The increase in the incidence of malignant neoplasms has recently become a global epidemic.

Modern medicine has made great strides in diagnosing and treating cancer in the early stages, and a wealth of clinical experience has been accumulated, but morbidity and mortality rates from tumor diseases are growing every day.

According to Rosstat, in 2012, 480 thousand cancer patients were first diagnosed in the Russian Federation, and 289 thousand people died from malignant neoplasms. Mortality from cancer still ranks second after cardiovascular diseases, while the share of this indicator has increased - in 2009 it was 13.7%, and in 2012 15%

More than 40% of cancer patients registered for the first time in Russia are detected in stages III-IV of the disease, which causes high rates of one-year mortality (26.1%), mortality, and disability of patients (22% of the total number of disabled people). Every year in Russia more than 185 thousand patients are recognized for the first time as disabled from cancer. Over a 10-year period, the incidence rate increased by 18%.

At the end of 2012, about three million patients were registered in oncological institutions in Russia, that is, 2% of the Russian population.

The priority and relevance of solving this problem became especially clear with the release of Presidential Decree No. 598 of 05/07/2012, where the reduction of mortality from cancer was included in a number of tasks on a national scale. Among a set of measures aimed at improving the quality of cancer care, nursing care is a factor that directly affects the patient’s well-being and mood. The nurse is a vital link in providing comprehensive and effective care to patients.

The purpose of the study is to identify the characteristics of nurse care for cancer patients.

To achieve the goal, we set the following tasks:

Conduct an analysis of the overall incidence of cancer.

Based on literature data, consider the causes of malignant neoplasms.

Identify common clinical signs of cancer.

Familiarize yourself with modern methods of diagnosis and treatment of malignant neoplasms.

Consider the structure of cancer care.

To determine the degree of satisfaction of cancer patients with the quality of medical care.

The object of the study is nursing care for cancer patients. The subject of the study is the activities of a nurse in the budgetary institution of the Khanty-Mansiysk Autonomous Okrug - Ugra “Nizhnevartovsk Oncology Dispensary”.

The basis for the research for writing the final qualifying work was the Budgetary Institution of the Khanty-Mansiysk Autonomous Okrug - Ugra “Nizhnevartovsk Oncology Dispensary”.

Brief summary of the work. The first chapter presents general information about cancer. The causes of malignant neoplasms according to modern concepts, general clinical signs of cancer, as well as modern methods of diagnosis and treatment of this pathology are considered. In the second chapter, an analysis of the organization of medical care for cancer patients is carried out, the features of the work of a nurse at the Nizhnevartovsk Oncology Dispensary in caring for patients are identified.

CHAPTER 1. GENERAL INFORMATION ABOUT ONCOLOGICAL DISEASES

1 Analysis of the overall incidence of malignant neoplasms

The overall incidence of malignant neoplasms in the Russian Federation in 2012 was 16.6 per 1000 people, in the Khanty-Mansiysk Autonomous Okrug - Ugra in 2012 it was 11.5 per 1000 people, in the city of Nizhnevartovsk in 2012 it was 13 cases, 6 per 1,000 people, which is higher than the county's incidence rate.

In 2012, in the city of Nizhnevartovsk, for the first time in life, 717 cases of malignant neoplasms were identified (including 326 and 397 in male and female patients, respectively). In 2011, 683 cases were identified.

The increase in this indicator compared to 2011 was 4.9%. The incidence rate of malignant neoplasms per 100,000 population of Nizhnevartovsk was 280, 3 which is 2.3% higher than the level of 2011 and 7.8% higher than the level of 2010 (Fig. 1).

Figure 1. Cancer incidence in the city of Nizhnevartovsk in 2011-2012.

Figure 2 shows the structure of the incidence of malignant neoplasms in the city of Nizhnevartovsk in 2011. The chart shows the percentage of lung cancer (9%), breast cancer (13.7%), skin cancer (6%), stomach cancer (8.5%), colon cancer (5.7%), rectal cancer (5.3%), kidney cancer (5.1%), and other tumors (46.7%).

Figure 2. Morbidity structure in the city of Nizhnevartovsk in 2011.

Figure 3 shows the structure of morbidity in the city of Nizhnevartovsk in 2012. Lung tumors account for 11% of all tumors, breast tumors 15.5%, skin cancer 9.4%, stomach tumors 6.3%, colon cancer 9.4%, rectal cancer 6.8%, kidney cancer 4, 5%, as well as other tumors 43.7%.

Figure 3. Morbidity structure in the city of Nizhnevartovsk in 2012.

1.2 Causes of cancer development

According to modern concepts, tumors are a disease of the genetic apparatus of a cell, which is characterized by long-term pathological processes caused by the action of any carcinogenic agents. Of the many reasons that increase the risk of developing a malignant tumor in the body, their importance as a possible leading factor is unequal.

It is now established that tumors can be caused by chemical, physical or biological agents. The implementation of the carcinogenic effect depends on the genetic, age-related and immunobiological characteristics of the organism.

Chemical carcinogens.

Chemical carcinogens are organic and inorganic compounds of various structures. They are present in the environment, are waste products of the body or metabolites of living cells.

Some carcinogens have a local effect, others affect organs sensitive to them, regardless of the site of administration.

Smoking. Tobacco smoke consists of a gas fraction and solid tar particles. The gas fraction contains benzene, vinyl chloride, urethane, formaldehyde and other volatile substances. Approximately 85% of cases are associated with tobacco smoking lung cancer, 80% lip cancer, 75% esophageal cancer, 40% bladder cancer, 85% larynx cancer.

IN last years Evidence has emerged showing that even passive inhalation of tobacco smoke from environment non-smokers can significantly increase their risk of developing lung cancer and other diseases. Biomarkers of carcinogens have been found not only in active smokers, but also in their loved ones.

Nutrition is an important factor in the etiology of tumors. Food contains more than 700 compounds, including about 200 PAHs (polycyclic aromatic hydrocarbons), aminoazo compounds, nitrosamines, aflatoxins, etc. Carcinogens enter food from the external environment, as well as during the preparation, storage and culinary processing of products.

Excessive use of nitrogen-containing fertilizers and pesticides pollutes and leads to the accumulation of these carcinogens in water and soil, in plants, in milk, in the meat of birds, which humans then eat.

The content of PAHs in fresh meat and dairy products is low, since they quickly break down in the body of animals as a result of metabolic processes. A representative of PAHs, 3,4-benzpyrene, is found when fats are overcooked and overheated, in canned meat and fish, and in smoked products after food has been treated with smoke. Benzpyrene is considered one of the most active carcinogens.

Nitrosamines (NA) are found in smoked, dried and canned meat and fish, dark beer, dry and salted fish, some types of sausages, pickled and salted vegetables, some dairy products. Salting and canning, overcooking fats, and smoking accelerate the formation of NA.

In finished form, a person absorbs a small amount of nitrosamines from the external environment. The content of NA, synthesized in the body from nitrites and nitrates under the influence of enzymes of microbial flora in the stomach, intestines, and bladder, is significantly higher.

Nitrites are toxic; in large doses they lead to the formation of methemoglobin. Contained in cereals, root vegetables, soft drinks, preservatives are added to cheeses, meat and fish.

Nitrates are not toxic, but about five percent of nitrates are reduced to nitrites in the body. The largest amount of nitrates is found in vegetables: radishes, spinach, eggplants, black radish, lettuce, rhubarb, etc.

Aflatoxins. These are toxic substances contained in the mold of the fungus Aspergillus flavus. They are found in nuts, grains and legumes, fruits, vegetables, and animal feed. Aflatoxins are strong carcinogens and lead to the development of primary liver cancer.

Excessive fat consumption contributes to the development of breast, uterine, and colon cancer. Frequent use of canned foods, pickles and marinades, and smoked meats leads to an increase in the incidence of stomach cancer, as well as excess table salt and insufficient consumption of vegetables and fruits.

Alcohol. According to epidemiological studies, alcohol is a risk factor in the development of cancer of the upper respiratory tract, oral cavity, tongue, esophagus, pharynx and larynx. In animal experiments ethanol does not exhibit carcinogenic properties, but promotes or accelerates the development of cancer as a chronic tissue irritant. In addition, it dissolves fats and facilitates contact of the carcinogen with the cell. The combination of alcohol and smoking greatly increases the risk of developing cancer.

Physical factors.

Physical carcinogens include various types of ionizing radiation (X-rays, gamma rays, elementary particles of the atom - protons, neutrons, etc.), ultraviolet irradiation and tissue trauma.

Ultraviolet radiation is a cause for the development of skin cancer, melanoma, and cancer of the lower lip. Neoplasms occur with prolonged and intense exposure to ultraviolet rays. People with weakly pigmented skin are at greater risk.

Ionizing radiation more often causes leukemia, less often breast cancer and thyroid glands, lung, skin, bone tumors and other organs. Children are the most sensitive to radiation.

When exposed to external radiation, tumors develop, as a rule, within the irradiated tissues; when exposed to radionuclides, they develop in areas of deposition, which is confirmed by epidemiological studies after the explosion at the Chernobyl nuclear power plant. The frequency and localization of tumors caused by the introduction of various radioisotopes depends on the nature and intensity of radiation, as well as on its distribution in the body. When isotopes of strontium, calcium, and barium are introduced, they accumulate in the bones, which contributes to the development of bone tumors - osteosarcomas. Radioisotopes of iodine cause the development of thyroid cancer.

For both chemical and radiation carcinogenesis, there is a clear dose-dependent effect. An important difference is that fragmentation of the total dose during irradiation reduces the oncogenic effect, while under the influence of chemical carcinogens it increases it.

Injuries. The role of trauma in the etiology of cancer is still not fully understood. An important factor is tissue proliferation in response to damage. Chronic trauma (for example, to the oral mucosa from carious teeth or dentures) is important.

Biological factors.

As a result of a systematic study of the role of viruses in the development of malignant tumors, oncogenic viruses were discovered, such as Rous sarcoma virus, Bittner mammary cancer virus, chicken leukemia virus, leukemia and sarcoma viruses in mice, Shoup's papilloma virus, etc.

As a result of research, a connection was established between the risk of developing Kaposi's sarcoma and non-Hodgkin's lymphomas and the human immunodeficiency virus.

The Eipstein-Barr virus plays a role in the development of non-Hodgkin's lymphoma, Burkitt's lymphoma, and nasopharyngeal carcinoma. Hepatitis B virus increases the risk of developing primary cancer liver.

Heredity.

Despite the genetic nature of all cancers, only about 7% of them are inherited. Genetic disorders in most cases are manifested by somatic diseases, due to which malignant tumors arise much more often and at a younger age than in the rest of the population.

There are about 200 syndromes that are inherited and predispose to malignant neoplasms (xeroderma pigmentosum, familial intestinal polyposis, nephroblastoma, retinoblastoma, etc.).

The importance of the socio-economic and psycho-emotional state of the population as cancer risk factors.

In modern Russia, the leading cancer risk factors for the population are:

poverty of the vast majority of the population;

chronic psycho-emotional stress;

low awareness of the population about the causes of cancer and its early signs, as well as about measures for its prevention;

unfavorable environmental conditions.

Poverty and severe chronic stress are two the most important factors cancer risk for the Russian population.

Actual food consumption in our country is significantly lower than recommended standards, which affects the quality of health and the body’s resistance to the effects of a damaging agent.

The level of socio-economic well-being is also related to housing conditions, hygienic literacy of the population, the nature of work, lifestyle features, etc.

Most researchers agree that excessive stress, arising in conflict or hopeless situations and accompanied by depression, feelings of hopelessness or despair, precedes and causes high degree reliability of the occurrence of many malignant neoplasms, especially breast cancer and uterine cancer (K. Balitsky, Yu. Shmalko).

Currently, crime, unemployment, poverty, terrorism, major accidents, natural disasters - these are the numerous stress factors that affect tens of millions of Russian residents.

1.3 General clinical signs of cancer

Symptoms of cancer are characterized by great diversity and depend on various factors - the location of the tumor, its type, growth pattern, growth pattern, tumor extent, patient age, concomitant diseases. Symptoms of cancer are divided into general and local.

General symptoms of malignant neoplasms. General weakness is a common symptom of malignant neoplasm. Fatigue occurs when performing minor tasks physical activity, is gradually increasing. Habitual work makes you feel tired and exhausted. Often accompanied by deterioration in mood, depression or irritability. General weakness is caused by tumor intoxication - gradual poisoning of the body with waste products of cancer cells.

Loss of appetite with malignant tumors is also associated with intoxication and gradually progresses. It often begins with a loss of pleasure from eating food. Then selectivity appears in the choice of dishes - most often the refusal of protein, especially meat foods. In severe cases, patients refuse any type of food, eat little by little, forcefully.

Loss of body weight is associated not only with intoxication and loss of appetite, but also with disturbances in protein, carbohydrate and water-salt metabolism, imbalance in the hormonal status of the body. For tumors gastrointestinal tract and organs of the digestive system, weight loss is aggravated by disruption of the supply of digestive enzymes, absorption or movement of food masses.

An increase in body temperature can also be a manifestation of tumor intoxication. Most often, the temperature is 37.2-37.4 degrees and occurs in the late afternoon. An increase in temperature to 38 degrees or higher indicates severe intoxication, a disintegrating tumor, or the addition of an inflammatory process.

Depression is a depressed state with a sharply low mood. A person in this state loses interest in everything, even his favorite activity (hobby), and becomes withdrawn and irritable. As an independent symptom of cancer, depression is of the least importance.

These symptoms are not specific and can be observed in many non-oncological diseases. A malignant tumor is characterized by a long and steadily increasing course of data with and combination with local symptoms.

Local manifestations of neoplasms are no less diverse than general ones. However, knowledge of the most typical of them is very important for every person, since often local symptoms appear before general changes in the body.

Pathological discharge, unnatural compactions and swellings, changes in skin formations, non-healing ulcers on the skin and mucous membranes are the most common local manifestations of cancer.

Local symptoms of tumor diseases

unnatural discharge during urination, bowel movements, vaginal discharge;

the appearance of compactions and swelling, asymmetry or deformation of a body part;

rapid increase, change in color or shape of skin formations, as well as their bleeding;

non-healing ulcers and wounds on the mucous membranes and skin;

Local symptoms of cancer make it possible to diagnose a tumor during examination, and four groups of symptoms are distinguished: palpation of the tumor, blocking of the lumen of the organ, compression of the organ, destruction of the organ.

Palpation of the tumor makes it possible to determine from which organ it is growing; at the same time, the lymph nodes can be examined.

Blocking the lumen of an organ, even with a benign tumor, can have fatal consequences in the event of obstruction in intestinal cancer, starvation in esophageal cancer, impaired urine output in ureteral cancer, suffocation in larynx cancer, collapse of the lung in bronchial cancer, jaundice in a bile duct tumor.

Organ destruction occurs in the later stages of cancer, when the tumor disintegrates. In this case, symptoms of cancer may include bleeding, perforation of organ walls, and pathological bone fractures.

Local symptoms also include persistent dysfunction of organs, which are manifested by complaints related to the affected organ.

Thus, in order to suspect the presence of a malignant tumor, one should carefully and purposefully collect anamnesis, analyzing existing complaints from an oncological point of view.

1.4 Modern methods of diagnosing oncological diseases

In recent years, there has been an intensive development of all radiation diagnostic technologies traditionally used in oncology.

Such technologies include traditional X-ray examination with its various techniques (fluoroscopy, radiography, etc.), ultrasound diagnostics, computed tomography and magnetic resonance imaging, traditional angiography, as well as various methods and techniques of nuclear medicine.

In oncology, radiation diagnostics is used to identify tumors and determine their identity (primary diagnosis), clarify the type pathological changes(differential diagnosis, that is, oncological lesion or not), assessment of the local extent of the process, identification of regional and distant metastases, puncture and biopsy of pathological foci in order to morphologically confirm or refute the oncological diagnosis, marking and planning the scope of various types of treatment, to evaluate the results treatment, detection of disease relapses, for treatment under the control of radiation research methods.

Endoscopic examinations are a method for early diagnosis of malignant neoplasms that affect the mucous membrane of organs. They allow:

detect precancerous changes in the mucous membrane of organs (respiratory tract, gastrointestinal tract, genitourinary system);

form risk groups for further dynamic observation or endoscopic treatment;

diagnose hidden and “minor” initial forms of cancer;

conduct differential diagnosis(between benign and malignant lesions);

assess the condition of the organ affected by the tumor, determine the direction of growth of the malignant neoplasm and clarify the local prevalence of this tumor;

Evaluate the results and effectiveness of surgical, drug or radiation treatment.

Morphological examination and biopsy for further cellular research help in formulating a clinical diagnosis, urgent diagnosis during surgery, and monitoring the effectiveness of treatment.

Tumor markers have prognostic properties and contribute to the selection of adequate therapy even before the start of treatment for the patient. Compared to all known methods, tumor markers are the most sensitive means of diagnosing relapse and are able to detect relapse in the preclinical phase of its development, often several months before the onset of symptoms. To date, 20 tumor markers are known.

The cytological diagnostic method is one of the most reliable, simple and cheap methods. It allows you to formulate a preoperative diagnosis, conduct intraoperative diagnostics, monitor the effectiveness of therapy, and evaluate prognosis factors for the tumor process.

1.5 Treatment of cancer

The main methods of treating tumor diseases are surgery, radiation and drugs. Depending on the indications, they can be used independently or used in the form of combined, complex and multicomponent treatment methods.

The choice of treatment method depends on the following signs of the disease:

localization of the primary lesion;

extent of spread of the pathological process and stage of the disease;

clinical and anatomical form of tumor growth;

morphological structure of the tumor;

general condition of the patient, his gender and age;

the state of the patient’s basic homeostasis systems;

state of the physiological immune system.

1.5.1 Surgical method of treatment

The surgical method in oncology is the main and predominant method of treatment.

Surgery for cancer can be:

) radical;

) symptomatic;

) palliative.

Radical operations imply complete removal of the pathological focus from the body.

Palliative surgery is performed if it is impossible to perform radical surgery in full. In this case, part of the tumor tissue is removed.

Symptomatic operations are performed to correct emerging disturbances in the functioning of organs and systems associated with the presence of a tumor node, for example, the application of an enterostomy or bypass anastomosis for a tumor obstructing the gastric outlet. Palliative and symptomatic operations cannot save a cancer patient.

Surgical treatment of tumors is usually combined with other treatment methods, such as radiation therapy, chemotherapy, hormone therapy and immunotherapy. But these types of treatments can also be used independently (in hematology, radiation treatment of skin cancer). Radiation treatment and chemotherapy can be used in the preoperative period in order to reduce the volume of the tumor, relieve perifocal inflammation and infiltration of surrounding tissues. As a rule, the course of preoperative treatment is not long, since these methods have many side effects and can lead to complications in the postoperative period. The bulk of these therapeutic measures carried out in the postoperative period.

1.5.2 Radiation treatment methods

Radiation therapy is an applied medical discipline based on the use of various types of ionizing radiation. In the human body, all organs and tissues are sensitive to varying degrees. ionizing radiation. Tissues with a high rate of cell division (hematopoietic tissue, gonads, thyroid gland, intestines) are especially sensitive.

Types of Radiation Therapy

) Radical radiation therapy aims to cure the patient and is aimed at the complete destruction of the tumor and its regional metastases.

It includes irradiation of the primary tumor focus and areas of regional metastasis in maximum doses.

Radical radiation therapy is often the mainstay of treatment for malignant tumors of the retina and choroid, craniopharyngioma, medulloblastoma, ependymoma, cancer of the skin, oral cavity, tongue, pharynx, larynx, esophagus, cervix, vagina, prostate, as well as early stages of Hodgkin lymphoma .

) Palliative radiation therapy suppresses tumor growth and reduces its volume, which makes it possible to alleviate the condition of patients, improve their quality of life, and increase its duration. Partial destruction of the tumor mass reduces the intensity of pain and the risk of pathological fractures in case of metastatic bone lesions, eliminates neurological symptoms in case of metastases in the brain, restores the patency of the esophagus or bronchi in case of their obstruction, preserves vision in case of primary or metastatic tumors eyes and eye sockets, etc.

) Symptomatic radiation therapy is carried out to eliminate severe symptoms of a common malignant process, such as intense pain with bone metastases, compression-ischemic radiculomyelopathy, central neurological symptoms with metastatic brain damage.

) Anti-inflammatory and functional radiation therapy is used to eliminate postoperative and wound complications.

) Irradiation before surgery is carried out to suppress the activity of tumor cells, reduce tumor size, reduce the frequency of local relapses and distant metastases.

) Radiation therapy in the postoperative period is carried out in the presence of histologically proven metastases.

) Intraoperative radiation therapy involves a single irradiation of the surgical field or inoperable tumors during laparotomy with an electron beam.

1.5.3 Drug treatments

Drug therapy uses drugs that slow the proliferation or irreversibly damage tumor cells.

Chemotherapy of malignant tumors.

The effective use of antitumor cytostatics is based on an understanding of the principles of tumor growth kinetics, the main pharmacological mechanisms actions of drugs, pharmacokinetics and pharmacodynamics, mechanisms of drug resistance.

Classification of antitumor cytostatics depending on

mechanism of action:

) alkylating agents;

) antimetabolites;

) antitumor antibiotics;

) antimitogenic drugs;

) inhibitors of DNA topoisomerases I and II.

Alkylating agents exert an antitumor effect against proliferating tumor cells regardless of the period of the cell cycle (i.e., they are not phase specific). Drugs in this group include derivatives of chlorethylamines (melphalan, cyclophosphamide, ifosfamide) and ethylenimines (thiotepa, altretamine, imifos), esters of disulfonic acids (busulfan), nitrosomethylurea derivatives (carmustine, lomustine, streptozocin), platinum complex compounds (cisplatin, carboplatin, oxaliplatin ), triazines (dacarbazine, procarbazine, temozolomide).

Antimetabolites act as structural analogues of substances involved in the synthesis of nucleic acids. The inclusion of antimetabolites in the tumor DNA macromolecule leads to disruption of nucleotide synthesis and, as a consequence, to cell death.

Drugs in this group include folic acid antagonists (methotrexate, edatrexate, trimetrexate), pyrimidine analogues (5-fluorouracil, tegafur, capecitabine, cytarabine, gemcitabine), purine analogues (fludarabine, mercaptopurine, thioguanine), adenosine analogues (cladribine, pentostatin).

Antimetabolites are widely used in the drug therapy of patients with cancer of the esophagus, stomach and colon, head and neck, breast, and osteogenic sarcomas.

Antitumor antibiotics (doxorubicin, bleomycin, dactinomycin, mitomycin, idarubicin) act regardless of the period of the cell cycle and are most successfully used for slowly growing tumors with a low growth fraction.

The mechanisms of action of antitumor antibiotics are different and include suppression of nucleic acid synthesis as a result of the formation of free oxygen radicals, covalent DNA binding, and inhibition of the activity of topoisomerase I and II.

Antimitogenic drugs: vinca alkaloids (vincristine, vinblastine, vindesine, vinorelbine) and taxanes (docetaxel, paclitaxel).

The action of these drugs is aimed at inhibiting the processes of tumor cell division. Cells are delayed in the mitosis phase, their cytoskeleton is damaged, and death occurs.

Inhibitors of DNA topoisomerases I and II. Camptothecin derivatives (irinotecan, topotecan) inhibit the activity of topoisomerase I, epipodophyllotoxins (etoposide, teniposide) inhibit topoisomerase II, which ensures the processes of transcription, replication and mitosis of cells. This causes DNA damage, leading to tumor cell death.

Adverse reactions from various organs and systems:

Hematopoietic systems - inhibition of bone marrow hematopoiesis (anemia, neutropenia, thrombocytopenia);

digestive system - anorexia, change in taste, nausea, vomiting, diarrhea, stomatitis, esophagitis, intestinal obstruction, increased activity of liver transaminases, jaundice;

respiratory system - cough, shortness of breath, pulmonary edema, pulmonitis, pneumofibrosis, pleurisy, hemoptysis, voice change;

cardiovascular system - arrhythmia, hypo or hypertension, myocardial ischemia, decreased myocardial contractility, pericarditis;

genitourinary system - dysuria, cystitis, hematuria, increased creatinine levels, proteinuria, menstrual irregularities;

nervous system - headache, dizziness, hearing impairment and

vision, insomnia, depression, paresthesia, loss of deep reflexes;

skin and its appendages - alopecia, pigmentation and dry skin, rash, itchy skin, extravasation of the drug, changes in the nail plates;

metabolic disorders - hyperglycemia, hypoglycemia, hypercalcemia, hyperkalemia, etc.

Hormone therapy in oncology

Three types of hormonal therapeutic effects on malignant neoplasms are considered:

) additive - additional administration of hormones, including those of the opposite sex, in doses exceeding physiological ones;

) ablative - suppression of hormone formation, including through surgery;

) antagonistic - blocking the action of hormones at the level of the tumor cell.

Androgens (male sex hormones) are indicated for breast cancer in women with preserved menstrual function, and can also be prescribed during menopause. These include: testosterone propionate, medrotestosterone, tetrasterone.

Antiandrogens: flutamide (flucinom), androcur (cyproterone acetate), anandrone (nilutamide). They are used for prostate cancer; they can be prescribed for breast cancer in women after removal of the ovaries (oophorectomy).

Estrogens: diethylstilbestrol (DES), fosfestrol (Honvan), ethinyl estradiol (microfollin). Indicated for disseminated prostate cancer, metastases of breast cancer in women in deep menopause, disseminated breast cancer in men.

Antiestrogens: tamoxifen (Billem, Tamofen, Nolvadex), toremifene (Fareston). Used for breast cancer in women in natural or artificial menopause, as well as in men; for ovarian cancer, kidney cancer, melanoma.

Progestins: oxyprogesterone capronate, Provera (Farlutal), Depo-Provera, megestrol acetate (Megace). Used for uterine cancer, breast cancer, prostate cancer.

Aromatase inhibitors: aminoglutethimide (orimerene, mamomit), arimidex (anastrozole), letrozole (femara), vorozole. Used for breast cancer in women in natural or artificial menopause, in the absence of effect when using tamoxifen, breast cancer in men, prostate cancer, cancer of the adrenal cortex.

Corticosteroids: prednisolone, dexamethasone, methylprednisolone. Indicated for: acute leukemia, non-Hodgkin's lymphoma, malignant thymoma, breast cancer, kidney cancer; for symptomatic therapy for tumor hyperthermia and vomiting, for pneumonitis caused by cytostatics, to reduce intracranial pressure for brain tumors (including metostatic ones).

In this chapter, based on literature data, we analyzed the risk factors for cancer and examined the general clinical symptoms oncological diseases, and also became familiar with modern methods of diagnosis and treatment of malignant neoplasms.

pain relief oncology ward risk

CHAPTER 2. FEATURES OF ORGANIZING NURSE CARE FOR CANCER PATIENTS

2.1 Organization of medical care for the population in the field of oncology

Medical care for cancer patients is provided in accordance with the “Procedure for providing medical care to the population in the field of oncology,” approved by Order of the Ministry of Health of the Russian Federation dated November 15, 2012 N 915n.

Medical assistance is provided in the form of:

primary health care;

emergency, including specialized emergency medical care;

specialized, including high-tech, medical care;

palliative care.

Medical assistance is provided in the following conditions:

outpatient;

in a day hospital;

stationary.

Medical care for cancer patients includes: prevention, diagnosis of cancer, treatment and rehabilitation of patients of this profile using modern special methods and complex, including unique, medical technologies.

Medical care is provided in accordance with the standards of medical care.

2.1.1 Providing primary health care to the population in the field of oncology

Primary health care includes:

primary pre-hospital health care;

primary medical care;

primary specialized health care.

Primary pre-medical health care is provided by medical workers with secondary medical education in an outpatient setting.

Primary medical care is provided on an outpatient basis and in a day hospital setting by local therapists and general practitioners (family doctors) on a territorial-precinct basis.

Primary specialized health care is provided in a primary oncology office or in a primary oncology department by an oncologist.

2.1.2 Providing emergency, including specialized, medical care to the population in the field of oncology

Emergency medical care is provided in accordance with the order of the Ministry of Health and Social Development of the Russian Federation dated November 1, 2004 N 179 “On approval of the Procedure for the provision of emergency medical care” (registered by the Ministry of Justice of the Russian Federation on November 23, 2004, registration N 6136), as amended, introduced by orders of the Ministry of Health and Social Development of the Russian Federation dated August 2, 2010 N 586n (registered by the Ministry of Justice of the Russian Federation on August 30, 2010, registration N 18289), dated March 15, 2011 N 202n (registered by the Ministry of Justice of the Russian Federation on April 4, 2011, registration N 20390) and dated January 30, 2012 N 65n (registered by the Ministry of Justice of the Russian Federation on March 14, 2012, registration N 23472).

Emergency medical care is provided by paramedic mobile ambulance teams, medical mobile ambulance teams in an emergency or emergency form outside a medical organization, as well as in outpatient and inpatient conditions for conditions requiring urgent medical intervention.

2.1.3 Providing specialized, including high-tech, medical care to the population in the field of oncology

Specialized, including high-tech, medical care is provided by oncologists, radiotherapists in an oncology clinic or in medical organizations that provide medical care to patients with cancer, have a license, the necessary material and technical base, certified specialists, in inpatient settings and conditions of a day hospital and includes prevention, diagnosis, treatment of oncological diseases requiring the use of special methods and complex (unique) medical technologies, as well as medical rehabilitation.

The provision of specialized, including high-tech, medical care in an oncology clinic or in medical organizations providing medical care to patients with cancer is carried out in the direction of an oncologist of the primary oncology office or primary oncology department, a specialist doctor in case of suspicion and (or) detection in a patient with cancer during emergency medical care.

In a medical organization that provides medical care to patients with cancer, the tactics of medical examination and treatment are established by a council of oncologists and radiotherapists, with the involvement of other medical specialists, if necessary. The decision of the council of doctors is documented in a protocol, signed by the participants of the council of doctors, and entered into the patient’s medical documentation.

2.1.4 Providing palliative medical care to the population in the field of oncology

Palliative care is provided by medical professionals trained in palliative care in outpatient, inpatient, and day hospital settings and includes a set of medical interventions aimed at relieving pain, including the use of narcotic drugs, and alleviating other severe manifestations of cancer.

The provision of palliative medical care in an oncology clinic, as well as in medical organizations with palliative care departments, is carried out on the direction of a local physician, a general practitioner (family doctor), an oncologist at a primary oncology office or a primary oncology department.

2.1.5 Follow-up of cancer patients

during the first year - once every three months,

during the second year - once every six months,

in the future - once a year.

If the patient is confirmed to have cancer, information about the patient’s updated diagnosis is sent from the organizational and methodological department of the oncology clinic to the primary oncology office or the primary oncology department of a medical organization providing medical care to patients with cancer, for subsequent follow-up of the patient.

2.2 Organization of activities budgetary institution Khanty-Mansiysk Autonomous Okrug - Ugra "Nizhnevartovsk Oncology Center"

The budgetary institution of the Khanty-Mansiysk Autonomous Okrug - Ugra "Nizhnevartovsk Oncology Dispensary" has been operating since April 1, 1985.

Today, the institution includes: a hospital with four departments with 110 beds, an outpatient department for 40 thousand visits per year, diagnostic services: cytological, clinical, pathohistological laboratory and auxiliary units. The oncology clinic employs 260 specialists, including 47 doctors, 100 paramedical personnel, and 113 technical personnel.

Nizhnevartovsk Oncology Dispensary is a specialized medical institution that provides specialized, including high-tech medical care.

assistance to patients with cancer and precancerous diseases in accordance with the procedure for providing medical care to the population in the field of “Oncology”.

Structural divisions of the Budgetary Institution of the Khanty-Mansiysk Autonomous Okrug - Ugra "Nizhnevartovsk Oncology Dispensary": polyclinic, anesthesiology and intensive care department, radiation therapy department, operating unit, surgical departments, chemotherapy department, diagnostic base.

The registry office of the dispensary's clinic is responsible for registering patients for appointments with an oncologist, a gynecologist-oncologist, an endoscopist-oncologist, and a hematologist-oncologist. The registry keeps records of those admitted for inpatient and outpatient examinations for the purpose of consultation. Confirmation or clarification of the diagnosis, consultation: surgeon-oncologist, gynecologist-oncologist, endoscopist, hematologist. The treatment plan for patients with malignant neoplasms is decided by the CEC.

Clinical laboratory where clinical, biochemical, cytological, hematological studies are carried out.

The X-ray diagnostic room performs examinations of patients to clarify the diagnosis and further treatment in the oncology clinic (irrigoscopy, fluoroscopy of the stomach, chest radiography, radiography of bones, skeleton, mammography), special studies for treatment (marking the pelvis, rectum, bladder).

The endoscopic room is designed for endoscopic therapeutic and diagnostic procedures (cystoscopy, sigmoidoscopy, endoscopy).

The treatment room is used to carry out medical appointments for outpatients.

Rooms: surgical and gynecological, in which outpatients are received and consultations are carried out by oncologists.

At an outpatient appointment with patients, after their examination, the issue of confirming or clarifying this diagnosis is decided.

2.3 Features of nurse care for cancer patients

The main areas of work of a nurse in oncology are:

administration of medications (chemotherapy, hormone therapy,

biotherapy, painkillers, etc.) according to medical prescriptions;

participation in the diagnosis and treatment of complications arising during the treatment process;

psychological and psychosocial assistance to patients;

educational work with patients and their family members;

participation in scientific research.

2.3.1 Features of the work of a nurse during chemotherapy

Currently, in the treatment of oncological diseases at the Nizhnevartovsk Oncology Dispensary, preference is given to combination polychemotherapy.

The use of all anticancer drugs is accompanied by the development of adverse reactions, since most of them have a low therapeutic index (the interval between the maximum tolerated and toxic dose).

The development of adverse reactions when using anticancer drugs creates certain problems for the patient and medical personnel caring for them. One of the first side effects is a hypersensitivity reaction, which can be acute or delayed.

An acute hypersensitivity reaction is characterized by the appearance in patients of shortness of breath, wheezing, a sharp drop in blood pressure, tachycardia, a feeling of heat, and hyperemia of the skin. The reaction develops already in the first minutes of drug administration. Actions of the nurse: immediately stop administering the drug, immediately inform the doctor. In order not to miss the onset of these symptoms, the nurse constantly monitors the patient. At certain intervals, she monitors blood pressure, pulse, respiratory rate, skin condition and any other changes in the patient’s well-being. Monitoring should be carried out whenever anticancer drugs are administered.

A delayed hypersensitivity reaction is manifested by persistent hypotension and the appearance of a rash. Actions of the nurse: reduce the rate of drug administration, immediately inform the doctor.

Other side effects that occur in patients receiving anticancer drugs include neutropenia, myalgia, arthralgia, mucositis, gastrointestinal toxicity, peripheral neutropathy, alopecia, phlebitis, extravasation.

Neutropenia is one of the most common side effects, which is accompanied by a decrease in the number of leukocytes, platelets, neutrophils, accompanied by hyperthermia and, as a rule, the addition of some infectious disease. It usually occurs 7-10 days after chemotherapy and lasts 5-7 days. It is necessary to measure body temperature twice a day, and perform a CBC once a week. To reduce the risk of infection, the patient should refrain from excessive activity and remain calm, avoid contact with patients with respiratory infections, and avoid visiting places with large crowds of people.

Leukopenia is dangerous for the development of severe infectious diseases, depending on the severity of the patient’s condition, requiring the administration of hemostimulants, the prescription of broad-spectrum antibiotics, and placement of the patient in a hospital.

Mucositis and stomatitis are manifested by dry mouth, a burning sensation when eating, redness of the oral mucosa and the appearance of ulcers on it. Symptoms appear on the 7th day and persist for 7-10 days. The nurse explains to the patient that he must examine the oral mucosa, lips, and tongue every day. When stomatitis develops, it is necessary to drink more fluids, rinse your mouth often (necessarily after eating) with a furacillin solution, brush your teeth with a soft brush, and avoid spicy, sour, hard and very hot foods.

Gastrointestinal toxicity is manifested by anorexia, nausea, vomiting, and diarrhea. Occurs 1-3 days after treatment and can persist for 3-5 days. Almost all cytostatic drugs cause nausea and vomiting. Patients may experience nausea just at the thought of chemotherapy or at the sight of a pill or a white coat.

The nurse provides a calm environment and, if possible, reduces the influence of factors that can provoke nausea and vomiting. For example, does not offer the patient food that makes him sick, feeds him in small portions, but more often, does not insist on eating if the patient refuses to eat. Recommends eating slowly, avoiding overeating, resting before and after meals, not turning over in bed and not lying on your stomach for 2 hours after eating.

Peripheral nephropathy is characterized by dizziness, headache, numbness, muscle weakness, impaired motor activity, and constipation. Symptoms appear after 3-6 courses of chemotherapy and may persist for about 1-2 months. The nurse informs the patient about the possibility of the above symptoms and recommends that they urgently contact a doctor if they occur.

Alopecia (baldness) occurs in almost all patients, starting from 2-3 weeks of treatment. The hairline is completely restored 3-6 months after completion of treatment. The patient must be psychologically prepared for hair loss (convinced to buy a wig or hat, use a headscarf, teach some cosmetic techniques).

Phlebitis (inflammation of the vein wall) is a local toxic reaction and is a common complication that develops after multiple courses of chemotherapy. Manifestations: swelling, hyperemia along the veins, thickening of the vein wall and the appearance of nodules, pain, striations of the veins. Phlebitis can last up to several months. The nurse regularly examines the patient, assesses venous access, selects appropriate medical instruments for administering chemotherapy (butterfly needles, peripheral catheters, central venous catheters).

Extravasation (drug penetration under the skin) is a technical error by medical personnel. Also, the reasons for extravasation may be the anatomical features of the patient’s venous system, fragility of blood vessels, rupture of the vein at a high rate of drug administration. Contact of drugs such as adriamicide, farmorubicin, mitomycin, and vincristine under the skin leads to necrosis of the tissue around the injection site. At the slightest suspicion that the needle is outside the vein, the administration of the drug should be stopped without removing the needle, try to aspirate the contents, the drug substance that has got under the skin, inject the affected area with an antidote, and cover it with ice.

General principles for the prevention of infections associated with peripheral venous access:

Follow the rules of asepsis during infusion therapy, including installation and care of the catheter.

2. Carry out hand hygiene before and after any intravenous procedures, as well as before putting on and after taking off gloves.

Check the expiration dates of medications and devices before performing the procedure. Do not use expired medications or devices.

Treat the patient's skin with a skin antiseptic before installing the PVC.

Rinse the PVC regularly to maintain patency. The catheter should be flushed before and after infusion therapy to prevent mixing of incompatible drugs. For washing, it is allowed to use solutions drawn into a disposable 10 ml syringe from a disposable ampoule (NaCl 0.9% ampoule 5 ml or 10 ml). In the case of using a solution from large volume bottles (NaCl 0.9% 200 ml, 400 ml), it is necessary that the bottle is used only for one patient.

Secure the catheter after installation with a bandage.

Replace the dressing immediately if its integrity is compromised.

In a hospital setting, inspect the catheter installation site every 8 hours. On an outpatient basis once a day. More frequent inspection is indicated when irritating drugs are administered into a vein. Assess the condition of the catheter insertion site using the phlebitis and infiltration scales (Appendices 2 and 3) and make appropriate notes on the PVC observation sheet.

2.3.2 Nutritional features of an oncology patient

Dietary nutrition for an oncology patient should solve two problems:

Protecting the body from dietary intake of carcinogenic substances and factors that provoke the development of a malignant tumor,

saturating the body with nutrients that prevent the development of tumors - natural anti-carcinogenic compounds. Based on the above objectives, the nurse gives recommendations to patients who want to adhere to an antitumor diet (principles of an antitumor diet in Appendix 6):

Avoid excess fat intake. The maximum amount of free fat is 1 tbsp. a spoonful of vegetable oil per day (preferably olive). Avoid other fats, especially animal fats.

Do not use fats that are reused for frying or that have been overheated during cooking. When cooking foods, it is necessary to use fats that are resistant to heat: butter or olive oil. They should be added not during, but after cooking foods.

Cook with little salt and do not add salt to your food.

Limit sugar and other refined carbohydrates.

Limit your meat intake. Replace it partially with vegetable proteins (legumes), fish (small deep-sea varieties are preferred), eggs (no more than three per week), and low-fat dairy products. When eating meat, proceed from its “value” in descending order: lean white meat, rabbit, veal, free range chicken (not broiler), lean red meat, fatty meat. Eliminate sausages, sausages, as well as charcoal-grilled meats, smoked meats and fish.

Steam, bake or simmer foods over low heat with a minimum amount of water. Don't eat burnt food.

Eat whole grain cereals and baked goods enriched with dietary fiber.

Use spring water for drinking, settle the water, or purify it in other ways. Drink herbal infusions and fruit juices instead of tea. Avoid drinking carbonated drinks with artificial additives.

Don't overeat, eat when you feel hungry.

Don't drink alcohol.

2.3.3 Carrying out pain relief in oncology

The likelihood of pain and its severity in cancer patients depends on many factors, including the location of the tumor, the stage of the disease and the location of metastases.

Each patient perceives pain differently, and this depends on factors such as age, gender, pain threshold, history of pain, and others. Psychological characteristics such as fear, anxiety and certainty of imminent death may also influence the perception of pain. Insomnia, fatigue and anxiety lower the pain threshold, while rest, sleep and distraction from the disease increase it.

Treatment methods for pain syndrome are divided into medicinal and non-medicinal.

At the first stage, a non-narcotic analgesic is used with the possible addition of an additional drug. If the pain persists or intensifies over time, the second stage is used - a weak narcotic drug in combination with a non-narcotic and possibly an adjuvant drug (an adjuvant is a substance used in combination with another to increase the activity of the latter). If the latter is ineffective, the third stage is used - a strong narcotic drug with the possible addition of non-narcotic and adjuvant drugs.

Non-narcotic analgesics are used to treat moderate cancer pain. This category includes non-steroidal anti-inflammatory drugs - aspirin, acetaminophen, ketorolac.

Narcotic analgesics are used to treat moderate to severe cancer pain. They are divided into agonists (completely imitating the effect of narcotic drugs) and agonist-antagonists (imitating only part of their effects - providing an analgesic effect, but without affecting the psyche). The latter include moradol, nalbuphine and pentazocine.

For the effective action of analgesics, the mode of their administration is very important. In principle, two options are possible: reception at certain hours and “as needed”. Studies have shown that the first method for chronic pain syndrome is more effective, and in many cases requires a lower dose of drugs than the second regimen.

Non-drug treatment of pain. To combat pain, a nurse can use physical and psychological methods (relaxation, behavioral therapy). Pain can be significantly reduced by changing the patient’s lifestyle and the environment that surrounds him. Activities that provoke pain should be avoided and, if necessary, use a support collar, surgical corset, splints, walking aids, wheelchair, or lift.

A nurse caring for a patient with pain:

acts quickly and compassionately when a patient requests pain relief;

observes nonverbal signs of the patient’s condition (facial expressions, forced posture, refusal to move, depressed state);

educates and explains to patients and their caring relatives medication regimens, as well as normal and adverse reactions when taking them;

shows flexibility in approaches to pain relief, and does not forget about non-medicinal methods;

takes measures to prevent constipation (advice on nutrition, physical activity);

provides psychological support to patients and their

relatives, uses measures of distraction, relaxation, shows care;

Conducts regular assessments of the effectiveness of pain relief and promptly reports to the doctor about all changes;

encourages the patient to keep a diary about changes in his condition.

Relieving cancer patients of pain is the fundamental basis of their treatment program. This can only be achieved through the joint actions of the patient himself, his family members, doctors and nurses.

3.4 Palliative care for cancer patients

Palliative care for a seriously ill patient is, first of all, the highest quality care possible. The nurse must combine her knowledge, skills and experience with caring for the person.

Modern principles of nursing care

Safety (prevention of patient injury).

2. Confidentiality (details of the patient’s personal life, his diagnosis should not be known to outsiders).

Respect for dignity (perform all procedures with the patient’s consent, ensuring privacy if necessary).

Independence (encouraging the patient when he becomes independent).

5. Infection safety.

In this regard, the following problems and complications may arise: the occurrence of bedsores, respiratory disorders (congestion in the lungs), urinary disorders (infection, formation of kidney stones), the development of joint contractures, muscle wasting, lack of self-care and personal hygiene, constipation, disorders sleep, lack of communication.

Ensuring physical and psychological peace - to create comfort, reduce the effect of irritants.

Monitoring compliance with bed rest - to create physical rest and prevent complications.

Changing the patient's position after 2 hours - to prevent bedsores.

Ventilation of the ward, room - to enrich the air with oxygen.

Control of physiological functions - for the prevention of constipation, edema, and the formation of kidney stones.

Monitoring the patient's condition (temperature measurement, blood pressure, pulse counting, respiratory rate) - for early diagnosis of complications and timely provision of emergency care.

Personal hygiene measures to create comfort and prevent complications.

Skin care - for the prevention of bedsores, diaper rash.

Change of bed linen and underwear - to create comfort and prevent complications.

Feeding the patient, assisting with feeding - to ensure vital functions of the body.

Training relatives in care activities to ensure patient comfort.

Creating an atmosphere of optimism - to ensure the greatest possible comfort.

Organization of the patient's leisure time - to create the greatest possible comfort and well-being.

Teaching self-care techniques - for encouragement and motivation to action.

This chapter examined the organization of care for cancer patients at the Nizhnevartovsk Oncology Center, the Khanty-Mansiysk Autonomous Okrug - Ugra, and studied the overall incidence of malignant tumors in the Russian Federation, in the Khanty-Mansiysk Autonomous Okrug - Ugra, as well as in the city of Nizhnevartovsk. The activities of an oncology dispensary nurse are analyzed and the features of caring for cancer patients are identified.

CONCLUSION

In this work, the features of nurse care for cancer patients were studied. The relevance of the problem under consideration is extremely great and lies in the fact that, due to the increasing incidence of malignant neoplasms, the need for specialized care for cancer patients is growing, special attention is paid to nursing care, since a nurse is not just a doctor’s assistant, but a competent, independently working specialist.

) We carried out an analysis of risk factors for cancer. General clinical signs have been identified, modern methods of diagnosis and treatment of malignant neoplasms have been studied.

) During the work, the organization of medical care provided by the Budget Institution of the Khanty-Mansiysk Autonomous Okrug - Ugra “Nizhnevartovsk Oncology Dispensary” to patients was reviewed.

3) Statistical data on the incidence of malignant neoplasms in the Russian Federation, in the Khanty-Mansiysk Autonomous Okrug - Ugra, and in the city of Nizhnevartovsk were studied.

4) The activities of a nurse at the BU KhMAO - Ugra “Nizhnevartovsk Oncology Dispensary” were analyzed, and the features of nursing care by a nurse for cancer patients were identified.

5) A survey of patients of the Khanty-Mansi Autonomous Okrug - Ugra “Nizhnevartovsk Oncology Dispensary” was conducted to identify satisfaction with the quality of medical care.

During the study, statistical and bibliographic methods were used. An analysis of twenty literary sources on the research topic was carried out, which showed the relevance of the topic and possible ways to solve problems in caring for cancer patients.

This work can find application in preparing students of the budgetary institution of vocational education of the Khanty-Mansiysk Autonomous Okrug - Ugra "Nizhnevartovsk Medical College" to undergo industrial practice in oncology medical institutions.

BIBLIOGRAPHY

1. Regulatory documentation:

1. Order of the Ministry of Health of the Russian Federation dated November 15, 2012 No. 915n “On approval of the procedure for providing medical care to the population in the field of Oncology.”

2. Job description of a nurse in the ward surgical department of the Nizhnevartovsk Oncology Dispensary.

1. M. I. Davydov, Sh. H. Gantsev., Oncology: textbook, M., 2010, - 920 p.

2. Davydov M.I., Vedsher L.Z., Polyakov B.I., Gantsev Zh.Kh., Peterson S.B., Oncology: modular workshop. Tutorial. / - 2008.-320 p.

3. S. I. Dvoinikov, Fundamentals of Nursing: Textbook, M., 2007, p. 298.

4. Zaryanskaya V.G., Oncology for medical colleges - Rostov n/d: Phoenix / 2006.

5. Zinkovich G. A., Zinkovich S. A., If you have cancer: Psychological help. Rostov n/d: Phoenix, 1999. - 320 pp., 1999

Oncology: modular workshop. Tutorial. / Davydov M.I., Vedsher L.Z., Polyakov B.I., Gantsev Zh.Kh., Peterson S.B. - 2008.-320 p.

Collections:

1. Guidelines for ensuring and maintaining peripheral venous access: Practical guide. St. Petersburg, publishing house, 20 pp., 2012. All-Russian public organization “Association of Russian Nurses”.

2. Kaprin A.D., State of oncological care to the population of Russia / V.V. Starinsky, G.V. Petrova-M: Ministry of Health of Russia /2013.

3. Materials of the scientific and practical seminar "Nursing care for cancer patients" - Nizhnevartovsk / Oncological dispensary / 2009.

Articles from magazines

1. Zaridze D. G., Dynamics of morbidity and mortality from malignant neoplasms of the population // Russian Journal of Oncology. - 2006.- No. 5.- P.5-14.

APPLICATIONS

Annex 1

Glossary

Absolute contraindications are conditions when, for some reason, the use of the method is categorically not recommended due to possible consequences.

Anorexia - lack of appetite.

Biopsy - (from the Latin "bio" - life and "opsia" - I look) - is the intravital removal of tissue from the body and its subsequent microscopic examination after staining with special dyes.

Destruction (destructio; lat. Destruction) - in pathomorphology, the destruction of tissue, cellular and subcellular structures.

Differentiation - in oncology - the degree of similarity of tumor cells with the cells of the organ from which the tumor originates. Tumors are classified as well, moderately or poorly differentiated.

Benign - used to describe non-cancerous tumors, i.e. those that do not destroy the tissue in which they are formed and do not form metastases.

The preclinical period is a long stage of the asymptomatic course of the tumor.

Morbidity is the development of a disease in a person. The incidence rate is characterized by the number of cases of a disease that occurs in a certain population (usually it is expressed as the number of cases of the disease per 100,000 or per million people, but for some diseases the latter number may be lower).

Malignant - this term is used to describe tumors that quickly spread and destroy surrounding tissues, and can also metastasize, i.e. affect other parts of the body, entering them through the bloodstream and lymphatic system. In the absence of the necessary treatment, such tumors lead to a rapidly progressive deterioration in a person’s health and death.

Invasion - spread of cancer to adjacent normal tissue; invasion is one of the main characteristics of tumor malignancy.

Initiation - (in oncology) the first stage of development of a cancerous tumor.

Irrigoscopy is an X-ray examination of the colon with retrograde filling of it with a radiopaque suspension.

Carcinogenesis is the emergence and development of a malignant tumor from a normal cell. Intermediate stages of carcinogenesis are sometimes called the premalignant or noninvasive form.

Leukemia is a kind of malignant lesion of the hematopoietic organs, among which various variants are distinguished (lymphadenosis, myelosis, etc.), sometimes combined with the term “hemoblastosis”.

Leukopenia is a decrease in the level of leukocytes in the blood. In oncology, it is most often observed during chemotherapy, resulting from the effect of chemotherapy on the bone marrow (where hematopoiesis occurs). With a critical decrease in leukocytes, infectious lesions can develop, which can cause a significant deterioration of the condition and in some cases lead to death.

Magnetic resonance imaging is a non-radiological research method internal organs and human tissues. This does not use x-rays, which makes this method safe for most people.

Mammography is radiography of the breast or obtaining its image using infrared rays. Used for early detection of breast tumors.

A tumor marker is a substance produced by tumor cells, which can be used to judge the size of the tumor and the effectiveness of the treatment. An example of such a substance is alphafetoprotein, which is used to evaluate the effectiveness of treatment for testicular teratoma.

Metastasis (from the Greek metastasis - movement) is a secondary pathological focus that occurs as a result of the transfer of pathogenic particles (tumor cells, microorganisms) from the primary focus of the disease through the blood or lymph flow. In the modern understanding, metastasis usually characterizes the dissemination of malignant tumor cells.

Non-invasive - 1. The term is used to characterize research or treatment methods during which the skin is not exposed to any impact using needles or various surgical instruments. 2. The term is used to describe tumors that do not spread to surrounding tissues

Obstruction (obturation) is the closure of the lumen of a hollow organ, including bronchi, blood or lymphatic vessels, causing a violation of its patency. Obstruction of the bronchi can be foreign bodies, mucus.

oma is a suffix denoting tumor.

Onko is a prefix meaning: 1. Tumor. 2. Capacity, volume.

Oncogene is a gene of some viruses and mammalian cells that can cause the development of malignant tumors. It may express special proteins (growth factors) that regulate cell division; however, under certain conditions, this process can get out of control, causing normal cells to begin to degenerate into malignant ones.

Oncogenesis is the development of neoplasms (benign or malignant tumors).

Oncogenic - this term is used to describe substances, organisms or environmental factors that can cause a person to develop a tumor.

Oncolysis is the destruction of tumors and tumor cells. This process can occur independently or, more often, in response to the use of various medicinal substances or radiation therapy.

The oncological dispensary is the main link in the system of anti-cancer control, providing qualified, specialized inpatient and outpatient medical care to the population, provides organizational and methodological management and coordination of the activities of all oncological institutions under its subordination.

Oncology is a science that studies the origin of various tumors and methods of their treatment. It is often divided into medical, surgical and radiation oncology.

A tumor is any new growth. The term is usually applied to an abnormal growth of tissue, which can be either benign or malignant.

A false tumor is a swelling that occurs in the abdomen or in any other part of the human body, caused by local muscle contraction or accumulation of gases, which in its own way appearance resembles a tumor or some other structural change fabrics.

Palpation is the examination of any part of the body using the fingers. Thanks to palpation, in many cases it is possible to distinguish the consistency of a person’s tumor (is it solid or cystic).

Digital rectal examination is a mandatory method for diagnosing diseases of the rectum, pelvis and abdominal organs.

Papilloma is a benign tumor on the surface of the skin or mucous membranes, resembling a small papilla in appearance

Precancerous - this term applies to any non-cancerous tumor that can develop into malignant without appropriate treatment.

Predisposition is a person’s tendency to develop a disease.

Radiosensitive tumors are neoplasms that completely disappear under irradiation without being accompanied by necrosis of surrounding tissues.

Cancer is any malignant tumor, including carcinoma and sarcoma.

Cancer is a malignant tumor of epithelial tissue. In foreign literature, the term “cancer” is often used to refer to all malignant tumors, regardless of their tissue composition and origin.

Remission - 1. Weakening of the symptoms of the disease or their complete temporary disappearance during the illness. 2. Reducing the size of a malignant tumor and easing the symptoms associated with its development.

Sarcoma is a malignant tumor of connective tissue. Such tumors can develop anywhere human body and are not limited to any particular body.

Paraneoplastic syndrome - signs or symptoms that may develop in a patient with a malignant tumor, although they are not directly related to the effect of malignant cells on the body. Removing the tumor usually leads to their disappearance. Thus, myasthenia gravis is a secondary sign of the presence of a thymus tumor in a person.

Stage - (stage) - (in oncology) determination of the presence and location of metastases of the primary tumor to plan the upcoming course of treatment.

Therapy Radiation therapy - therapeutic radiology: treatment of diseases using penetrating radiation (such as x-rays, beta or gamma radiation), which can be obtained in special installations or from the decay of radioactive isotopes.

Neoadjuvant chemotherapy is a course of chemotherapy administered immediately before surgical removal of the primary tumor to improve the results of surgery or radiation therapy and to prevent the formation of metastases.

Cystoscopy is an examination of the bladder using a special cystoscope instrument inserted into it through the urethra.

Aspiration cytology - aspiration of cells from a tumor or cyst using a syringe and a hollow needle and their further microscopic examination after special preparation.

Enucleation - surgery, during which the complete removal of an organ, tumor or cyst is performed.

Iatrogenic diseases are a disease caused by careless statements or actions of a doctor (or other person from among the medical personnel) that adversely affect the patient’s psyche. Iatrogenic diseases manifest themselves mainly as neurotic reactions in the form of phobias (carcinophobia, cardiophobia) and various types of autonomic dysfunction.

Appendix 2

Phlebitis rating scale

Signs
The catheterization site appears normal		There are no signs of phlebitis. Continue monitoring the catheter.
Pain/redness around the catheter site.		Remove the catheter and install a new one in another area. Continue monitoring both areas.
Pain, redness, swelling around the catheter site. The vein is palpated as a dense cord.		Remove the catheter and install a new one in another area. Continue monitoring both areas. If necessary, begin treatment as prescribed by your doctor.
Pain, redness, swelling, compaction around the catheter site. The vein is palpated in the form of a dense cord more than 3 cm. Suppuration.		Remove the catheter and install a new one in another area. Send the catheter cannula for bacteriological examination. Conduct a bacteriological analysis of a blood sample taken from a vein in a healthy arm.
Pain, redness, swelling, compaction around the catheter site. The vein is palpated in the form of a dense cord more than 3 cm. Suppuration. Tissue damage.		Remove the catheter and install a new one in another area. Send the catheter cannula for bacteriological examination. Conduct a bacteriological analysis of a blood sample taken from a vein in a healthy arm. Register the case in accordance with the rules of the health care facility.

Appendix 3

Infiltration Rating Scale

	Signs
	There are no symptoms of infiltration
	Pale, cold to the touch skin. Swelling up to 2.5 cm in any direction from the catheter site. Possible pain.
	Pale, cold to the touch skin. Swelling from 2.5 to 15 cm in any direction from the catheter site. Possible pain.
	Pale, translucent skin that is cold to the touch. Extensive swelling greater than 15 cm in any direction from the catheter site. Complaints of mild or moderate pain. Possible decrease in sensitivity.
	Pale, bluish, swollen skin. Extensive swelling greater than 15 cm in any direction from the catheter site; After pressing with a finger on the site of swelling, an impression remains. Circulatory disorders, complaints of moderate or severe pain.

Actions of the nurse during infiltration:

If signs of infiltration appear, shut off the infusion system and remove the catheter.

Notify your doctor if a complication occurs during infusion therapy.

Record the complication on the PVC observation sheet.

Follow all doctor's orders.

Appendix 4

Qualitative performance indicators of the Budgetary Institution of Khanty-Mansi Autonomous Okrug - Ugra "Nizhnevartovsk Oncology Dispensary"

Qualitative indicators
Number of beds
Patients received
Patients discharged
Bed days spent
Hospital mortality
Surgical activity (by surgical department)
Operations completed
PCT courses conducted
Person treated with PCT
Accepted as an outpatient
Endoscopic studies
Clinical and biochemical studies
X-ray studies
Pathohistological studies
Cytological studies
Ultrasound research

Appendix 5

Questionnaire of patient satisfaction of the Khanty-Mansi Autonomous Okrug - Ugra "Nizhnevartovsk Oncology Center" with the quality of nursing care"

Your age_____________________________________

Education, profession___________________________

Did the nurses sufficiently explain to you the goals of diagnostic and therapeutic procedures?_________________________________

Are you satisfied with the attitude of the medical staff___________

Are you satisfied with the quality of room cleaning, room lighting, temperature conditions___________________________

Do nurses take timely measures to solve problems that arise?________________________________

Your wishes________________________________

Appendix 6

Responsibilities of a ward nurse at the Nizhnevartovsk Oncology Dispensary

Ward nurse:

Provides care and supervision based on the principles of medical deontology.

Receives and places patients in the ward, checks the quality of sanitary treatment of newly admitted patients.

3. Checks packages for patients to prevent the intake of contraindicated foods and drinks.

Participates in rounds of doctors in the wards assigned to her, reports on the condition of patients, records prescribed treatment and care for patients in the journal, and monitors patients' compliance with doctor's orders.

Provides sanitary and hygienic services to the physically weakened and seriously ill.

Follows the orders of the attending physician.

Organizes examination of patients in diagnostic rooms, with consultant doctors and in the laboratory.

Immediately informs the attending physician, and in his absence, the head of the department or the doctor on duty about a sudden deterioration in the patient's condition.

Isolating patients in an agonal state, calls a doctor to carry out the necessary resuscitation measures.

Prepares the corpses of the deceased for sending them to the pathology department.

While on duty, she inspects the premises assigned to her, checks the condition of electric lighting, the presence of hard and soft equipment, medical equipment and instruments, medicines.

Signs for duty in the department diary.

Monitors the compliance of patients and their relatives with the regimen of visits to the department.

Monitors the sanitary maintenance of the wards assigned to her, as well as the personal hygiene of patients, the timely taking of hygienic baths, and the change of underwear and bed linen.

Ensures that patients receive food according to the prescribed diet.

Maintains medical records.

Assigns duty in the wards at the bedside of patients.

Provides strict accounting and storage of drugs of groups A and B in special cabinets.

Carries out the collection and disposal of medical waste.

^ Lecture No. 24. NURSING PROCESS IN NEW PLACES
Oncology is the science that studies tumors.

1/5 of cases are detected during clinical examinations.

The role of the nurse in the early diagnosis of tumors is extremely important; she communicates closely with patients and, having a certain “oncological alertness” and knowledge of the issue, she has the ability to promptly refer the patient to a doctor for examination and clarification of the diagnosis.

The nurse should contribute to the prevention of cancer by recommending and explaining the positive role healthy image life and the negative role of bad habits.

Features of the oncological process.

A tumor is a pathological process that is accompanied by the uncontrolled proliferation of atypical cells.

Tumor development in the body:

the process occurs where it is completely undesirable;
tumor tissue differs from normal tissues by its atypical cellular structure, which changes beyond recognition;
cancer cell behaves differently from other tissues, its function does not correspond to the needs of the body;
being in the body, the cancer cell does not obey it, lives at the expense of it, takes away all the vitality and energy, which leads to the death of the body;
in a healthy body, there is no place for the location of a tumor; for its existence, it “conquers” a place and its growth is either expansive (pushing apart the surrounding tissues) or infiltrating (growing into the surrounding tissues);
The cancer process itself does not stop.

Theories of tumor occurrence.

Viral theory (L. Zilber). According to this theory, the cancer virus enters the body in the same way as the influenza virus does, and the person becomes ill. The theory assumes that the cancer virus is present in every body initially, and not everyone gets sick, but only the person who finds himself in unfavorable living conditions.

Irritation theory (R. Virchow). The theory suggests that the tumor occurs in those tissues that are more often irritated and injured. Indeed, cervical cancer is more common than uterine cancer, and rectal cancer is more common than other parts of the intestine.

Germ tissue theory (D. Konheim). According to this theory, during the process of embryonic development, more tissue is formed somewhere than is required to form the organism, and then a tumor grows from these tissues.

Theory of chemical carcinogens (Fischer-Wasels). Cancer cell growth is caused by chemical substances, which can be exogenous (nicotine, metal poisons, asbestos compounds, etc.) and endogenous (estradiol, folliculin, etc.).

Immunological the theory says that weak immunity is not able to restrain the growth of cancer cells in the body and a person gets cancer.

^ Classification of tumors

The main clinical difference between tumors is benign and malignant.

Benign tumors: slight deviation of the cellular structure, expansive growth, has a membrane, growth is slow, large in size, does not ulcerate, does not recur, does not metastasize, self-healing is possible, does not affect the general condition, interferes with the patient's weight, size, appearance.

Malignant tumors: completely atypical, infiltrating growth, does not have a membrane, growth is rapid, rarely reaches a large size, the surface is ulcerated, recurs, metastasizes, self-healing is impossible, causes cachexia, life-threatening.

A benign tumor can also be life-threatening if it is located near a vital organ.

A tumor is considered recurrent if it occurs again after treatment. This suggests that there is a cancer cell remaining in the tissue that can give rise to new growth.

Metastasis is the spread of cancer in the body. With the flow of blood or lymph, the cell is transferred from the main focus to other tissues and organs, where it produces new growth - metastasis.

Tumors vary depending on the tissue from which they originate.

Benign tumors:

Epithelial:

papillomas" (papillary layer of skin);

adenomas (glandular);

cysts (with a cavity).

Muscular - fibroids:

rhabdomyomas (striated muscle);
leiomyomas (smooth muscle).

Fatty ones - lipomas.
Bone - osteomas.
Vascular - angiomas:

hemangioma (blood vessel);
lymphangioma (lymphatic vessel).

Connective tissue - fibromas.
From nerve cells - neuromas.
From brain tissue - gliomas.
Cartilaginous - chondromas.
Mixed - fibroids, etc.

Malignant tumors:

Epithelial (glandular or integumentary epithelium) - cancer (carcinoma).
Connective tissue - sarcomas.
Mixed - liposarcoma, adenocarcinoma, etc.

Depending on the direction of growth:

Exophytic, which have exophytic growth, have a narrow base and grow away from the wall of the organ.
Endophytes, which have endophytic growth, infiltrate the wall of the organ and grow along it.

International TNM classification:

T - indicates the size and local spread of the tumor (can be from T-0 to T-4;

N - indicates the presence and nature of metastases (can be from N-X to N-3);

M - indicates the presence of distant metastases (can be M-0, i.e. absence, and M, i.e. presence).

Additional designations: from G-1 to G-3 - this is the degree of malignancy of the tumor, the conclusion is given only by a histologist after examining the tissue; and from P-1 to P-4 - this is applicable only for hollow organs and shows the tumor has invaded the organ wall (P-4 - the tumor extends beyond the organ).

^ Stages of tumor development

There are four stages:

stage - the tumor is very small, does not grow into the wall of the organ and does not have metastases;
stage - the tumor does not extend beyond the organ, but there may be a single metastasis to the nearest lymph node;
stage - the size of the tumor is large, it grows into the wall of the organ and there are signs of decay, it has multiple metastases;
stage - either germination into neighboring organs, or multiple distant metastases.

^ Stages of the nursing process

Stage 1 – interview, observation, physical examination.

History: duration of the disease; ask what the patient has discovered (the tumor is visible on the skin or in soft tissues, the patient himself discovers a certain formation), the tumor was found by chance during fluorography, during endoscopic examinations, during a clinical examination; the patient noticed the appearance of discharge (usually bloody), gastric, uterine, urological bleeding, etc.

Symptoms of cancer depend on the organ affected.

General symptoms: the onset of the process is imperceptible, there are no specific signs, increasing weakness, malaise, loss of appetite, pallor, vague low-grade fever, anemia and accelerated ESR, loss of interest in previous hobbies and activities.

It is necessary to actively identify signs of a possible disease in the patient.

History: chronic inflammatory diseases, for which he is registered. Such diseases are considered “precancer”. But not because they necessarily turn into cancer, but because a cancer cell, entering the body, is embedded in chronically altered tissue, i.e., the risk of a tumor increases. The same “risk group” includes benign tumors and all processes of impaired tissue regeneration. The presence of occupational hazards that increase the risk of cancer.

Observation: movements, gait, physique, general condition.

Physical examination: external examination, palpation, percussion, auscultation - notes deviations from the norm.

In all cases of suspected tumor, the nurse should refer the patient for examination to an oncology clinic with an oncologist.

Using knowledge medical psychology, the nurse must correctly present to the patient the need for such an examination by an oncologist and not cause him a stressful state, categorically writing in the direction an oncological diagnosis or suspicion of it.

Stage 2 - nursing diagnosis, formulates the patient's problems.

Physical problems: vomiting, weakness, pain, insomnia.

Psychological and social - fear of learning about the malignant nature of the disease, fear of surgery, inability to take care of oneself, fear of death, fear of losing a job, fear of family complications, depressing state from the thought of staying forever with an “ostomy”.

Potential problems: formation of bedsores, complications of chemotherapy or radiation therapy, social isolation, disability without the right to work, inability to eat by mouth, threat to life, etc.

Stage 3 – draws up a plan to solve the priority problem.

Stage 4 – implementation of the plan. The nurse plans activities based on the nursing diagnosis. Therefore, according to the action plan, the problem implementation plan will also change.

If the patient has an ostomy, the nurse instructs the patient and family on how to care for it.

Stage 5 - evaluate the result.

^ The role of the nurse in examining a cancer patient

Examination: to make a primary diagnosis or otherwise additional examination to clarify the disease or stage of the process.

The decision on examination methods is made by the doctor, and the nurse draws up a referral, conducts a conversation with the patient about the purpose of a particular method, tries to organize the examination in a short time, gives advice to relatives about psychological support for the patient, and helps the patient prepare for certain examination methods.

If this is an additional examination with the aim of resolving the issue of a benign or malignant tumor, then the nurse will highlight the priority from all the problems (fear of detecting a malignant process) and will help the patient solve it, talk about the possibilities diagnostic methods and the effectiveness of surgical treatment and will advise you to give consent to surgery in the early stages.

For early diagnosis use:

X-ray methods (fluoroscopy and radiography);
computed tomography;
ultrasonography;
radioisotope diagnostics;
thermal imaging research;
biopsy;
endoscopic methods.

The nurse must know which methods are used in an outpatient setting and which only in specialized hospitals; be able to prepare for various studies; know whether the method requires premedication and be able to administer it before the study. The result obtained depends on the quality of the patient’s preparation for the study. If the diagnosis is unclear or not specified, then a diagnostic operation is resorted to.

^ The role of the nurse in the treatment of cancer patients

The decision on the method of treating the patient is made by the doctor. The nurse must understand and support the doctor’s decisions to perform or refuse surgery, about the timing of surgery, etc. Treatment will largely depend on the benign or malignant nature of the tumor.

If the tumor benign, then, before giving advice about the operation, you need to find out:

Location of the tumor (if it is located in a vital or endocrine organ, then she is operated on). If it is located in other organs, then check:

a) whether the tumor is a cosmetic defect;

b) whether it is constantly injured by the collar of clothes, glasses, a comb, etc. If it is a defect and is injured, then it is removed promptly, and if not, then only observation of the tumor is required.

Effect on the function of another organ:

a) disrupts evacuation:

b) compresses blood vessels and nerves;

c) closes the lumen;

If there is such a negative effect, then the tumor must be removed promptly, and if it does not disrupt the function of other organs, then there is no need to operate.

Is there confidence that the tumor is benign: if it is, then they do not operate; if not, then it is better to remove it.

If the tumor malignant, Then the decision about surgery is much more complicated; the doctor takes into account many factors.

Surgery - most effective method treatment.

Danger: spread of cancer cells throughout the body, danger of not removing all cancer cells.

There are concepts of “ablastic” and “antiblastic”.

Ablastika is a set of measures aimed at preventing the spread of tumor cells in the body during surgery.

This complex includes:

do not injure the tumor tissue and make an incision only through healthy tissue;
quickly apply ligatures to vessels in the wound during surgery;
bandage the hollow organ above and below the tumor, creating an obstacle to the spread of cancer cells;
delimit the wound with sterile napkins and change them during the operation;
changing gloves, instruments and surgical linen during surgery.

Antiblastics is a set of measures aimed at destroying cancer cells remaining after tumor removal.

Such events include:

use of a laser scalpel;
irradiation of the tumor before and after surgery;
use of antitumor drugs;
treatment wound surface alcohol after tumor removal.

“Zoning” - not only the tumor itself is removed, but also possible sites of cancer cell retention: lymph nodes, lymphatic vessels, tissue around the tumor by 5 - 10 cm.

If it is impossible to perform a radical operation, a palliative operation is performed; it does not require ablastics, antiblastics, or zonality.

Radiation therapy . Radiation only affects the cancer cell; the cancer cell loses its ability to divide and multiply.

RT can be both the main and additional method of treating a patient.

Irradiation can be carried out:

external (through the skin);
intracavitary (uterine cavity or bladder);
interstitial (into tumor tissue).

Due to radiation therapy The patient may have problems:

on the skin (in the form of dermatitis, itching, alopecia - hair loss, pigmentation);
general reaction of the body to radiation (in the form of nausea and vomiting, insomnia, weakness, heart rhythm disturbances, lung function and changes in blood tests).

Chemotherapy - this is an effect on the tumor process medicines. Chemotherapy has achieved the best results in the treatment of hormone-dependent tumors.

Groups of drugs used to treat cancer patients:

cytostatics that stop cell division;
antimetabolites that affect metabolic processes in a cancer cell;
antitumor antibiotics;
hormonal drugs;
immunity enhancing agents;
drugs affecting metastases.

Immunomodulator therapy - biological response modulators that stimulate or suppress the immune system:

Cytokines - protein cellular regulators immune system: interferons , colony-stimulating factors.
monoclonal antibodies.

Since the most effective method is the surgical method, in case of a malignant process it is necessary, first of all, to evaluate the possibility of a quick operation. And the nurse should adhere to this tactic and not recommend that the patient give consent to surgery only if other treatment methods are ineffective.

The disease is considered cured if: the tumor is completely removed; no metastases were detected during surgery; within 5 years after the operation the patient has no complaints.

6 semester 534 group (full-time - distance learning)

L E C T I O N No. 12

“Features of the nursing process for benign and malignant diseases of the genitals”
TUMORS (neoplasms) – excessive pathological growth of tissue, consisting of qualitatively changed cells that have lost their normal shape and function.

TUMOR-LIKE FORMS are not the result of excessive pathological growth and reproduction of qualitatively changed cells (tubo-ovarian inflammatory formation), ovarian cysts.

Distinguish: 1 . BENIGN TUMORS:

– other tissues do not grow, but as they grow, they push apart and compress the surrounding tissues.

2. MALIGNANT TUMORS:

The surrounding tissues germinate, destroy them, and have the ability to metastasize.

RETENTION CYSTS - tumor-like formations of the female genital organs. This is a cavity filled with liquid contents, resulting from retention or excess secretion of fluid.

Cysts can occur in all parts of the female reproductive system: vulva, vagina, cervix, ovary, broad ligament of the uterus.

Most often localized in the ovary and its appendage (paraovarian cyst).

Ovarian cysts can form from a follicle - follicular, corpus luteum– cyst of the corpus luteum, endometrium, implanted on the surface of the ovary (endometrioid).

CLINIC:

Cysts grow slowly, do not reach large sizes, and are often asymptomatic.

In case of complications - torsion of the cyst leg, rupture of the capsule - the clinical picture of an acute abdomen is pronounced.

DIAGNOSTICS:

With two-manual vaginal examination, ultrasound, laparoscopy.

TREATMENT:

- small cysts can resolve with anti-inflammatory therapy within 4 to 6 weeks. If there is no effect, resection of the ovary or its removal.

ENDOMETRIOSIS - a disease in which inclusions are formed outside the uterine cavity, whose structure and function resemble the uterine mucosa and undergo cyclic transformations, respectively menstrual cycle. It can be localized: genital (uterus, cervix, tubes, ovaries) and extragenital (postoperative scar, intestines, bladder and etc.).

CLINIC :

Appears cyclically. Complaints of pain before and after menstruation, bleeding in the form of polymenorrhea, dark spotting before and after menstruation.

Colposcopy, cervical biopsy, hysterosalpingography, hysteroscopy, laparoscopy help in diagnosis.

TREATMENT :

Conservative therapy is symptomatic (painkillers, hemostatic agents) and hormonal therapy.

The extent of surgical intervention depends on the prevalence of endometriosis, age, and the condition of other parts of the reproductive system.

UTERINE FIBROID - a benign, hormonal-dependent tumor of the uterus, consisting of smooth muscle and fibrous connective tissue elements. Occurs during the reproductive period, most often after 30 years. During this period, it is usually asymptomatic and is detected on preventive examinations. IN menopause Myoma growth accelerates, it is accompanied by symptoms, and stops growing with the onset of menopause.

Uterine fibroids are nodes enclosed in a capsule, their size varies.

POTENTIAL : complications after surgery, chemotherapy, radiation therapy.

The patient is registered at a dispensary, since rehabilitation is long-term.

In the surgical treatment of benign tumors and endometriosis, temporary disability lasts 1.5 - 2 months from the date of surgery, depending on its volume and the presence or absence of postoperative complications.

Employment is of great importance - freedom from heavy lifting, vibration, and work with poisons for up to 3 months.

FOR MALIGNANT TUMORS - temporary incapacity for work effective treatment and a favorable prognosis can last up to 4–6 months; if the course is unfavorable, a disability group is established. All this time, rehabilitation measures are being carried out after treatment with chemotherapy and radiation therapy.

COMPLICATIONS AFTER CHEMOTHERAPY : depression of the hematopoietic system (decrease in leukocytes and platelets), nausea, vomiting, hair loss on the head.

COMPLICATION AFTER RADIATION THERAPY :

From the intestines – enterocolitis, rectitis;

from the urinary system - cystitis, vesicovaginal fistulas;
skin and subcutaneous fat – burns (hyperemia, peeling, pigmentation, appearance of weeping areas, ulcers).

It is very important to maintain the patient’s faith in the success of treatment, instill in her the need to adhere to the regimen and diet, support mental condition. Food should be easily digestible with high energy value, control the patient’s body weight.

Clear and correct implementation of doctor’s orders is the key to recovery and the role of the nurse in this is very great.

It studies the causes of occurrence, mechanisms of development and clinical manifestations of tumors (neoplasms), develops methods for their diagnosis, treatment and prevention.

Surgical oncology - a branch of surgery that studies the pathology, clinical picture, diagnosis and treatment of those oncological diseases in the recognition and treatment of which surgical methods are of leading importance.

Currently, more than 60% of patients with malignant neoplasms are treated using surgical methods, and in more than 90% of cancer patients, surgical methods are used in the diagnosis and determination of the stage of the disease. Such widespread use of surgical methods in oncology is based, first of all, on modern ideas about the biology of tumor growth and the mechanisms of development of oncological diseases.

Tumors(neoplasms) of humans have been known since ancient times. Hippocrates also described certain forms of tumors. New bone formations have been found in mummies ancient egypt. Surgical methods for treating tumors were used in medical schools of ancient Egypt, China, India, the Incas of Peru, etc.

In 1775, the English surgeon P. Pott described skin cancer of the scrotum in chimney sweeps, which arose as a result of long-term contamination with soot, smoke particles and coal distillation products.

In 1915-1916, Japanese scientists Yamagiwa and Ichikawa began to lubricate the skin of the ears of rabbits with coal tar and obtained experimental cancer.

In 1932-1933 The work of Kineway, Heeger, Cook and their colleagues established that the active carcinogenic agent of various resins is polycyclic aromatic hydrocarbons (PAHs) and, in particular, benzopyrene.

in 1910-1911 Routh's discovery of the viral nature of some chicken sarcomas appeared. These works formed the basis of the viral concept of cancer and served as the basis for many studies that discovered a number of viruses that cause tumors in animals (Shop's rabbit papillomavirus, 1933; Bitner's murine mammary cancer virus, 1936; Gross' mouse leukemia viruses, 1951; virus " polyomas" by Stewart, 1957, etc.).

In 1910, the first manual by N.N. was published in Russia. Petrov “General doctrine of tumors.” At the beginning of the 20th century, I.I. spoke about the viral nature of malignant tumors. Mechnikov and N.F. Gamaleya.

In Russia, the first oncological institution for the treatment of tumors was the Institute named after. Morozov, founded with private funds in 1903 in Moscow. During the Soviet years, it was completely reorganized into the Moscow Oncology Institute, which had existed for 75 years, and was named after P.A. Herzen - one of the founders of the Moscow school of oncologists.

In 1926, on the initiative of N.N. Petrov, the Leningrad Institute of Oncology was created, which now bears his name.

In 1951, the Institute of Experimental and Clinical Oncology was founded in Moscow, now the Oncological Research Center of the Russian Academy of Medical Sciences named after its first director N.N. Blokhin.

In 1954, the All-Union (now Russian) Scientific Society of Oncologists was organized. Branches of this society operate in many regions, although now, due to certain economic circumstances, many of them have acquired independence and organized regional associations of oncologists. Interregional and republican conferences are held with the participation of oncological institutes. The Society of Oncologists of Russia organizes congresses and conferences, and is also part of the International Union Against Cancer, which unites oncologists from most countries of the world.

In World Organization Healthcare (WHO) has a special Cancer Department, founded and for many years headed by Russian oncologists. Russian specialists actively participate in international congresses, work in permanent commissions and committees of the International Union Against Cancer, WHO and IARC, and take an active part in symposia on various problems of oncology.

The legislative foundations for organizing cancer care in our country were laid by the resolution of the Council of People's Commissars of the USSR “On measures to improve cancer care to the population” dated April 30, 1945.

Modern oncology service is represented by a complex and coherent system of oncological institutions dealing with all issues of practical and theoretical oncology.

The main link in providing oncological care to the population is oncology clinics: republican, regional, regional, city, inter-district. All of them have multidisciplinary departments (surgical, gynecological, radio-radiological, laryngological, urological, chemotherapy and children's).

In addition, the dispensaries have morphological and endoscopic departments, a clinical and biological laboratory, an organizational and methodological department, and outpatient rooms.

The work of the dispensaries is headed by the Main Oncology Institute of the Ministry of Health and Social Development of the Russian Federation.

In recent years, auxiliary oncological services in the form of hospices have begun to develop, medical institutions for the care of incurable patients. Their main task is to alleviate the suffering of patients, select effective pain relief, provide good care and a dignified death.

Tumor- excessive tissue proliferation, uncoordinated with the body, which continues after the cessation of the action that caused it. It consists of qualitatively changed cells that have become atypical, and the cells pass on these properties to their descendants.

Cancer(cancer) - epithelial malignant tumor.

Blastoma- neoplasm, tumor.

Histological examination– study of the tissue composition of the tumor (biopsy).

Incurable patient – not subject to specific treatment due to the prevalence (advanced) tumor process.

Inoperable patient- not subject to surgical treatment due to the prevalence of the tumor process.

Carcinogens– substances that cause tumor formation.

Lymphadenectomy– surgery to remove lymph nodes.

Mastectomy– breast removal surgery.

Metastasis– a secondary pathological focus that occurs as a result of the transfer of tumor cells in the body.

Palliative surgery- an operation in which the surgeon does not set himself the goal of completely removing the tumor, but seeks to eliminate the complication caused by the tumor and alleviate the suffering of the patient.

Radical operation – complete removal of the tumor with regional lymph nodes.

Tumorectomy– removal of the tumor.

Cytological examination- study cellular composition smear or tumor biopsy.

Extirpation- operation complete removal organ.

Features of tumor cells in the body.
Autonomy- independence of the rate of cell reproduction and other manifestations of their vital activity from external influences that change and regulate the vital activity of normal cells.

Tissue anaplasia- returning it to a more primitive type of fabric.
Atypia- difference in structure, location, relationship of cells.
Progressive growth– non-stop growth.
Invasive, or infiltrative growth– the ability of tumor cells to grow into surrounding tissues and destroy and replace them (typical of malignant tumors).
Expansive growth – the ability of tumor cells to displace
surrounding tissues without destroying them (typical for benign tumors).
Metastasis- formation of secondary tumors in organs distant from the primary tumor (the result of tumor embolism). Characteristic of malignant tumors.

Pathways of metastasis

hematogenous,
lymphogenous,
implantation

Stages of metastasis:

invasion of the wall of a blood or lymph vessel by primary tumor cells;
release of single cells or groups of cells into the circulating blood or lymph from the vessel wall;
retention of circulating tumor emboli in the lumen of a small-diameter vessel;
invasion of the vessel wall by tumor cells and their proliferation in the new organ.

Tumor-like processes, dyshormonal hyperplasia, should be distinguished from true tumors:

BPH (prostate adenoma),
uterine fibroids,
thyroid adenoma, etc.

The nature clinical course tumors are divided into:

benign,
malignant.

Benign (mature)

expansive growth,
clear boundaries of the tumor,
slow growth
absence of metastases,
do not grow into surrounding tissues and organs.

Malignant (immature) they are characterized by the following properties:

infiltrative growth,
lack of clear boundaries,
fast growth,
metastasis,
recurrence.

Table 12. Morphological classification of tumors .

Fabric name	Benign tumors	Malignant tumors
Epithelial tissue	apiloma-papillary adenoma (glandular cyst with a cavity) Epithelioma Polyp	Cancer Adenocarcinoma Basilioma
Connective tissue	Fibroma	Sarcoma
Vascular tissue	Angioma, Hemangioma, Lymphangioma	Angiosarcoma, Hemangiosarcoma, Lymphosarcoma
Adipose tissue	Lipoma	Liposarcoma
Muscle	Myoma	Myosarcoma
Nervous tissue	Neuroma, Ganglioneuroma, Glioma.	Neurosarcoma
Bone	Osteoma	Osteosarcoma
Cartilage tissue	Chondroma	Chondrosarcoma
Tendon sheaths	Benign synovioma	Malignant synovioma
Epidermal tissue	Papilloma	Squamous
Pigment fabric	Nevus*	Melanoma
*Nevus is an accumulation of skin pigment cells; in the strict sense, it does not belong to tumors; it is a tumor-like formation.

International classification according to TNM ( used to comprehensively characterize the prevalence of tumors).

T – tumor – tumor size,
N – nodulus – presence of regional metastases to lymph nodes,
M – metastasis – presence of distant metastases.
In addition to classification by stages of the process, a unified classification of patients into clinical groups has been adopted:

Group I a- patients with suspected malignant tumor. The duration of their examination is 10 days.
Group I b- patients with precancerous diseases.
Group II- patients subject to special treatment. A subgroup is distinguished within this group.
II a- patients subject to radical treatment (surgical, radiation, combined, including chemotherapy).
Group III- practically healthy people who have undergone radical treatment and have no relapses or metastases. These patients require dynamic monitoring.
Group IV- patients, in advanced stage diseases for which radical treatment is not feasible, they are given palliative or symptomatic therapy.

Groups I a (suspicion of Cr), II ( special treatment) and II a (radical treatment).
Stages of tumor development - This is the visible spread of the disease, established during a clinical examination of the patient.
According to the degree of distribution there are:

Stage I - local tumor.
Stage II - the tumor increases, nearby lymph nodes are affected.
Stage III - the tumor grows into neighboring organs, regional lymph nodes are affected.
Stage IV - the tumor grows into neighboring organs.

Nursing care for patients and palliative care for cancer :

Palliative care(from the French palliatif from the Latin pallium - blanket, cloak) is an approach to improve the quality of life of patients and their families faced with life-threatening illness by preventing and alleviating suffering through early detection, careful assessment and treatment of pain and other physical symptoms, as well as providing psychosocial and spiritual support to the patient and his loved ones.

Goals and objectives of palliative care:

Adequate pain relief and relief of other painful symptoms.
Psychological support for the patient and relatives caring for him.
Developing an attitude towards death as a natural stage in a person’s journey.
Satisfying the spiritual needs of the patient and his loved ones.
Solving social, legal, and ethical issues that arise in connection with a person’s serious illness and approaching death.

Caring for patients with malignant neoplasms:

The need for a special psychological approach (since patients have a very labile, vulnerable psyche, which must be kept in mind at all stages of their care).
The patient should not be allowed to find out the true diagnosis.
The terms “cancer” and “sarcoma” should be avoided and replaced with the words “ulcer”, “narrowing”, “induration”, etc.
In all extracts and certificates issued to patients, the diagnosis should not be clear to the patient.
The expressions: “neoplasm” or “neo”, blastoma or “Bl”, tumor or “T”, and especially “cancer” or “cr” should be avoided.
Try to separate patients with advanced tumors from the rest of the patient population (this is especially important during x-ray examination, since this is usually where the maximum concentration of patients selected for a more in-depth examination is achieved).
It is advisable that patients with early stages of malignant tumors or precancerous diseases do not meet patients with relapses and metastases.
In an oncology hospital, newly arrived patients should not be placed in wards where there are patients with advanced stages of the disease.
If consultation with specialists from another medical institution is necessary, then a doctor or nurse is sent with the patient and carries the documents. If this is not possible, then the documents are sent by mail to the head physician or given to the patient’s relatives in a sealed envelope.
The actual nature of the disease can only be communicated to the patient’s closest relatives.
You should be especially careful when talking not only with patients, but also with their relatives.
If a radical operation fails, patients should not be told the truth about its results.
Relatives of the patient should be warned about the safety of the malignant disease for others.
Take measures against the patient’s attempts to be treated with witchcraft remedies, which can lead to the most unforeseen complications.
Regular weighing is of great importance, since a drop in body weight is one of the signs of disease progression.
Regular measurement of body temperature allows us to identify the expected disintegration of the tumor and the body’s reaction to radiation.
Body weight and temperature measurements should be recorded in the medical history or in the outpatient card.
It is necessary to train the patient and relatives in hygienic measures.
Sputum, which is often secreted by patients suffering from cancer of the lungs and larynx, is collected in special spittoons with well-ground lids. Spittoons should be washed daily with hot water and disinfected.
Urine and feces for research are collected in an earthenware or rubber vessel, which should be regularly washed with hot water and disinfected.
For metastatic lesions of the spine, which often occur with breast or lung cancer, maintain bed rest and place a wooden shield under the mattress to avoid pathological bone fractures.
When caring for patients suffering from inoperable forms of lung cancer, exposure to air, non-tiring walks, and frequent ventilation of the room are of great importance, since patients with limited respiratory surface of the lungs need an influx of clean air.
Proper diet is important. The patient should receive food rich in vitamins and proteins at least 4-6 times a day, and attention should be paid to the variety and taste of the dishes.
You should not adhere to any special diets, you just need to avoid excessively hot or very cold, rough, fried or spicy foods.
Patients with advanced forms of stomach cancer should be fed more gentle foods (sour cream, cottage cheese, boiled fish, meat broths, steamed cutlets, crushed or pureed fruits and vegetables, etc.)
During meals, it is necessary to take 1-2 tablespoons of a 0.5-1% solution of hydrochloric acid. Severe obstruction of solid food in patients with inoperable forms of cancer of the cardial part of the stomach and esophagus requires the administration of high-calorie and vitamin-rich liquid foods (sour cream, raw eggs, broths, liquid porridges, sweet tea, liquid vegetable puree, etc.).
If there is a threat of complete obstruction of the esophagus, hospitalization for palliative surgery is necessary.
For a patient with a malignant tumor of the esophagus, you should have a sippy cup and feed him only liquid food. In this case, it is often necessary to use a thin gastric tube passed into the stomach through the nose.

Care for patients with complications of malignant neoplasms and their surgical treatment:

Provide the patient with a strict pastel regime during the first 3-5 days after surgery, and then dosed activation of the patient.
Observe the patient's consciousness.
Monitor the functions of vital organs:

monitor blood pressure,
pulse,
breathing,
Ascultative picture in the lungs,
body temperature,
diuresis,
frequency and character of stool.

Note regularly:

O2 concentration in the inhaled mixture,
Its humidity
Temperature
Oxygen therapy technique
Operation of the ventilator;

The most important point is the elimination of pain, which can be extremely severe in some forms of cancer. Pain when malignant neoplasms is a consequence of compression by the tumor nerve endings and therefore is of a constant, gradually increasing nature.
Give the patient an elevated position (raising the head end of the bed) to facilitate respiratory excursion of the chest and prevent congestion in the lungs.
Carry out measures to prevent pneumonia: remove liquid media from the oral cavity using napkins or electric suction; effleurage, vibration massage chest, teach the patient breathing exercises.
If there are intra-abdominal drainages, monitor their condition, the amount and nature of the discharge, and the condition of the skin around the drainage canal.
In the medical history, note the amount of discharge and its nature (ascites fluid, pus, blood, etc.).
Once a day, replace the connecting tubes with new ones or wash and disinfect the old ones.
Record the amount and nature of discharge into the dressing, promptly replace the dressing according to general rules dressings of surgical patients.
Monitoring the condition of the gastric or nasogastric tube and their treatment.
Provide psychological support to the patient.
Provide a regimen of intravascular (parenteral) nutrition using protein preparations, amino acid solutions, fat emulsions, glucose solutions and electrolytes.
Ensuring a gradual transition to enteral nutrition (4-5 days after surgery), feeding patients (until self-care skills are restored), monitoring the diet (fractional, 5-6 times a day), the quality of mechanical and thermal processing of food.
Provide assistance in case of physiological poisoning.
Monitor urination and timely bowel movements. If feces or urine bags are installed, replace them as they become full.
Provide hygienic care of skin and mucous membranes.
Help with oral care (brush your teeth, rinse your mouth after eating), help wash your face in the morning.
Carry out measures to combat constipation, use enemas.
Care for the urinary catheter, if present.
Prevent bedsores when forced to extend bed rest (especially in elderly and debilitated patients).
Maintain the sanitary and epidemiological regime of the ward. Ventilate it often (the air temperature in the room should be 23-24 o C), irradiate it with a bactericidal lamp, and carry out wet cleaning more often.
The patient's bed and linen must be clean, dry, and replaced when soiled.
Create an atmosphere of peace in the ward.

Lecture No. 6