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PERAWATAN KANKER

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					PERAWATAN KANKER
                    DEFINISI
• penyakit yang menyerang proses dasar kehidupan sel,
  mengubah genom sel (komplemen genetik total sel)
  dan menyebabkan penyebaran liar dan pertumbuhan
  sel-sel.
• sebuah penyakit yang ditandai dengan pembagian sel
  yang tidak teratur dan kemampuan sel-sel ini untuk
  menyerang jaringan biologis lainnya, baik dengan
  pertumbuhan langsung di jaringan yang bersebelahan
  (invasi) atau dengan migrasi sel ke tempat yang jauh
  (metastasis). Pertumbuhan yang tidak teratur ini
  menyebabkan kerusakan DNA, menyebabkan mutasi di
  gen vital yang mengontrol pembagian sel, dan fungsi
  lainnya
                “Akar Kata”
•   Neo- raru
•   Plasia-pertumbuhan
•   Plasm- substance
•   Trophy- ukuran
•   +Oma- tumor/benjolan
•   Statis- lokasi/regio
                   “Akar Kata”
•   A- tidak/tidak ada
•   Ana- kekurangan/ketiadaan
•   Hyper- berlebihan/terlalu banyak
•   Meta- perubahan/penyebaran
•   Dys- kekurangan, kesakitan/nyeri
         Karakteristik Neoplasia
•   Pertumbuhan Sel Abnormal tidak Terkontrol
•   1. Benign  tumor jinak
•   2. Malignant  tumor ganas
•   3. Borderline  tumor jinak mengarah
    keganasan
      Characteristics of Neoplasia
•   BENIGN
•   Well-differentiated
•   Slow growth
•   Encapsulated
•   Non-invasive
•   Does NOT metastasize
       Characteristics of Neoplasia
•   MALIGNANT
•   Undifferentiated
•   Erratic and Uncontrolled Growth
•   Expansive and Invasive
•   Secretes abnormal proteins
•   METASTASIZES
     Nomenclature of Neoplasia
Tumor is named according to:
1. Parenchyma, Organ or Cell
• Hepatoma- liver
• Osteoma- bone
• Myoma- muscle
     Nomenclature of Neoplasia
Tumor is named according to:
2. Pattern and Structure, either GROSS or
  MICROSCOPIC
• Fluid-filled CYST
• Glandular ADENO
• Finger-like PAPILLO
• Stalk POLYP
     Nomenclature of Neoplasia
Tumor is named according to:
3. Embryonic origin
• Ectoderm ( usually gives rise to epithelium)
• Endoderm (usually gives rise to glands)
• Mesoderm (usually gives rise to Connective
  tissues)
             BENIGN TUMORS
•   Suffix- “OMA” is used
•   Adipose tissue- LipOMA
•   Bone- osteOMA
•   Muscle- myOMA
•   Blood vessels- angiOMA
•   Fibrous tissue- fibrOMA
         MALIGNANT TUMOR
• Named according to embryonic cell origin
1. Ectodermal, Endodermal, Glandular, Epithelial
• Use the suffix- “CARCINOMA”
• Pancreatic AdenoCarcinoma
• Squamos cell Carcinoma
         MALIGNANT TUMOR
• Named according to embryonic cell origin
2. Mesodermal, connective tissue origin
• Use the suffix “SARCOMA
• FibroSarcoma
• Myosarcoma
• AngioSarcoma
                 “PASAWAY”
1. “OMA” but Malignant
  – HepatOMA, lymphOMA, gliOMA, melanOMA
2. THREE germ layers
  – “TERATOMA”
3. Non-neoplastic but “OMA”
  – Choristoma
  – Hamatoma
            Etiology of cancer

1. PHYSICAL AGENTS
• Radiation
• Exposure to irritants
• Exposure to sunlight
• Altitude, humidity
2. CHEMICAL AGENTS
• Smoking
• Dietary ingredients
• Drugs
3. Genetics and Family History
• Colon Cancer
• Premenopausal breast cancer
4. Dietary Habits
• Low-Fiber
• High-fat
• Processed foods
• Alcohol
5. Viruses and Bacteria
• DNA viruses- HepaB, Herpes, EBV, CMV,
   Papilloma Virus
• RNA Viruses- HIV, HTCLV
• Bacterium- H. pylori
6. Hormonal agents
• Pada beberapa penelitian diketahui bahwa
  pemberian hormon tertentu secara berlebihan
  dapat menyebabkan peningkatan terjadinya
  beberapa jenis kanker seperti payudara,
  rahim, indung telur dan prostat (kelenjar
  kelamin pria)
7. Immune Disease
• AIDS
            Spread of Cancer

• 1. LYMPHATIC
    • Most common
• 2. HEMATOGENOUS
  – Blood-borne, commonly to Liver and Lungs
• 3. DIRECT SPREAD
  – Seeding of tumors
    PRTAHANAN TUBUH MELAWAN
             TUMOR
• 1. T cell System/ Cellular Immunity
  – Cytotoxic T cells kill tumor cells
• 2. B cell System/ Humoral immunity
  – B cells can produce antibody
• 3. Phagocytic cells
  – Macrophages can engulf cancer cell debris
                DIAGNOSTIC
1. BIOPSY
  – The most definitive
2. CT, MRI
3. Tumor Markers
                GRADING
The degree of DIFFERENTIATION
• Grade 1- Low grade
• Grade 4- high grade
                   Cancer Staging
1. Uses the T-N-M staging system
• T- tumor
• N- Node
• M- Metastasis
2. Stage 1 to Stage 4
• Stage 0: A small group of cancerous cells have been found in
   one location in the lung.
• Stage I: The cancer is only in the lung and has not spread
   anywhere else.
• Stage II: The cancer has spread to nearby lymph nodes.
• Stage III: The cancer has spread to more distant lymph nodes,
   and/or other parts of the chest like the diaphragm.
• Stage IV: The cancer has spread to other parts of the body
   (distant metastasis).
            CANCER NURSING
GENERAL MEDICAL MANAGEMENT
• 1. Surgery- cure, control, palliate
• 2. Chemotherapy
• 3. Radiation therapy
• 4. Immunotherapy
• 5. Bone Marrow Transplant
            CANCER NURSING
    GENERAL Promotive and Preventive Nursing
                     Management
•   1. Lifestyle Modification
•   2. Nutritional management
•   3. Screening
•   4. Early detection
                SCREENING
• 1. Male and female- Occult Blood, CXR, and
  DRE
• 2. Female- SBE, CBE, Mammography and Pap’s
  Smear
• 3. Male- DRE for prostate, Testicular self-exam
            Nursing Assessment
Utilize the ACS 7 Warning Signals
• CAUTION
• C- Change in bowel/bladder habits
• A- A sore that does not heal
• U- Unusual bleeding
• T- Thickening or lump in the breast
• I- Indigestion
• O- Obvious change in warts
• N- Nagging cough and hoarseness
            Nursing Assessment
•   Weight loss
•   Frequent infection
•   Skin problems
•   Pain
•   Hair Loss
•   Fatigue
•   Disturbance in body image/ depression
         Nursing Intervention
MAINTAIN TISSUE INTEGRITY
• Handle skin gently
• Do NOT rub affected area
• Lotion may be applied
• Wash skin only with SOAP and Water
          Nursing Intervention
MANAGEMENT OF STOMATITIS
• Use soft-bristled toothbrush
• Oral rinses with saline gargles/ tap water
• Avoid ALCOHOL-based rinses
         Nursing Intervention
MANAGEMENT OF ALOPECIA
  Alopecia begins within 2 weeks of therapy
 Regrowth within 8 weeks of termination
 Encourage to acquire wig before hair loss occurs
 Encourage use of attractive scarves and hats
 Provide information that hair loss is temporary
  BUT anticipate change in texture and color
        Nursing Intervention
PROMOTE NUTRITION
Serve food in ways to make it appealing
Consider patient’s preferences
Provide small frequent meals
Avoids giving fluids while eating
Oral hygiene PRIOR to mealtime
Vitamin supplements
        Nursing Intervention
RELIEVE PAIN
Mild pain- NSAIDS
  Moderate pain- Weak opiods
Severe pain- Morphine
Administer analgesics round the clock with
  additional dose for breakthrough pain
         Nursing Intervention
DECREASE FATIGUE
Plan daily activities to allow alternating rest
 periods
Light exercise is encouraged
Small frequent meals
        Nursing Intervention
IMPROVE BODY IMAGE
Therapeutic communication is essential
Encourage independence in self-care and
  decision making
Offer cosmetic material like make-up and
  wigs
        Nursing Intervention
ASSIST IN THE GRIEVING PROCESS
Some cancers are curable
Grieving can be due to loss of health,
  income, sexuality, and body image
Answer and clarify information about
  cancer and treatment options
Identify resource people
Refer to support groups
         Nursing Intervention
MANAGE COMPLICATION: INFECTION
 Fever is the most important sign (38.3)
 Administer prescribed antibiotics X 2weeks
 Maintain aseptic technique
 Avoid exposure to crowds
 Avoid giving fresh fruits and veggie
 Handwashing
 Avoid frequent invasive procedures
       Nursing Intervention
MANAGE COMPLICATION: Septic shock
Monitor VS, BP, temp
Administer IV antibiotics
Administer supplemental O2

				
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posted:3/25/2011
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