General principles of organizing nursing care in oncology. Features of the nursing process in the rehabilitation of patients with cancer. Psychological support for patients

1/5 of cases are detected during clinical examinations.

The role of the nurse is extremely important in the early diagnosis of tumors, who 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 help prevent cancer by recommending and explaining the positive role of a healthy lifestyle 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;
• 
  a cancer cell behaves differently from other tissues; its function does not meet 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.

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 initially present in every body, 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). Height cancer cells cause chemicals, which can be exogenous (nicotine, metal poisons, asbestos compounds, etc.) and endogenous (estradiol, folliculin, etc.).

Immunological theory says that weak immunity is unable to contain the growth of cancer cells in the body and the person develops 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 left in the tissues that can give 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:

1. 
   Epithelial:

STATE BUDGET EDUCATIONAL INSTITUTION

SECONDARY VOCATIONAL EDUCATION OF THE CITY OF MOSCOW MEDICAL SCHOOL No. 13

MOSCOW HEALTH DEPARTMENT

Methodological development

theoretical lesson

(for teacher)

"Nursing process

for lung cancer"

PM.02 “Participation in diagnostic, treatment and rehabilitation processes”

Moscow

2014

Reviewers:

Andreeva L.M., teacher of professional modules of higher education qualification category GBOU SPO MU No. 13 DZM

Skripnik N.S. , teacher of professional modules, chairman of the Central Medical Committee No. 3 GBOU SPO MU No. 13 DZM

Explanatory note.

Methodological development on the topic “Nursing process for lung cancer” is intended for conducting a theoretical lesson on the professional module PM-02 “Participation in treatment, diagnostic and rehabilitation processes”,including the interdisciplinary course MDK 02.01 T-7 Nursing care for respiratory diseases.

Methodological development corresponds work program and thematic plan, contains information about risk factors, clinical manifestations, complications, diagnostic methods, principles of treatment and prevention of lung cancer, as one of the most common cancer diseases with a high mortality rate.

Methodological development is a detailed plan for conducting a theoretical lesson. To better assimilate new material, a presentation on the topic of the lesson with illustrations and photographs is used, photographs of radiographs and bronchoscopic images of central and peripheral lung cancer are also shown. Good visualization helps improve the quality of learning. To facilitate understanding of the topic, students are asked to fill out a graphological table while presenting new material.

Methodological development contains a methodological block; block for monitoring the initial level of knowledge; information block; training efficiency control unit; applications. At the end of the lesson, reflection is provided for students to evaluate whether they have achieved the goals of the lesson and to analyze the difficulties that arose during the lesson.

Methodological block.

Subject: Nursing process in lung cancer.

Professional module PM-02 “Participation in diagnostic, treatment and rehabilitation processes”

Interdisciplinary course MDK 02.01 T-7 Nursing care for respiratory diseases

Form:theoretical lesson

Type of lesson: combined lesson.

Time: 30 minutes.

Lesson objectives:

Educational:

The student must know:

• definition of “lung cancer”
• risk factors;
• clinical manifestations;
• diagnostic methods;
• principles of treatment;
• principles of prevention

Educational:

• ability to develop memory, imagination, logical thinking;
• develop the ability to systematize, analyze, and draw conclusions.

Educational:

• to cultivate students’ professional interest in the issue being studied;
• to cultivate a sense of responsibility and significance of the nurse’s role in the implementation of the nursing process and the implementation of preventive measures.

Interdisciplinary connections

Equipment

Logistics:

Computer with multimedia projector, laser pointer.

Methodical:

• Presentation on the topic “Nursing process for lung cancer” with illustrations and photographs of radiographs and bronchoscopic images for central and peripheral lung cancer.
• Handouts for students:

1. Glossary;

2. Graphological tables that are proposed to be filled out when presenting new material;

3. Assignments in test form on the topic “Nursing process for lung cancer.”

Chronocard of the lesson.

Motivation.

At the beginning of the 20th century, lung cancer was very rare. In subsequent years, there was a significant increase in incidence. Currently, lung cancer ranks first in prevalence among all cancers. The rapid increase in incidence is becoming an epidemic disaster.

Lung cancer occurs in approximately 1.3 million cases per year worldwide.

In Russia - first place among malignant neoplasms - 14%.

More than 63,000 cases of the disease are registered annually in Russia.

Lung cancer is 6 times more common in men than in women;

The average incidence in Russia is 40-45 cases per 100,000 population per year.

The mortality rate from lung cancer today is very high - 80-85% of the number of cases, despite the qualitative progress of medical technologies

About 8 million people die from lung cancer every year.

Lung cancer occurs mainly in people over 40 years of age; mainly among residents of large industrial centers due to air pollution with dust, smoke, and gases. Up to 80% of all lung cancer cases are associated with smoking, including passive smoking. Moreover, according to medical forecasts, the number of deaths in the next 25 years is increasing, given the increase in the number of smokers. Moreover, the average incidence in men is 65-70 cases per 100,000 population, and among women this figure is only 8-12 cases per 100,000 population.

So is it still possible to stop the increase in the incidence of lung cancer? Is it possible to reduce mortality from lung cancer? Is it possible to increase the life expectancy of patients who have been given this terrible diagnosis? What is the sister's role in resolving these issues?

We can find answers to these and other questions in this lesson.

Block for monitoring the initial level of knowledge.

Questions to control the initial level of knowledge.

1. What about the respiratory organs?
2. What are the outside of the lungs covered with? How many layers does the pleura have?
3. What is the name of the cavity between the layers of the pleura? What's in it?
4. How many lobes are there in the left and right lung?
5. What is the name of the structural and functional unit of the lung?
6. What is in the wall of the alveoli?
7. What are the main symptoms of the disease? respiratory system You know?
8. What is hemoptysis?
9. What types of tumors do you know by nature? clinical course?
10. Give comparative characteristics benign and malignant tumors according to the following characteristics:

1) is the tumor growing fast or slow?

2) does the tumor have clear or unclear boundaries?

3) is the tumor capable of destroying surrounding tissue?

4) is the tumor capable of metastasizing?

1. What are carcinogens?
2. What are the main instrumental methods for examining the respiratory system?

Information block.

Glossary.

1. Cancer (cancer) – malignant tumor of epithelial cells.
2. Biopsy – taking a piece of tissue for histological examination.
3. Bronchoscopy – endoscopic examination of the bronchi using a bronchoscope.
4. Bronchography – X-ray examination of the bronchi after filling them with a contrast agent.
5. Computed tomography (CT) –X-ray examination allows you to obtain layer-by-layer images and determine the size of the tumor.
6. Carcinogens –
7. Cachexia – pronounced degree of exhaustion of the body.
8. Metastasis –spread of the tumor to the lymph nodes or other organs.
9. Dysphagia – swallowing disorder.
10. Aphonia – hoarseness or loss of voice

Lecture plan.

1. Definitions of lung cancer (LC).
2. Prevalence of RA.
3. Risk factors.
4. Stages of RA
5. Classification of RA.
6. Clinical manifestations of RA.
7. Complications
8. Main problems of patients with RA.
9. Methods for diagnosing RA.
10. Principles of RA treatment.
11. Prevention of RA.

Nursing process for lung cancer

Lung cancer - malignant tumor of the lung,growing from the epithelium of the bronchial mucosa or the epithelium of the alveoli.

Lung cancer is one of the most complex medical scientific and social problems modernity. The rapid increase in incidence is becoming an epidemic disaster.

Lung cancer ranks 2nd after stomach cancer in men and 3rd after stomach and uterine cancer in women.

It is 6 times more common in men than in women; 10 times more often among smokers than among non-smokers, more often among residents of large industrial centers; more often over the age of 40 years.

The cancerous tumor may be primary, i.e. immediately localized in the lung, and secondary (metastatic), which develops as a result of the introduction of cancer cells from other organs into the lungs (for example, stomach cancer).

Etiology The disease is not completely clear.

Predisposing factors:

Burdened heredity.

Exposure to carcinogenic substances: products of incomplete combustion of fuel, industrial dust containing asbestos, cobalt, nickel, beryllium, uranium, aromatic substances, etc.

Exposure to tobacco smoke.

Chronic inflammatory processes in the lungs.

Immunodeficiency.

Classification.

1. Central cancer (damage to the main, lobar, segmental bronchus) (72% of all tumors).

2. Peripheral cancer (tumor from the epithelium of small bronchi, bronchioles, alveoli).

The clinical picture is very varied and depends on the location of the tumor.

The disease develops gradually, its onset is very difficult to determine. With central cancer, the symptoms are more pronounced and appear earlier; peripheral cancer is sometimes detected by chance or when the tumor has grown into the pleura.

Possible symptoms:

The cough, especially at the beginning, can be dry, hacking, and constant. Later it becomes productive, mucous or mucopurulent sputum is released.

Hemoptysis occurs in approximately half of patients. In advanced stages, “raspberry jelly” colored sputum is typical for cancer.

Pulmonary hemorrhage is often observed in the later stages of the disease.

Dyspnea gradually increases, it can be inspiratory, expiratory, mixed, depending on the localization of the process and the development of complications (pulmonary atelectasis, pleural effusion, bronchial obstruction, pneumonia, etc.).

Pain in the chest when the tumor grows into the pleura, as well as when the ribs and vertebrae are affected by metastases.

Fever is caused by the development of the inflammatory process of the bronchopulmonary system (bronchitis, pneumonia, pleurisy), cancer intoxication, and complications. The temperature is usually stable, decreasing briefly under the influence of antibacterial therapy.

Weakness, sweating, weight loss, fatigue, pale gray or sallow complexion are associated with the general effect of a cancer tumor on the body, and occur with an advanced process.

On auscultation - first dry, then wet rales.

On percussion – dullness of the percussion sound over the tumor.

On palpation, there is an increase in the axillary, supraclavicular and subclavian, and sometimes even cervical lymph nodes.

Metastasis of lung cancer through the lymphatic tract first goes to regional lymph nodes and pleura (pleurisy), and then to the liver, kidneys, brain, bones, spine and other organs.

Dry persistent cough or with sputum, hemoptysis, shortness of breath are more typical for central lung cancer; chest pain – for peripheral.

In advanced forms of lung cancer, symptoms caused by tumor growth into neighboring organs are revealed:

Compression of the superior vena cava causes unilateral swelling of the veins of the neck, swelling of the face, neck, and upper extremities.

Cervical compression sympathetic nerve- retraction eyeball, omission upper eyelid(ptosis), constriction of the pupil.

Ingrowth into the esophagus - dysphagia, formation of broncho-esophageal fistulas.

Recurrent nerve compression- hoarseness or aphonia.

Ingrowth into the pleura - pleurisy or spontaneous pneumothorax.

Stages of lung cancer.

Stage 1 – a small limited tumor without invasion into the pleura and without

Metastasis.

Stage 2 – a small tumor with single metastases to regional lymph nodes.

Stage 3 – the tumor extends beyond the lung, grows into one of the neighboring

Organs; numerous metastases to regional lymph nodes.

Stage 4 – large tumor with distant metastases and secondary

Inflammatory changes in tissues.

Diagnostics:

Clinical blood test: may be anemia, lymphopenia, increased ESR.

Chest X-ray: central cancer is characterized by darkening of a lobe or segment of the lung, peripheral cancer is a dense round shadow of small diameter, usually in the upper lobes.

Computed tomography.

Bronchoscopy with biopsy (allows you to determine the localization and extent of the tumor process and the histological features of the tumor).

Angiography of the bronchial arteries.

Cytological examination of sputum (atypical cells).

Immunological, cytogenetic research, identification of tumor markers

Treatment.

The choice of treatment method depends on the stage of development and histological features of the tumor.

Radical treatment -surgical –complete elimination of all foci of tumor growth, possible at stages 1, 2, 3 of the tumor.

Palliative treatment –radiation therapy, chemotherapy- impact on the tumor in order to reduce tumor mass and delay growth, which helps prolong the patient’s life. The main cytostatic drugs: cyclophosphamide, vincristine, metatrexate, taxol, etc.

Symptomatic treatment is treatment aimed at eliminating or reducing the painful manifestations of the disease for the patient.

• Painkillers: non-narcotic and narcotic analgesics - analgin, baralgin, morphine, promedol, etc.); non-steroidal anti-inflammatory drugs (ketorol, diclofenac).
• Antibacterial drugs for the development of perifocal pneumonia.
• Coagulants for bleeding.
• Cardiotonic drugs for bleeding.

Primary prevention.

Anti-smoking and healthy image life.

Timely treatment of chronic lung diseases.

Reducing dust and gas pollution in atmospheric air.

Combating occupational hazards at industrial enterprises.

Mass fluorographic examinations.

The main problems of patients with lung cancer:

Chest pain, cough, shortness of breath, weakness, weight loss;

Hemoptysis and pulmonary hemorrhage;

Lack of awareness about the disease.

Training efficiency monitoring unit.

1. Questions for final control of knowledge on the studied topic.

1. Define lung cancer.
2. List the main risk factors for lung cancer.
3. Name the main one early symptom central lung cancer.
4. Name the main early symptom of peripheral lung cancer.
5. Name the number of stages of lung cancer. Where can metastases occur in stage 4?
6. List the main symptoms characteristic of late stage lung cancer.
7. What type of sputum may appear in case of lung cancer?
8. List the main instrumental methods for diagnosing lung cancer.
9. Name a method for early diagnosis of lung cancer.
10. Name the most accurate method for diagnosing lung cancer.
11. List the basic principles of lung cancer treatment.
12. What are the basic principles of lung cancer prevention?

1. Assignments in test form.

These tasks are used to test the assimilation of new material. In preparation for practical lesson students need to look more closely at the issues that are causing them difficulty.

Instructions for students to complete tasks in test form.

1. Each task contains 4 answer options. Choose one correct answer
2. After completing the task, exchange answer sheets with your neighbor.
3. Check your work results by comparing them with the standard answers. Evaluate the work.
4. Get your work back. Pay attention to the questions where you made a mistake.

Assignments in test form on the topic

Choose one correct answer:

1. Main risk factors for lung cancer:

a) bronchial asthma

b) smoking, chronic bronchitis

c) alcoholism

d) pleurisy

2. Weight loss, dry persistent cough are observed with:

a) acute bronchitis

b) bronchial asthma

d) central lung cancer

3. Weight loss and chest pain are observed with:

a) acute bronchitis

b) bronchial asthma

c) peripheral lung cancer

d) central lung cancer

4. Complication of lung cancer:

a) bronchial asthma

b) chronic bronchitis

c) emphysema

d) pulmonary hemorrhage

5. In case of lung cancer, the following is found in sputum:

a) atypical cells

b) a lot of red blood cells

c) many leukocytes

d) a lot of protein

6. With lung cancer, sputum occurs:

A) “rusty”

B) purulent

B) in the form of “raspberry jelly”

D) glassy

7. Most effective treatment V initial stage lung cancer:

A) surgery

B) cytostatics

B) radiation therapy

D) hormones

8. Sputum analysis for suspected lung cancer is:

A) general

B) bacteriological

B) on BC

D) for atypical cells

9. To accurately diagnose lung cancer, the following is carried out:

A) bronchoscopy with biopsy

B) collection of sputum for general analysis

B) general blood test

D) general urine test

10. Method for early diagnosis of lung cancer:

A) fluorography

B) blood test

B) sputum analysis

D) spirography

Reflection.

The teacher invites students to assess the degree to which goals have been achieved, to pay attention to issues that caused difficulty; analyze the causes of these difficulties; express your opinion about what you liked during the lesson; what material students remembered the most.

Summing up the lesson.

The teacher sums up the lesson, evaluating the group’s work; evaluates the work of active students and assigns homework.

Homework.

• Smoleva E.V., Nursing in therapy with a course of primary medical care- pp140-143 – Rostov-on-Don: Phoenix, 2011.

Literature for students

• Smoleva E.V., Nursing in therapy with a course of primary medical care. – Rostov-on-Don: Phoenix, 2011.

Applications.

Standards of answers to questions to control the initial level of knowledge.

1. The respiratory organs include: respiratory tract, lungs, pleura. The respiratory tract includes the nasal cavity, larynx, trachea, and bronchi.
2. The outside of the lungs is covered with pleura. The pleura has 2 layers: the internal visceral layer, which is tightly fused with the chest, and the external parietal layer, which lines the chest cavity from the inside.
3. Between the layers of the pleura there is pleural cavity? It contains serous fluid, which facilitates the breathing movements of the lungs.
4. The left lung has 2 lobes, and the right lung has 3 lobes.
5. The structural and functional unit of the lung is called the pulmonary acinus, which consists of a group of alveoli.
6. In the wall of the alveoli there are blood capillaries through which gas exchange occurs.
7. Main symptoms: cough, sputum, shortness of breath, chest pain.
8. Hemoptysis is blood in the sputum. The sputum is streaked or clotted or pink in color;
9. Based on the nature of the clinical course, there are 2 types of tumors: benign and malignant.
10. comparative characteristics of benign and malignant tumors:

a) in benign tumor growth is rapid, and in malignant tumor growth is slow

b) a benign tumor has clear boundaries, while a malignant tumor has unclear boundaries

c) a benign tumor does not destroy surrounding tissues, but a malignant tumor destroys surrounding tissues and grows into them

d) a benign tumor does not metastasize, but a malignant one is capable of metastasizing.

1. Carcinogens – harmful substances that contribute to the development of a malignant tumor.
2. The main instrumental methods for examining the respiratory organs: radiography of the lungs, bronchography, tomography, fluorography, computed tomography, bronchoscopy, ultrasound of the lungs.

Sample answers to tasks in test form on the topic

"Nursing process for lung cancer"

1 b

2 g

3 in

4 g

5 a

6 in

7 a

8 g

9 a

10 a

Standards of answers to questions for the final control of students' knowledge.

1. Lung cancer is a malignant tumor growing from the epithelium of the mucous membrane of the bronchi or alveoli.

1. Smoking, chronic diseases lungs. industrial hazards, air pollution.

1. Weakness, dry persistent cough.

1. There are no symptoms for a long time, then chest pain appears when the tumor grows into the pleura.

1. Four stages of lung cancer. Metastases in stage 4 can be to distant organs.

1. Weakness, fever, shortness of breath, sputum in the form of “raspberry jelly” or hemoptysis, chest pain, cachexia.

1. Sputum from lung cancer may be in the form of “raspberry jelly.”

1. The main instrumental methods for diagnosing lung cancer are chest radiography, bronchography, bronchoscopy with biopsy, computed tomography.

1. A method for early diagnosis of lung cancer is fluorography.

1. The most accurate method for diagnosing lung cancer is bronchoscopy with biopsy

1. Principles of lung cancer treatment: surgical treatment, chemotherapy, radiation therapy, symptomatic treatment.

1. Basic principles of lung cancer prevention: combating smoking, air pollution, occupational hazards, timely treatment of chronic lung diseases, fluorographic examination, healthy lifestyle.

TO criteria for assessing knowledge.

A rating of “5” is given if a student:

1. Gives correct formulations, precise definitions and concepts of terms, shows a complete understanding of the material and can justify his answer, give the necessary examples “not only from textbooks, but also selected independently”, correctly answers additional questions from the teacher aimed at finding out the degree of student understanding of this material .
2. Confidently and correctly analyzes errors, knows the positive and negative aspects of the practical work performed.
3. Fluent in speech and medical terminology.

A rating of “4” is given if a student:

1. Gives an answer that meets the same requirements as the “5” marks.

1. Makes isolated mistakes, which he corrects after the teacher’s comments.

A rating of “3” is given if a student:

1. Knows and understands the main provisions of this topic, but admits inaccuracies in the formulation of the rules.
2. Allows partial errors.
3. Presents the material in an insufficiently coherent and consistent manner.

A rating of “2” is given if a student:

1. Shows ignorance of the general part of the relevant section of the topic, makes mistakes in the formulation of rules that distort their meaning.
2. Presents the material erratically and uncertainly, accompanied by frequent stops and interruptions.

Criteria for assessing test control

90-100% correct answers – “5”

80% of correct answers – “4”

70% of correct answers – “3”

The test control includes 10 questions

9-10 correct answers – “5”

8 correct answers – “4”

7 correct answers – “3”

• Size: 1.7 Megabytes
• Number of slides: 37

Description of presentation Topic: “Nursing care for lung cancer” based on slides

Lecture plan 1. Lung cancer: definition. 2. Classification. 3. Etiology. Contributing factors. 4. Clinic. 5. Diagnostics. 6. Treatment. 7. Prevention. 8. An example of solving a patient’s problem.

Lung cancer is a malignant tumor growing from the epithelium of the mucous membrane of the bronchi or alveoli. It occurs frequently, mainly in men aged 40-60 years. Etiology. The cause of cancer is not fully understood.

Contributing factors: 1) exposure to carcinogenic substances (inhalation of dust in the mining industry, aromatic substances, polluted atmospheric air) 2) smoking 3) chronic. inflammatory processes in the lungs 4) heredity 5) immunodeficiency states 6) exposure to radioactive substances

Classification 1. a) bronchogenic cancer (develops from the epithelium of the bronchi) b) pneumonogenic (develops from alveolar tissue).

2. a) primary - the tumor develops from the alveolar epithelium of the lungs b) secondary - (metastatic), resulting from the introduction of cancer cells from other organs.

3. According to the degree of growth, 4 stages are distinguished: Stage 1 - a small limited tumor Stage 2 - the same tumor and metastases to the lymph nodes Stage 3 - a tumor that has spread beyond the lungs and metastases to the lymph nodes. 4. stage – tumor large sizes and distant metastases to other organs.

Primary lung cancer develops from the epithelium of the bronchi, most often affects the right lung and is localized in the upper lobes. The tumor grows endobronchially with subsequent closure of the bronchial lumen and disruption of its patency.

It spreads to nearby lung tissue, mediastinal organs, and regional lymph nodes. The mediastinal organs are shifted towards the lesion.

Tumor germination leads to: destruction of pulmonary vessels with the development of bleeding, damage to the pleura with the development of hemorrhagic pleurisy. Extrapulmonary metastases affect the liver, brain, bones and other organs.

With central cancer, they appear relatively early, these are: cough, often dry, at night, difficult to treat. The nature of the cough changes, becoming paroxysmal, whooping cough.

The sputum is mucopurulent, purulent hemoptysis in the form of streaks of blood, less often in the form of clots, sometimes pulmonary bleeding develops, often sputum in the form of “raspberry jelly”.

Peripheral cancer can develop asymptomatically for quite a long time and is often a finding during fluorography (60 - 80% of cases).

a consequence of complications associated with impaired bronchial obstruction, with the development pneumonia, abscess formation or decay of lung tissue: shortness of breath increases, a significant amount of sputum of a different nature is released,

Body temperature rises, chills, reactive pleurisy, and signs of intoxication may appear. These symptoms are more typical for central cancer

Peripheral cancer can proceed with decay and therefore resemble the picture of a pulmonary abscess. With the growth of the tumor and the development of intrathoracic metastases, increasing pain in the chest is associated with the growth of the chest wall, the development of compression syndrome of the superior vena cava and esophagus.

Superior vena cava syndrome - a violation of the outflow of blood from the head, neck, upper chest, manifested by the development of collateral veins and swelling shoulder girdle and neck; mediastinal compression syndrome (when a tumor grows into the trachea, esophagus, heart, pericardium), manifested by hoarseness, impaired swallowing, regurgitation of food, pain in the sternum;

Pencoast syndrome (damage to the apex with invasion of 1 rib, vessels and nerves of the shoulder girdle), characterized by severe pain in the shoulder girdle, muscle atrophy upper limb, Compression of the cervical sympathetic nerve: dilation of blood vessels and increased temperature of one half of the head, retraction of the eyeball, development of Horner's syndrome - constriction of the pupil;

Pleural effusion - the exudate is hemorrhagic in nature, does not respond to puncture treatment methods, and quickly accumulates after removal; Atelectasis - collapse lung tissue, develops when a tumor grows or compresses the bronchial tube

Perifocal inflammation is the focus of pneumonia around the tumor, manifested by fever, cough with sputum, and catarrhal symptoms; syndrome of neurological disorders, manifested by symptoms of paralysis of the phrenic and recurrent nerves, nerve ganglia, with metastases to the brain - various neurological disorders;

Carcinoid syndrome manifests itself in attacks bronchial asthma, hypotension, tachycardia, flushing of the skin of the face and neck, nausea, vomiting, diarrhea.

diagnostics General blood test - anemia, increased ESR, leukocytosis Examination of sputum for atypical cells.

X-ray examination: there may be darkening of the entire lobe or segment. Bronchography for central cancer reveals narrowing of the lumen of the bronchus, closure of the lumen of the bronchus, the symptom of a “stump” of the bronchus, movement of the bronchus

Treatment. Must be comprehensive and timely. 1. Timely surgical treatment is most effective. 2. Radiation therapy (delays tumor growth). 3. Chemotherapy - medications are prescribed that suppress tumor growth, cytostatics: cyclophosphamide, vincristine, etc.

4. Symptomatic therapy: a) for a painful cough - codeine, b) for pain - analgesics, drugs (promedol, morphine, omnopon) c) cardiovascular drugs d) for the development of pneumonia - antibiotics. In terminal (stage 4) treatment is only symptomatic, the main thing is patient care.

Prevention Primary: 1. Smoking control 2. Sanitary and hygienic measures in production to reduce occupational hazards, dust, gas contamination. 3. Annual fluorography for early tumor detection. 4. Formation of a healthy lifestyle.

1. Considering vulnerability nervous system, the m/s must treat the patient politely and respectfully. 2. Be able to keep the “secret” of the patient’s illness. 3. Follow all doctor's orders.

4. Remember that thermal procedures, cupping, and mustard plasters are contraindicated for such patients. 4. If there is excessive sputum production, provide a spittoon. 5. Be able to provide assistance with a dry, painful cough.

6. Be able to tactfully talk with the patient’s relatives. Patient's problems lung cancer: shortness of breath, chest pain, fever, cough, hemoptysis, fear of death, anxiety about one’s condition.

Emergency condition - pulmonary hemorrhage Manifestations: discharge of scarlet foamy blood from the mouth during coughing, tachycardia, decreased blood pressure.

Algorithm emergency care. 1. Call a doctor through an intermediary to provide qualified assistance. 2. Help the patient take a semi-sitting position, turning his head to the side, to prevent aspiration.

3. Provide complete physical, psychological and speech rest to reduce bleeding and prevent asphyxia. 4. Provide care items (towel, spittoon) 5. Place an ice pack on chest. To reduce bleeding.

6. Follow the doctor’s prescriptions: hemostatic agents (5% solution of aminocaproic acid, dicinone, 10% solution of calcium chloride.) 7. Monitor appearance, blood pressure, pulse, respiratory rate. For early diagnosis of complications.

Comprehensive care of a patient with gastric cancer by a nurse is called the nursing process.

Its impact on the general condition and health of the patient is difficult to overestimate.

Nurses provide patients with qualified care, helping to overcome emerging problems, and make every effort to improve the quality of life of their patients.

It is impossible to effectively carry out the nursing process for gastric cancer without knowledge of the nature of the disease and its etiology. The main causes of this disease are:

• age-related changes;
• irradiation;
• hereditary predisposition;
• viral infection;
• polyps;
• autoimmune or antral gastritis;
• chronic ulcers;
• nutritional features;
• decreased immune status;
• living in regions where polyvinyl chloride, chrome, mineral oils, rubber, and asbestos-containing materials are produced.

Major diseases Gastritis is a precursor to the appearance of a tumor. In second place are adenomas, then polyps and stomach ulcers. Molecular biologists were also able to identify changes in the expression of a number of genes associated with the appearance of precancerous and cancerous conditions.

Stages of assistance for neoplasms

The nursing process for gastric cancer consists of several stages, allowing the patient's needs and the necessary care to be determined as accurately as possible.

• First stage. An examination is carried out to determine objective and subjective changes in the patient’s condition and the presence of impaired needs associated with the development of cancer.
• Second stage. Identifying patient problems and making possible nursing diagnoses. They diagnose real or potential problems, in addition, each problem can be primary, intermediate or secondary.
• Third stage. Determination of short-term and long-term goals and objectives, an intervention plan on the part of the nurse, as well as discussion of them with the attending physician, other staff and the patient himself.

It is especially important to promptly recognize emergency conditions requiring immediate intervention.

This is a collapse (a sharp drop in pressure, life-threatening patient), fainting, shock, or stomach bleeding. At such moments, it is necessary to provide assistance to the patient as quickly as possible - his life depends on it.

Signs of stomach cancer vary depending on the stage of tumor formation. Knowing these signs and what causes them helps nurse stop them as effectively as possible and provide timely assistance to the patient.

• Signs of a latent form of the disease. Weakness, dyspepsia (indigestion), discomfort in the epigastric (supragastric) region, irritability, weakness, rapid satiation with food, and decreased ability to work can occur with latent gastric cancer.
• Early signs. There are hemorrhagic and painful forms. The first are characterized by the appearance of blood in the stool (so-called occult blood), unexpected bleeding, and the development of symptoms of anemia. Painful sensations localized in the epigastric region.
• Late signs. The form of the disease is determined by the predominance of specific symptoms. There are dyspeptic, painful, feverish, anemic, edematous, and intestinal forms (diarrhea, constipation). Objectively, there is puffiness of the face, jaundice or sallow complexion, loss of shine in the eyes, exhaustion, the appearance of migratory thrombophlebitis, enlarged lymph nodes, enlarged liver, dropsy.

Psychological support for patients

The nursing process for stomach cancer includes not only caring for the patient, but also providing him with the necessary psychological assistance. It includes overcoming the patient’s lack of knowledge about his disease, recommended changes in lifestyle, diet, rules for taking medications, as well as preparation for instrumental and laboratory tests.

Another important point is to teach the patient the skills necessary for this disease - self-control, self- and mutual assistance, self-care, as well as reducing his anxiety about the outcome of the disease.

Tumor- pathological tissue proliferation, which differs from other pathological tissue proliferations in its autonomy and hereditary ability for unlimited, uncontrolled growth.

Benign - expansive growth (pushes tissue apart), less pronounced anaplasia (atypia), metastasis is not typical, less pronounced damaging effect on the body, rarely cachexia.

Malignant - infiltrative growth, pronounced anaplasia, metastasis, general damaging effect on the body and the development of cachexia.

Malignant tumors based on their histological structure are divided into:

Cancers, tumors arising from epithelial tissue;

Sarcomas are connective tissue tumors.

Benign tumors from:

Epithelial tissue– papillomas, adenomas, cysts;

Connective tissue – fibromas, lipomas;

Vascular tissue – angiomas;

Nervous tissue– neuromas, gliomas, ganglioneuromas.

Biological features tumor cells and tissues.

1. unlimited growth - tumor cells multiply as long as the body is alive, nothing stops them except treatment.

2. autonomy - insensitivity of tumor growth to the neurohumoral effects of the whole organism.

3. infiltrative growth (main criteria for malignancy).

4. metastasis - the appearance of new foci of tumor growth in tissues remote from the primary tumor node.

5. anaplasia (atypia) - features that distinguish tumor cells from normal ones and create similarities with embryonic cells.

6. clonal growth pattern - all tumor cells originate from one transformed cell.

7. tumor progression - an increase in the malignant properties of the tumor (malignancy) - autonomy, metastasis, infiltrative growth.

Carcinogens.

Chemical

endogenous

Hormones (female sex hormones, etc.)

Cholesterol derivatives

Products of amino acid metabolism

exogenous

Products of incomplete combustion (exhaust gases, smoke products)

Initial products in synthesis medicines, dyes, in color photography, rubber production.

Inorganic - arsenic, nickel, cobalt, chromium, lead (their extraction and production).

Physical

Ionizing radiation(causes leukemia, skin and bone tumors)

UFO (skin tumors).

Biological

Some viruses.

Origin of tumors.

Currently, the most common two points of view on the origin of tumors are:

1. Viral theory, which recognizes that tumor processes are infectious diseases caused by certain viruses, virus-like factors or agents.

2. Polyetiological theory, which does not try to reduce the diversity of tumors to any single cause: physiological, chemical or biological. This theory considers the pathogenesis of tumor transformation as the result of regeneration following damage caused by various factors and acting mostly repeatedly. Regeneration after repeated damage gains pathological forms and leads to changes in the properties of cells, causing tumor growth in some cases.

Precancerous diseases and conditions.

1. Endocrine disorders.

2. Long-term chronic inflammatory diseases.

3. Chronic trauma.

Clinical manifestations.

Benign tumors most often do not cause complaints and are often discovered by chance. Their growth is slow. Benign tumors internal organs manifest themselves only as symptoms of mechanical dysfunction of organs. The general condition of the patient, as a rule, does not suffer. When examining superficially located tumors, attention is drawn to the roundness of the shape and the lobulation of the structure. The tumor is mobile, not fused with surrounding tissues, its consistency may be different, regional lymph nodes are not enlarged, palpation of the tumor is painless.

Malignant tumors at the beginning of their development are asymptomatic, hidden from the patient himself, and yet their early diagnosis is important. In this regard, when examining persons, especially over 35 years of age, regarding vague complaints, incipient weight loss, long-term continuous and increasing symptoms of the disease without visible reasons oncological alertness should be demonstrated. This concept includes:

1. suspicion of cancer;

2. careful collection of anamnesis;

3. use of general and special methods of use;

4. in-depth analysis and synthesis of the data obtained.

The main complaints of the patient with malignant neoplasm is a violation general condition: loss of general tone at work, apathy, loss of appetite, morning sickness, weight loss, etc. These complaints may be accompanied by more local symptoms: the presence of a chronic disease of the stomach, rectum, the appearance of a lump in the mammary gland, etc. At first, these phenomena may not be accompanied by pain, but then, when the tumor begins to grow into the nerve trunks, pain appears that becomes increasingly intense. and a more tormenting nature. A malignant tumor grows quickly. Substances to nourish cells come from the whole body, causing a lack of nutrition in other tissues and organs. Moreover, despite large number blood vessels in a cancerous tumor, their inferiority often leads to malnutrition in separate areas tumors and decay of these areas. The products of necrosis and decay are absorbed into the body, leading to intoxication, progressive weight loss, exhaustion, and cachexia.

During the course of malignant tumors there are 4 stages:

1 tbsp. - the tumor does not extend beyond the organ, is small in size, without metastases;

2 tbsp. - the tumor is significant in size, but does not extend beyond the affected organ, there are signs of metastasis to regional lymph nodes;

3 tbsp. - the tumor extends beyond the affected organ with multiple metastases to regional lymph nodes and infiltration of surrounding tissues;

4 tbsp. - far advanced tumors with metastasis not only to regional lymph nodes, but also distant metastases to other organs.

Currently, the International Union Against Cancer has proposed a classification of tumors using the TNM system. TNM system provides classification according to three main indicators: T - tumor - tumor (its size, invasion into neighboring organs), N - nodulus - state of regional lymph nodes(density, adhesion to each other, infiltration of surrounding tissues), M - metastasis - hematogenous or lymphogenous metastases to other organs and tissues.

Examination methods.

1. History. In the anamnesis, attention is paid to chronic diseases, the appearance and growth of a tumor, the patient’s profession, and bad habits.

2. Objective examination. After a general examination of the patient, the tumor is examined and palpated (if it is accessible to inspection). Its size, character, consistency and relationship to surrounding tissues are determined. The presence of lesions, distant metastases, and enlargement of regional lymph nodes are determined.

3. Laboratory research methods. Except general analysis blood and urine, all functional studies of the organ in which the tumor is suspected must be performed.

4. X-ray research methods. To diagnose a tumor, a variety of studies are performed: radiography, tomography, kymography, angiography, etc. In some cases, these methods are the main ones for diagnosis and allow not only to identify a tumor, but also to clarify its location, extent, determine the displacement of an organ, etc. Currently Computed tomography is widely used.

5. Endoscopic examination. In the study of hollow organs and cavities, endoscopy (rectoscopy, esophagoscopy, gastroscopy, bronchoscopy, cystoscopy) is widely used. An endoscopic examination makes it possible not only to examine a suspicious area of ​​an organ (cavity), but also to take a piece of tissue for morphological research. A biopsy (excision) followed by microscopic examination is often crucial for making a diagnosis.

6. Cytological examination. Such a study makes it possible in some cases to detect rejected tumor cells in gastric juice, washing water, sputum, and vaginal discharge.

7. For diseases of internal organs, when, despite all the research methods used, the diagnosis of the disease remains unclear and the suspicion of a tumor process has not yet been removed, they resort to diagnostic surgery (chnosection, thoracotomy, etc.).

General principles treatment of tumors.

Treatment of a benign tumor is surgical: excision along with the capsule followed by histological examination. For small, superficially located benign tumors, not disturbing the patient, waiting is possible. The absolute indications for tumor removal are:

1. the presence of a symptom of organ compression, obstruction, caused by a tumor;