LUNG CANCER
Lung cancer - it is a malignant tumor from the epithelium of the mucous membrane of the bronchi or pulmonary alveoli. It is one of the most common malignant neoplasms (second in the world among men and third among women).
By localization the following forms of lung cancer are distinguished:
ü central cancer (bronchogenic) - is localized more often in segmental, less often in the main and lobar bronchi;
ü peripheral (alveolar) cancer - develops from the bronchi of small diameter, as well as from the epithelium.
Disease stages:
first stage - small, localized tumor without germination
pleura and no signs of metastasis;
second stage- tumor as in the first stage or several large
the size, but without the germination of the pleura, there are single metastases in the nearest regional lymph nodes;
third stage- a tumor that has gone beyond the lung, growing into
one of the neighboring organs in the presence of numerous metastases in regional lymph nodes;
fourth stage - a tumor of any size, but there is at least one
distant metastasis. Lung cancer usually metastasizes to the liver, stomach, kidneys, lymph nodes, brain, ribs, and vertebrae.
Etiology. Immediate causes the occurrence of cancer is still quite unknown. Among contributing factors smoking plays a leading role. Less significant are factors such as air pollution with dust, car exhaust gases, occupational hazards (asbestos, asphalt production, bitumen, chromium, nickel, rubber compounds), drugs, as well as chronic nonspecific respiratory diseases.
Clinic. In the clinical picture of lung cancer, general action symptoms cancerous tumor, i.e. manifestations of intoxication associated with the impact on the body of the waste products of the tumor itself - weakness, increased fatigue, increased body temperature, weight loss (up to 10-15 kg per month), and local symptoms due to changes in the lung itself. Symptoms of cancer intoxication are manifested in an early degree in both central and peripheral localization of cancer. Local symptoms are different.
Central cancer... Disturbing cough - dry or with a small amount of sputum, sometimes streaked with blood. Chest pain usually occurs in later stages and is associated with pleural involvement or atelectasis.
Peripheral cancer. It is asymptomatic for a long time and is sometimes detected by chance. One of the first and main symptom is chest pain, radiating in various directions, which is due to the growth of a tumor into the pleura or mediastinum.
Late stage both central and peripheral lung cancer is characterized by symptoms associated with metastatic lesions of other organs (mediastinum, liver, stomach, pancreas). With metastases, symptoms corresponding to the affected organ appear: the liver enlarges and becomes dense, bumpy, painful; there are pains in the bones, spontaneous fractures of the ribs and spine, pain in the stomach, etc.
Complications: pulmonary hemorrhage, spontaneous pneumothorax, lung atelectasis, pleurisy.
Diagnostics.
Laboratory research. In the general analysis of blood, leukocytosis, increased ESR, anemia are revealed. Atypical (cancerous) cells are determined in sputum, bronchial washings, pleural exudate.
Instrumental research. X-ray examination of the lungs (X-ray, X-ray tomography, computed tomography) reveals a shadow in the root zone with central lung cancer and a shadow in the peripheral areas of the lung tissue with peripheral. In the diagnosis of central lung cancer, bronchoscopy is the most informative, which allows you to see the tumor itself and produce a biopsy of a piece of tumor tissue with subsequent histological examination. In some cases, bronchography is performed (X-rays after filling the bronchi with a contrasting mass) in order to identify a tumor that has blocked the lumen of the bronchus and impedes the advancement of the contrasting mass (bronchial stump).
Treatment. The main methods of treatment for lung cancer are surgical, radiation, chemotherapy and combined (surgical + radiation + chemotherapy).
Chemotherapy carried out with drugs such as methotrexate, embihin, adriamycin, pharmacorubicin, vincristine, cyclophosphamide, cisplastin and others - in individual doses according to special schemes with careful control of side effects (headache, weakness, nausea, vomiting, allopecia, allergic reactions, pain in heart, heart failure.
The results of surgical treatment of patients with lung cancer are significantly improved with preoperative radiation therapy, which reduces perifocal inflammation, prevents and reduces metastasis during surgery and in the postoperative period.
In the inoperable stage, symptomatic (palliative) treatment.
Anesthesia. Currently, pain therapy is carried out according to a three-stage scheme. WHO, which provides for the use of analgesics with increasing potency as the intensity of pain increases in combination with coanalgesics (anticonvulsants, sedatives, hypnotics, antidepressants, tranquilizers);
1st stage - analgesics (analgin), non-steroidal anti-inflammatory drugs (diclofenac, nimesulide, paracetamol, ibuprofen);
Stage 2 - stronger analgesics (ketans) and "weak" opioids (tramadol);
3rd stage - narcotic analgesics (promedol, morphine, fentanyl).
For severe pain, patients should receive strong pain relievers. Tramadol treatment is well tolerated: the quality of life improves (sleep and appetite are normalized), which distinguishes the drug from narcotic analgesics that inhibit the physical and mental activity of patients. The use of narcotic analgesics is also associated with the development of physical dependence on them and tolerance to them. Fentanyl is now widely used in transdermal form (a transdermal patch with various drug dosages). The analgesic effect when using the patch lasts up to 72 hours.
With nausea and vomit prescribe antiemetics (cerucal, motilium). Loss of appetite and malnutrition up to complete exhaustion (cachexia) is also a common symptom in cancer patients with an advanced form. Such patients undergo artificial and parenteral nutrition(fat emulsions, amino acids, glucose solution, vitamins, etc.) under medical supervision.
Nursing care. The greatest difficulty is caring for a patient in an inoperable stage, which provides for the maximum relief of the patient's suffering, ensuring his needs. Nursing interventions for lung cancer should be carried out taking into account the prevalence of the process, the stage of tumor development, the main symptoms of the disease, the general reactivity of the body, the side effects of pharmacotherapy and possible complications in order to prevent them.
Nurse:
· Provides: timely and accurate fulfillment of doctor's prescriptions;
provision of first aid for hemoptysis and pulmonary hemorrhage; control over transfers of relatives; control of blood pressure, respiratory rate, pulse, preparation for X-ray examination;
Provides psychological support to the patient and his
relatives;
· Conducts discussions about the importance of systematic medication intake;
teaching patients and their relatives to care (self-care) for the prevention of pressure ulcers, the rules for taking medications, the rules for monitoring the respiratory rate, pulse.
Nursing process for lung cancer.
Patient M., 65 years old, is being treated at an oncological dispensary with a diagnosis of central lung cancer, stage 3. The nurse established complaints of severe chest pains, cough with mucous sputum, severe weakness, fever up to subfebrile numbers, poor appetite, weight loss of 3 kg in the last month. Objectively: the patient's condition is of moderate severity. The skin is pale. The ribcage is of normal shape, both halves are evenly involved in the act of breathing. A patient with low nutritional status, body temperature 37.0 C, NPV 18 per minute, BP 120/70 mm Hg. Art. The patient is worried about his condition, claims that his mother died of cancer and he expects the same outcome.
Tasks:
1) determine the needs, the satisfaction of which is violated; formulate the patient's problems;
2) set goals and plan motivated nursing interventions.
Sample answer:
1. Patient has impaired satisfaction needs breathe, eat, be healthy, work, be safe.
The problems are real: severe weakness, chest pain, cough with sputum, weight loss, concern about your condition. Potential problems: high risk of pulmonary bleeding.
Priority issue: severe chest pain.
2. Short term goal: the patient will notice a decrease in pain to tolerable
end of the week. Long term goal: the patient will not experience pain when discharged from the hospital.
| Nursing interventions | Motivation |
| Provide a therapeutic and protective regime, the main diet option | Effective treatment |
| Provide physical and mental rest | Restriction of pleural mobility and pain relief |
| Provide an individual spittoon, control its disinfection | Prevention of nosocomial infection |
| Explain the benefits of shallow breathing and limiting physical activity | Reducing pain due to limited mobility of the pleural sheets |
| To teach the techniques of self-hypnosis and recalculation during the week, every day for 15 minutes | Calming the patient and adapting to his condition |
| Ensure that pain relievers are taken as directed by a physician | Control over the dynamics of the disease and prevention of complications |
| Monitor the condition of the skin color, temperature, pulse, NPV, blood pressure, sputum | Prevention of complications |
| Timely report to the doctor about changes in the patient's condition | Psycho-emotional relief |
| Observe ethical and deontological rules when communicating with the patient and his relatives | Effective treatment |
| Correctly and timely fulfill the doctor's prescriptions | Effective treatment |
Evaluation of the effectiveness of nursing interventions: the patient noted a decrease in chest pain to bearable. The goal has been achieved.
Prevention:
primary: fight against smoking, other bad habits, environmental air pollution; carrying out sanitary and hygienic measures in production in order to reduce dustiness of workplaces, gas pollution of premises, occupational hazards; formation of healthy lifestyle skills;
secondary: timely detection and treatment of the initial stages of the disease. Patients with lung cancer are subject to dispensary observation at the oncological dispensary. The frequency of examinations and preventive treatment is prescribed by an oncologist.
Control questions
1. Give a definition of the term "lung cancer", outline the classification of lung cancer.
2. Name the predisposing factors for lung cancer.
3. Describe the clinical picture of central and peripheral lung cancer, diagnosis.
4. Outline the principles of lung cancer treatment.
5. List the nursing care activities.
6. Describe the nursing process in bronchial asthma.
7. Outline preventive measures.
The work of a nurse working with cancer patients is structured according to the stages of the nursing process.
Stage I. Initial assessment of the patient's condition. At the first contact with a cancer patient, the nurse gets to know him and his relatives, introduces herself. Conducts a survey and examination of the patient, determining the degree of his physical activity, the possibility of independent physiological functions, assesses the functional capabilities of vision, hearing, speech, determines the mood of the patient and his relatives prevailing at the time of admission, focusing on facial expressions, gestures, and the desire to make contact. The nurse also assesses the patient's condition by the nature of breathing, the color of the skin, measuring blood pressure, counting the pulse rate, data from laboratory and instrumental research methods.
All data of the initial examination is analyzed by the nurse and documented.
Stage II. Diagnosing or identifying patient problems.
When working with cancer patients, the following nursing diagnoses can be made:
Pains of various localization associated with the tumor process;
· Low nutrition associated with a decrease in appetite;
• fear, anxiety, anxiety associated with a suspicion of an unfavorable outcome of the disease;
• sleep disturbance associated with pain;
· Unwillingness to communicate, take medications, refusal of the procedure associated with a change in the emotional state;
· Inability of loved ones to take care of the patient, associated with a lack of knowledge;
Weakness, drowsiness due to intoxication;
Pallor of the skin due to a decrease in hemoglobin;
· Decreased physical activity due to pain and intoxication.
Stage III Stage IV
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PLANNING THE HELP YOU NEED FOR THE PATIENT |
IMPLEMENTATION OF THE NURSING INTERVENTION PLAN |
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Fulfillment of doctor's prescriptions |
1. Control over the timely administration of medications. 2. Teaching the patient to receive various dosage forms enterally. 3. Diagnosed complications arising from the parenteral route of drug administration. 4. Orientation of the patient to timely seeking help in the event of side effects of drugs. 5. Monitoring the patient's condition during dressings, medical procedures. |
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Elimination of drug overdose |
Information of the patient about the exact name of the drug and its synonyms, about the time of the appearance of the effect. |
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Helping the patient with hygiene measures |
1. Train the patient (patient's relatives) to conduct hygiene procedures. 2. Obtain the patient's consent to carry out personal hygiene manipulations. 3. Help the patient clean the mouth after each meal. 4. Wash vulnerable areas of the patient's body as it gets dirty. |
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Providing a comfortable microclimate in the ward, conducive to sleep |
1. To create comfortable conditions for the patient in bed and in the ward: the optimal bed height, a high-quality mattress, the optimal number of pillows and blankets, ventilation of the ward. 2. Reduce the patient's anxiety associated with unfamiliar surroundings. |
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Providing a balanced diet for the patient |
1. Organize dietary meals. 2. Create a supportive environment while eating. 3. Provide assistance to the patient while eating or drinking. 4. Ask the patient in what sequence he prefers to eat. |
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Reducing patient pain |
1. Determine the localization of pain, time, cause of pain, duration of pain. 2. Analyze, together with the patient, the effectiveness of previously used anesthetic drugs. 3. To divert attention by communication. 4. Train the patient in relaxation techniques. 5. Taking analgesics by the hour, not on demand. |
Stage V. Evaluation of nursing interventions. The time and date for evaluating the effectiveness of nursing interventions should be indicated for each problem identified. Nursing outcomes are measured by change in nursing diagnoses. When determining the effectiveness of nursing interventions, the opinion of the patient and his relatives is also taken into account, their contribution to the achievement of the set goals is noted. The care plan for a seriously ill patient has to be constantly adjusted, taking into account the change in his condition.
The nursing process for lung cancer is a well-established and carefully verified algorithm of actions. It can be different depending on the patient's state of health, whether care was previously provided and other nuances of the disease. For the sick, the nursing process guarantees the possibility of a quick recovery and restoration of the body.
In order for patient care to be complete, it is necessary to organize the courting process in the right way. A mandatory stage is the stage at which the doctor will study the medical history, past or current chronic diseases, the presence or absence of complications and other critical consequences. This process should be controlled not only by a special team, but also by the attending oncologist who knows the nuances of the condition associated with the patient.
Care is required to be organized based on the following precise criteria and characteristics:
- the patient's age and gender;
- the place of care and rehabilitation, based on the fact that it is a hospital, living quarters and other options that are discussed at the council;
- the nuances of looking after the patient and family members.
An important condition is the control over the implementation of the presented measures and the dynamic change of conditions, if necessary. The nurse should coordinate the actions with the oncologist and other specialists, which will make it possible to ensure that the patient is cured, the oncology does not manifest itself and targeted therapy is not needed.
Qualification of specialists
Caring for a cancer patient is an event that should take into account not only the medical history, but also numerous other nuances. Therefore, a prerequisite for the work of a nurse is qualification. She should have a complete knowledge of oncology, respiratory and other types of diseases.
It is necessary that she mastered such knowledge as targeted therapy, recovery from radiation and chemotherapy. This will speed up the recovery process, increase its quality and efficiency.
In order for a nurse to provide effective patient care, she must be certified annually.
An equally necessary parameter is professional development, which can be carried out less than once a year, but must be present. This will expand the knowledge about oncology and gain new knowledge about how to provide care, whether targeted therapy has been updated, how to measure fluid, and other innovations related to scientific advances in medicine.
Only in such a situation can a nurse be considered 100% prepared to care for a patient with lung cancer. This will allow her to be prepared for the unexpected and know exactly how to prepare the room for the patient so that the targeted therapy and medical history are positive.
How to prepare a room
One of the most important steps in the provision of nursing care is the preparation of the premises, if the process is carried out in an ordinary apartment or private home. It is recommended that you pay attention to the following points to improve patient care:
- availability of all basic necessities: telephone, water, food and everything else;
- the ability to urgently ask for help from someone who is nearby, to determine the nature of shortness of breath;
- the correct equipment of the bed, allowing you to independently rise or change position.
Oncologists pay attention to the fact that regardless of what the medical history is, the room should be spacious and ventilated, with the ability to accommodate the necessary medical equipment. At the same time, it should remain as warm as possible, without the penetration of drafts and other negative phenomena. The room must be kept clean at all times, meaning daily cleaning and disinfection as needed.
This will prove to be a guarantee that targeted therapy will be 100% successful, fluid in the body will be restored, and care will no longer be required. In order for this to remain relevant, it is necessary to have complete knowledge of how to supervise the patient at the initial stage of therapy.
Initial process
The nursing process, carried out in the early stages of lung cancer, is no less important than in the later stages. This is what will stop the growth of cancer cells, optimize fluid in the body, regardless of what the medical history is. Such supervision of the patient is necessary in order to fully comply with the recommendations of the oncologist, diet, intake of medicinal components and medications.
The first and second stages of cancer can be complicated, so the nurse must be ready to care and provide the conditions that are necessary in a particular case. For example, targeted therapy can be carried out under specific conditions that have not been encountered in other patients. Therefore, the qualifications of a nurse and her ability, knowledge of all oncological processes, deviations and problem points are important. An equally complex and specific process is the provision of care in the late stages of the development of lung cancer, when the medical history indicates high mortality rates, and therapy is ineffective.
Process in the later stages
From a moral point of view, caring for patients who are at an advanced stage of oncology is much more difficult. Due to this:
- the nurse must be prepared for stressful situations;
- the specialist must know everything about providing care for cancer patients who cannot move independently or experience severe pain;
- you may need the help of another nurse or oncologist in an emergency.
The requirements for the room, how the fluid flows, remain the same for all cancer patients. However, in the later stages of the development of the disease, constant supervision is required, being close to the patient. He may need help, the use of a new dose of pain relievers or other substances of medical importance, due to which the therapy is facilitated.
In some cases, assistance from relatives who have medical knowledge or sufficient experience to ensure proper care of the patient is acceptable. The situation of the implementation of the nursing process in the case of elderly people facing lung cancer is considered separately.
Elderly care
The process of caring for the elderly, their medical history is always the most difficult, and therefore the most qualified persons are allowed to work in the presented situation. This will guarantee the correct algorithm, as well as ensure the safety of the patient if, for example, he loses his balance.
In the case of elderly patients, supervision implies adherence to dietary nutrition, the use of vitamin and mineral complexes - in general, everything that supports vital processes. With a previous operation, a long rehabilitation period is shown, which in people over 55 lasts 50% longer. This is true in the case when targeted therapy was completed successfully, but the medical history is associated with similar diseases. In order to determine the effectiveness of the support, how the fluid and other necessary components are supplied, an assessment of the nursing process is envisaged, thanks to which the therapy is facilitated.
Nursing process assessment
In addition to qualifications, nurses who carry out the nursing process should take into account that a special assessment is carried out by higher specialists. It implies:
- determining the degree of effectiveness of the course by objective symptoms: improvement of the condition, normalization of pressure indicators and other physiological parameters;
- identification of success according to the personal opinion of the patient and his family members;
- the success of the preparation of the premises, the maintenance of cleanliness in it and other mandatory criteria outlined earlier.
Regardless of what the medical history is, the presented stage is mandatory. It makes it possible to determine how professional the nurse is and whether she needs additional refresher courses. Such an assessment is carried out after each case of caring for a new patient or during the presented process, if there is such a need and additional care is needed.
In order for the nursing-type process to be even more successful and effective, the implementation of prevention is shown, which at the initial stage should be controlled jointly by a nurse and an oncologist.
Preventive actions
Not a single nursing process is complete without correct and long-term prevention. The presented stage may take no less time than the main treatment, and therefore the patient needs to be patient. Prevention for lung cancer is to exclude the effects of bad habits. We are talking about nicotine addiction, the use of alcoholic and narcotic components.
An indispensable element is the use of additional medicines that improve the functioning of the body, strengthen the immune system and increase the natural degree of resistance.
In order for the process to be 100% effective, and recovery - fast, exposure to negative components: chemicals, asbestos should be avoided. Places with excellent ecological conditions and clean air are recommended for people who have recovered from lung cancer. Exclusively with this approach, the patient can be confident in the state of his health and the exclusion of the likelihood of relapse.
Lung cancer is a serious disease that requires nursing. This will make it possible to alleviate the patient's condition, the algorithm for caring for him, and also make it possible to exclude the development of complications and other critical consequences. It is the nursing process that will allow you to maintain the maximum degree of vital activity and activity.
Coursework
Medicine and veterinary medicine
Two cases illustrating the tactics of a nurse in the implementation of the nursing process in patients with this pathology; the main results of the examination and treatment of the described patients in the hospital Research methods: The following methods were used for the study: scientific-theoretical analysis of the medical literature on this topic; empirical observation additional research methods: organizational comparative complex method; subjective method of clinical examination of the patient collection ...
Executor: student group 402
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P. |
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INTRODUCTION |
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1. LUNG CANCER |
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1.1. Etiology |
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1.2. Classification |
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1.3. Clinic |
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1.4. Treatment features |
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1.6. Complications |
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1.7 Prevention, rehabilitation, prognosis |
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2. NURSING PROCESS FOR LUNG CANCER |
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3 PRACTICAL PART |
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3.1. Observation from practice 1 |
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3.2. Observation from practice 2 |
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3.3. conclusions |
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4. CONCLUSION |
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5. LITERATURE |
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6. APPENDICES |
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Introduction
In the 20th century, medicine won an almost complete victory over terrible diseases, most diseases are more or less successfully treated or prevented. People began to live longer, and in civilized countries, diseases, the likelihood of which increases with age, came to the fore, with various disorders of the cardiovascular system taking the first place in mortality, and cancer second.
The problem of timely diagnosis and treatment of lung cancer is becoming increasingly important every year due to the steady increase in the incidence and mortality from cancer in this localization. In the structure of oncological morbidity, lung cancer in Russia takes the first place.
More than 1.2 million new cases of lung cancer are registered in the world every year (more often among men), which is more than 12% of all diagnosed malignant neoplasms, of which up to 60% are in developed countries. 921 thousand deaths from lung cancer are registered. 1997 to 2012 the increase in the number of cases of cancer was 13%. The incidence of lung cancer (LC) decreased by 12.9.
Currently, in most developed countries, lung cancer is the most common form of tumor in men and remains one of the most important medical and socio-economic problems. Medicine has not yet learned how to prevent cancer. Today, even qualified treatment using the most modern methods does not guarantee a complete recovery from this disease and can cause severe side effects.
The urgency of the problem of lung cancer remains one of the most common malignant neoplasms in our country. Early diagnosis of the disease and timely radical treatment are the main predictions for the 5-year survival rate of patients with lung cancer. Analysis of the state of diagnosis of lung cancer shows that only the use of methods for active detection of tumors can increase the percentage of patients with early stages of the disease. Hence it follows that in order to effectively address the issues of diagnosing early forms of lung cancer, it is necessary to further improve organizational measures to identify preclinical forms of the disease during fluorographic examination of the population and in general medical institutions. And a special place in preventive and diagnostic measures is the role of a district nurse, a nurse. general practice, nurse advisory office.
Subject of studynursing process for lung cancer.
Object of studynursing process.
Purpose of the studyNursing process for lung cancer.
Tasks:
To achieve this research goal, it is necessary explore:
- The etiology and predisposing factors of this disease;
- The clinical picture and features of the diagnosis of lung cancer disease;
- Survey methods and preparation for them;
- Lung cancer treatment and prevention principles;
- Manipulations performed by a nurse in caring for a patient with lung cancer;
- Features of the nursing process in this pathology.
- Two cases illustrating the tactics of a nurse in the implementation of the nursing process in patients with this pathology;
- the main results of examination and treatment of the described patients in the hospital
Research methods:
The following methods were used for the study:
- scientific and theoretical analysis of medical literature on this topic;
- empirical - observation, additional research methods: organizational (comparative, complex) method;
- subjective method of clinical examination of the patient (collection of anamnesis);
- - objective methods of patient examination (physical, instrumental, laboratory).
The practical value of the course work:Detailed disclosure of material on this topic will improve the quality of nursing care.
Lung cancer
Lung cancer (bronchogenic carcinoma, cancer puhnomm) is a malignant tumor of the lung, arising mainly from the integumentary epithelium of the bronchial mucosa, epithelium of the glands of the bronchial wall (bronchogenic cancer) and very rarely from the alveolar epithelium (pneumonia).
- Etiology and pathogenesis.
Until now, the causes of lung cancer have not been clarified.
Risk factors:
- Age 55-65 years old;
- Hereditary predisposition;
- Smoking (the main risk factor), which is associated with more than 90% of all cases of this disease in men and 78% in women;
- Exposure to chemicals: professional contact with asbestos, cement dust, radon, nickel, sulfur compounds, etc.;
- Chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis.
Lung cancer is classified into the following stages:
- Stage I - a tumor up to 3 cm in the largest dimension, located in one segment of the lung or within the segmental bronchus. There are no metastases.
- Stage II - a tumor up to 6 cm in the largest dimension, located in one segment of the lung or within the segmental bronchus. There are single metastases in the pulmonary and bronchopulmonary lymph nodes.
- Stage III - the tumor is more than 6 cm with the transition to the adjacent lobe of the lung or germination of the adjacent bronchus or main bronchus. Metastases are found in bifurcation, tracheobronchial, paratracheal lymph nodes.
- Stage IV - the tumor extends beyond the lungs with spread to neighboring organs and extensive local and distant metastases, cancerous pleurisy joins.
- The clinical picture.
Clinical manifestations of lung cancer significantly depend on the localization of the primary tumor node.
Central cancer
- Endobronchial
- Peribronchial nodular
- Depressed
Peripheral
- Round swelling
- Pneumonia-like cancer
- Apex lung cancer
Atypical forms of cancer associated with the characteristics of metastasis.
Complaints
- Weakness
- Cough
- Sputum
- Chills
- Chest pain
- Hemoptysis
- Difficulty swallowing
- Regurgitation
- Weight loss
- Lack of appetite
- Bedsores
- Diagnostic methods and preparation for them.
- general clinical blood and urine tests;
- biochemical study of blood parameters;
- cytological examinations of sputum, bronchial lavage, pleural exudate;
- assessment of physical data;
- X-ray of the lungs in 2 projections, linear tomography, CT of the lungs
- pleural puncture (if there is an effusion);
- diagnostic thoracotomy;
- pre-scalded lymph node biopsy;
- bronchoscopy
Bronchoscopy - visual examination of the larynx, trachea and bronchi from the inside using a special optical device - a bronchoscope, which is a flexible elastic controlled probe equipped with an optical system, which is inserted through the nose (sometimes through the mouth), usually in a sitting position under local anesthesia.
With the help of the optical system of the device, the doctor examines in detail the enlarged image of the walls of the larynx, vocal cords, mucous membrane of the trachea and bronchi. If necessary, you can take pieces of tissue for histological examination. This procedure is called biopsy ... It proceeds absolutely painlessly. All this allows you to quickly and accurately diagnose, including at the earliest stages of the development of the disease (inflammation, swelling, foreign body). Based on the data of bronchoscopy, the doctor will select the most appropriate treatment for each patient.
Preparation for research.
- The study is performed on an empty stomach in the morning.
- In the evening on the eve of the study (until 20:00) a light dinner.
- After testing, do not drink or eat for 30 minutes.
1.4. Treatment.
Surgery
Surgical intervention is divided into:
- radical
- conditionally radical
- palliative
In a radical operation, the entire tumor complex is removed: the primary focus, regional lymph nodes, tissue with metastatic pathways. Radiation and drug therapy is added to conditionally radical surgery. It should also be borne in mind that part of the primary tumor tissue and metastases sometimes cannot be surgically removed due to the threat of bleeding or decay processes in atelectasis.
Contraindications to radical surgery are:
- inoperability - the spread of the tumor to adjacent tissues and organs
- inexpediency due to distant metastases to the liver, bones and brain
- insufficiency of the functions of the cardiovascular and respiratory systems
- severe diseases of internal organs
Surgical removal of the tumor is often accompanied by a wide removal of the root, tracheobronchial lymph nodes, tissue and lymph nodes of the mediastinum, resection of the chest wall, pericardium, diaphragm, tracheal bifurcation, atrium, great vessels (aorta, superior vena cava), muscle wall of the esophagus and other tissues that have grown by the tumor.
Radiation therapy
Radiation treatment of lung cancer is carried out with its inoperable forms, in case of refusal of the patient from surgical treatment, as well as in the presence of serious contraindications to surgery. The greatest effect is observed with radiation exposure to squamous cell and undifferentiated forms of lung cancer.
Radiation intervention is used for both radical and palliative treatment. With radical radiation treatment, both the tumor itself and the areas of regional metastasis, that is, the mediastinum, are irradiated with a total dose of 60-70 Gy.
Chemotherapy
In non-small cell lung cancer, chemotherapy is performed if there are contraindications to surgical and radiation treatment. In this case, the following drugs are prescribed: doxorubicin, cisplatin, vincristine, etoposide, cyclophosphamide, methotrexate, bleomycin, nitrosylurea, vinorelbine, paclitaxel, docetaxel, gemcetabin, etc., used in courses at intervals of 3-4 weeks (up to 6 courses).
Partial reduction in the size of the primary tumor and metastases is not observed in all patients; complete disappearance of malignant neoplasms is rare. Chemotherapy is ineffective for distant metastases in the liver, bones, head palliative treatment
Palliative treatment for lung cancer is used when the options for cancer treatment are limited or exhausted. Such treatment is aimed at improving the quality of life of incurable patients and includes:
- anesthesia
- psychological assistance
- detoxification
- palliative surgery (tracheostomy, gastrostomy, enterostomy, nephrostomy, etc.)
Palliative care for lung cancer is used to combat shortness of breath, cough, hemoptysis, pain. Treatment of pneumonia and pneumonitis associated with the tumor process, which occurs during radiation and chemotherapy, is carried out.
The methods of palliative treatment are largely individual and depend on the patient's condition.
1.5. Complications.
In advanced forms of lung cancer, complications from the organs affected by metastases, the decay of the primary tumor, the phenomena of bronchial obstruction, atelectasis, and profuse pulmonary hemorrhages join. The causes of death in lung cancer are most often extensive metastases, cancerous pneumonia and pleurisy, cachexia (severe exhaustion of the body).
1.6. Prevention.
The most important elements of lung cancer prevention are active health education, prevention of the development of inflammatory and destructive lung diseases, detection and treatment of benign lung tumors, smoking cessation, elimination of occupational hazards and daily exposure to carcinogenic factors. Undergoing fluorography at least once every 2 years allows you to detect lung cancer in the early stages and prevent the development of complications associated with advanced forms of the tumor process.
1.7. Nurse manipulation.
- Blood pressure and PS measurements
- Taking blood for biochemical analysis
- Collection of sputum for oncocytology
- Preparation for X-ray examination
Taking blood from a vein for biochemical analysis
Equipment: sterile tray, clean tray for material use, sterile tweezers, clean (non-sterile) tweezers, sterile cotton balls (gauze balls), sterile gauze wipes, test tubes, tourniquet, 70% alcohol or other skin antiseptic, container with disinfectant for soaking waste material.
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Action |
Justification |
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1.Preparation for the procedure |
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Prepare the patient for the upcoming procedure |
Respect for patient rights |
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Wash, dry your hands |
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Prepare equipment |
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Remove the sterile tray from the packaging |
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|
Prepare 5-6 cotton balls and a sterile napkin |
Compliance with the rules of asepsis and antiseptics |
|
Prepare a blood collection tube from a vein |
Prerequisite for the procedure |
|
2.Performing the procedure |
|
|
Help the patient get into a comfortable position |
So that the patient does not experience discomfort during the procedure |
|
Put a pad under the elbow |
Maximum extension in the elbow joint is achieved |
|
Apply a tourniquet in the middle third of the shoulder |
A tourniquet is applied to improve blood flow to the veins |
|
Ask the patient to "use the cam" |
Improvement of blood circulation in veins, as the flow of arterial blood increases |
|
Put on gloves |
Compliance with the rules of infection safety |
|
Palpate the vein at the elbow |
Prerequisite for determining the injection site |
|
Finish the inner surface of the elbow twice |
Removing microorganisms and impurities from the skin surface |
|
Fix the vein |
Prevention of complications |
|
Puncture the vein, make sure the needle is in the vein |
Prevention of complications |
|
Continuing to slowly pull the plunger towards you, draw the required amount of blood into the syringe |
The use of closed vacuum tubes significantly speeds up the blood collection process and reduces the risk of hemolysis |
|
Untie the tourniquet, ask the patient to unclench his fists |
Restoration of venous blood flow, reduction of arterial blood flow to the limb |
|
Press a cotton ball moistened with an antiseptic to the puncture site, remove the needle and bend the patient's arm at the elbow |
Prevention of complications |
|
3.Completion of the procedure |
|
|
Take off gloves, wash, dry hands |
Compliance with the rules of infection safety |
1.8. Features of the nursing process for lung cancer
1st stage - nursing examination of the patient.
When interviewing a patient with lung cancer, the nurse will clarify all of the patient's complaints.
Stage 2 - identification of the patient's problems.
After assessing the patient's condition, the nurse identifies the patient's problems. In lung cancer, they can be as follows:
- Weakness
- Cough
- Sputum
- Chills
- Chest pain
- Hemoptysis
- Difficulty swallowing
- Regurgitation
- Weight loss
- Lack of appetite
- Bedsores
After the assessment, the sister decides on their priority.
3rd stage - planning of nursing interventions.
Features of the patient in self-care.
4th stage - implementation of the nursing intervention plan.
Nursing interventions are carried out in collaboration with other health professionals. During this period, it is necessary to coordinate the actions of the nurse with the actions of the patient, other health workers, relatives, taking into account their plans and capabilities.
5th stage - assessment of nursing interventions.
Evaluation of nursing interventions is ongoing. The effectiveness of nursing care is determined after the goals are achieved.
The nurse in the nursing history records the patient's opinion of the care provided to him, the implementation of the care plan, the effectiveness of nursing interventions, side effects and unexpected results when performing nursing interventions.
Practical part
2.1. Observation from practice 1
A 47-year-old patient was admitted to the clinic with complaints of dry cough, shortness of breath during exertion, pain in the left side of the chest, fever up to 37.5 degrees during the last month, BP - 110/70 mm. rt. Art., NPV - 24 per minute, pulse 79 beats. per minute, rhythmic.
Examination on a radiograph in a direct projection revealed a pronounced darkening of the upper lobe of the left lung, on the lateral - a triangular shadow, during the survey it was revealed that the patient worked at a cement plant, smoked for 30 years.
Implementation of the nursing process.
First step
assessment of the patient's condition (examination).
The purpose of the assessment: to obtain information about the patient's condition.
For a competent assessment, it is necessary to collect objective and subjective data on the patient's health with their subsequent analysis, to determine the specific needs for nursing care and the ability of a person or family to provide assistance on their own.
The patient complains of fever, chest pain, weakness, loss of appetite, weight loss. The patient is restless, worried about his condition. The patient's condition is satisfactory. Pulse 79 beats. per minute, rhythmic, BP - 110 / 70mm. rt. Art. NPV - 24 per minute. Temperature 37, 3 C.
In accordance with the data received, the nurse fills out a sheet of initial assessment of the patient's condition.
Second phase nursing process: interpretation of the findings.Purpose: the formulation of existing (actual) and potential (probable) problems arising in the patient in connection with his condition, including as a reaction to the disease.
After the identification of problems, the identification of priority, actual and potential problems occurs.
During the examination, several problems can be identified at the same time, in this case the nurse must prioritize the sequence of their resolution, taking into account the risk to the life and health of the patient.
Patient problems:
The real ones:
chest pain;
Weakness;
Anxiety about your condition;
Fever
Decreased appetite
Potential:
Hemoptysis
Pulmonary bleeding
Priority - shortness of breath, pain in the left side of the chest
Stage three : planning nursing interventions.
Patient care plan inincludes the definition:
a) objectives (expected result) for each problem;
b) the nature and volume of nursing intervention required to achieve the goals;
c) duration of nursing intervention.
Goals distinguish between short-term and long-term.
Goals:
- the patient notes an improvement in the general condition;
- the patient makes contact, realistically assesses his condition, does not show excessive anxiety;
- chest pains have decreased;
- temperature is within normal limits;
- the patient has mastered the skills of self-care;
Fourth stage: implementation of the drawn up plan.
Nursing interventions recorded in a care plan are a list of the nurse's actions to address a particular patient's problems.
Nursing interventions can be:
a) addicts (fulfillment of doctor's prescriptions);
b) independent (actions carried out by a nurse on her own initiative based on her own considerations without a direct doctor's prescription):
c) interdependent.
Nurse actions.
- Dependents. As prescribed by the doctor, the nurse will provide the administration of pain relievers (pain relief), vitamin preparations.
- Teaching the patient to self-care;
- Provide the patient with the necessary literature (ensuring patient awareness, reducing anxiety);
- Providing psychological comfort (reducing anxiety);
- General care elements;
- Increased fluid intake (reduced intoxication);
- Monitoring.
Fifth stage - evaluation of the results of nursing interventions.
Evaluation of the effectiveness of care.
Purpose: to assess the patient's response to nursing intervention, to analyze the quality of care provided and to evaluate the results obtained.
The patient notes a significant improvement in his general condition.
The goal has been achieved.
2.2. Observation from practice 2
A 50-year-old patient was admitted to the clinic with complaints of a painful painful cough with scanty, mucous sputum, streaked with blood, shortness of breath and pain in the right side of the chest. These complaints appeared three months ago after hypothermia. Outpatient treatment was carried out for right-sided lower lobe pneumonia. However, there was no improvement. With repeated fluoroscopy of the chest - displacement of the mediastinum to the right.
- Signs of pulmonary bleeding.
Information that allows you to suspect a medical emergency:
Pale skin;
Low blood pressure;
Great blood loss;
- Nurse's algorithm of actions:
- calling a doctor in order to provide qualified assistance;
- to provide physical and mental rest, exclusion of sound and light stimuli;
- according to the doctor's prescription, introduce medications: painkillers (promedol, diphenhydramine), hemostatic (vicasol, dicinon, etamsilat);
- monitor the patient's appearance, blood pressure and blood loss;
- prepare the patient for surgery.
conclusions
Having thoroughly studied the nursing process in lung cancer, having analyzed two cases from practice, it was concluded that the goal of the work has been achieved. In the course of the work, it was shown that the use of all stages of the nursing process, namely:
Stage 1: assessment of the patient's condition (examination);
Stage 2: interpretation of the data obtained (identification of the patient's problems);
Stage 3: planning the upcoming work;
Stage 4: implementation of the drawn up plan (nursing interventions);
Stage 5: evaluation of the results of the listed stages, allows you to improve the quality of nursing care.
So, the purpose of the nursing process is to maintain and restore the independence of the patient, to meet the basic needs of the body. As part of nursing interventions for lung cancer, the nurse should talk with the patient and / or family about the risk factors for complications. She should teach the patient the principles of rational nutrition, taking medications as prescribed by the doctor, and outline the correct mode of physical activity with him. It is necessary to teach the patient to care for the skin and mucous membranes, for the oral cavity, nails, hair. The nurse should provide psychological support to the patient.
Conclusion
In conclusion, we can conclude that modern ideas about the development of nursing in society is to help individuals, families and groups to develop their physical, mental and social potential and maintain it at an appropriate level, regardless of changing living and working conditions. This requires the nurse to work to promote and maintain health and prevent disease.
Literature
- A.V. Syromyatnikova, M.S. Brookman. A guide to the practice of surgery. Moscow, Alliance, 2007.
- V.V. Ershov. Legal support of professional activity. Moscow, Anmi, 2003.
- V.I. Makolkin, S.I. Ovcharenko. Nursing in therapy. Moscow, Anmi, 2002.
- I.I. Goncharik, V.P. Well-fed. A practical guide to therapy. Minsk, Higher School, 2002.
- K.E. Davlitsarova, S.N. Mironov. Manipulation technique. Moscow, Forum-Infra-M., 2005
- N.V. Shirokova, I. V. Ostrovskaya. Fundamentals of Nursing. Moscow, Anmi, 2006.
- N.V. Turkina, A.B. Filenko. General patient care. Moscow, KMK Scientific Publishing Association, 2007.
- T.V. Kozlov. Legal support of professional activity. Moscow, Geotar-Media, 2008.
- Yu.A. Nesterenko, V.A. Stupin. Surgery. Moscow, Academy, 2007.
- Yu.P. Nikitin. Nurse Encyclopedia. Moscow, KMK Scientific Publishing Association, 2007.
Appendix 3
APPLICATION FOR 200__ year (anonymous)
Dear patient!
The reform of nursing is aimed at improving the quality of medical care for the population and the quality performance of various functions of a nurse. Its activities are aimed not only at diagnostic and treatment processes, but also at quality nursing care for patients and the satisfaction of patients and their relatives. In this regard, we ask you to answer the following questions (underline the necessary ones):
1. Are you satisfied with your stay in the therapy department?
Yes. No.
2. The appearance of the nurse of the department:
Satisfactory. Unsatisfactory.
3. Are you satisfied with how the nurse has followed the doctors' orders?
Yes. No.
Your wishes_______
4. Are you satisfied with nursing care?
Yes. No.
Your wishes________________________________________________
5. Have you received psychological support from the nursing staff?
Yes. No.
6. Which of the nurses do you consider more professional and would you like to recognize? ________________________________________________
All nurses are professionally competent, patient, compassionate, striving to alleviate both mental and physical suffering.
7. Are you satisfied with the work of the sentry nurses?
Yes. No.
Your wishes________________________________________________
Thank you for your participation and wish you good health.
Appendix 4
Timing of the guard nurse
|
Activities |
Time |
|
1. Delivery of duty |
|
|
2. Registration and communication with newly admitted patients |
|
|
3. Receiving medication from the head nurse |
|
|
4. Distribution of medicines to patients |
|
|
5. Checking case histories |
|
|
6. Nursing care of patients |
|
|
7. Personal time (lunch 30 min) |
|
|
Total: |
8 h 12 min |
Care plan
|
Problems |
Nurse actions |
Purpose of care |
Criteria for evaluation |
|
|
patient |
nurse |
|||
|
Anxiety about the upcoming surgery |
1. Conduct a conversation with the patient. |
Reduced patient anxiety |
Patient behavior |
|
|
Fear for the outcome of the operation |
1. Explain the rules of preparation for the operation. |
Reducing fear |
The patient calmly discusses the upcoming operation and expresses a desire to follow the recommendations of the nurse and doctor |
|
|
drinking regimen before surgery. |
||||
|
Lack of knowledge about behavior |
1. Train the patient: |
Getting the information you need before surgery |
The patient demonstrates measures to prevent postoperative complications. |
|
|
Risk of complications |
1. Check the patient's written consent for the operation. |
No complications during the operation |
Patient condition and completed documentation |
|
|
Patient problem |
Nursing activities |
Purpose of care |
Criteria for evaluation |
|
State of shock |
1. Assess the patient's condition immediately after admission to the ward. |
Stabilization of vital signs |
Patient behavior. Indicators of blood pressure, NPV, pulse, urine output. Visual assessment of the postoperative suture (dressing) |
|
Risk of vomit aspiration |
1. Prepare a bed without a pillow. |
Lack of aspiration |
Lack of aspiration and vomiting |
|
Pain in the area of the surgical access |
1. Administer pain relievers as directed by a physician. |
The patient will notice no pain after 5 days |
No pain, adequate patient response to pain |
|
Delayed urination |
1. To teach how to use the boat. |
Sufficient urine output |
Optimal bladder emptying |
|
Risk of lung congestion |
1. Recommend the patient to perform breathing exercises, monitor the performance. |
No signs of atelectasis and congestive pneumonia |
NPV, breathing pattern, free sputum discharge, breathing, absence of cough |
|
Risk of infection |
1. Monitor the condition of the postoperative suture. |
No signs of infection |
Clean wound, healing by primary intention. Normal temperature readings |
|
Self-care deficit |
1. Provide the patient with available means. |
The patient will receive the necessary care from the nurse and relatives |
The patient accepts the help of a nurse and relatives. The patient is able to self-care and is ready for discharge |
Primary nursing assessment sheet to the inpatient card No. _____________
|
Full name of the patient ___________________________ ________________________________________ Residence address ________________________ ________________________________________ Telephone________________________________ Therapist____________________________ Diagnosis_________________________________ ________________________________________ Date of receipt ___________ time ________ primary repeated Entered ambulance yourself outpatient clinic referral translation Method of transportation to the department on a gurney on a chair on foot Consciousness clear contact oriented Disoriented confused stupor stupor |
Diet observes allergy _____________________________ Dyspeptic disorders nausea, vomiting Severity, abdominal discomfort Physiological functions Urination common frequency rapid rare painful night (how many times) _________________ incontinence with a catheter Bowel function Frequency _________________________________ The nature of the chair usual consistency liquid solid incontinence Need for movement independent fully partially dependent Walking use of additional devices ________________________________________ Can independently
contractures paresis __________________________________ paralysis ________________________________ Risk of falling yes no The risk of developing pressure ulcers Not really Number of points on the Waterlow scale _____ no risk - 1 - 9 points, there is a risk - 10 points, high risk - 15 points, very high risk - 20 points Need for sleep sleeps well uses sleeping pills Sleep habits _____________________________ Factors disturbing sleep _________________ _________________________________________ The need to work and rest works________________________________ does not work retiree student disability hobbies _____________________________ _________________________________________ Is there an opportunity to realize your hobbies Possibility of communication Colloquial ___________________ Communication difficulties Hearing normal hearing loss on the right to the left hearing aid Vision normal contact lenses right left blindness on the right to the left is complete eye prosthesis right left Patient signature Nurse signature |
|
Need for breath Breath free is difficult Respiratory rate ______ per minute Heart rate __________ per minute rhythmic arrhythmic HELL _________________ mm Hg Is a smoker Number of smoked cigarettes __________ Cough yes dry wet The need for adequate food and drink Body weight _______ kg height _________ cm Eats and drinks needs help on his own Normal low appetite elevated absent Does it have diabetes Not really If yes, how does it regulate the disease? insulin-lowering diet pills No teeth preserved partially preserved Are there removable dentures das top bottom Takes liquid limited enough |
|
|
Ability to dress, undress, choose clothes, personal hygiene independent fully partially dependent Dressing, undressing on your own with outside help Does the choice of clothes Not really Does he care about his appearance sloppy ________________________________ ___________________________________________ shows no interest Can independently Partially cannot independently
Dentures
Perineum
Shower
Oral health sanitized not sanitized Skin condition dry normal oily swelling rashes Ability to maintain normal body temperature Body temperature at the time of examination __________ decreased normal increased There is sweating chills feeling hot Ability to maintain a safe environment Maintaining security on one's own with outside help Motor and sensory abnormalities dizziness unsteadiness of gait decreased sensitivity |
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Tumor- pathological tissue proliferation, which differs from other pathological tissue proliferations in autonomy and hereditarily fixed ability for unlimited, uncontrolled growth.
Benign - expansive growth (pushes tissue), less pronounced anaplasia (atypism), metastasis is not characteristic, less pronounced damaging effect on the body, rarely cachexia.
Malignant - infiltrative growth, pronounced anaplasia, metastasis, a general damaging effect on the body and the development of cachexia.
Malignant tumors on a histological structure are divided into:
Cancers, tumors originating from epithelial tissue;
Sarcomas are tumors of connective tissue.
Benign tumors from:
Epithelial tissue - papillomas, adenomas, cysts;
Connective tissue - fibroids, lipomas;
Vascular tissue - angiomas;
Nerve tissue - neuromas, gliomas, ganglioneuromas.
Biological features of tumor cells and tissues.
1. unlimited growth - tumor cells multiply as long as the body is alive, nothing stops them, except for 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 (atypism) - features that distinguish tumor cells from normal ones and create similarities with embryonic cells.
6. clonal growth - 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
Amino acid metabolism products
exogenous
Products of incomplete combustion (exhaust gases, smoking products)
Initial products in the synthesis of drugs, dyes, color photography, rubber production.
Inorganic - arsenic, nickel, cobalt, chromium, lead (their extraction and production).
Physical
Ionizing radiation (causes leukemia, tumors of the skin, bones)
UFO (skin tumors).
Biological
Some viruses.
Origin of tumors.
Currently, the most common two points of view on the origin of tumors:
1. Viral theory, recognizing that neoplastic processes are infectious diseases caused by certain viruses, virus-like factors or agents.
2. A polyetiological theory that does not try to reduce the variety of tumors to any single cause: physiological, chemical or biological. This theory considers the pathogenesis of tumor transformation as a result of regeneration following damage caused by various factors and acting mostly repeatedly. Regeneration after repeated damage acquires pathological forms and leads to a change in the properties of cells, in some cases causing tumor growth.
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 of internal organs are manifested only by 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 lobularity of the structure. The tumor is mobile, not adhered to the surrounding tissues, its consistency may be different, regional lymph nodes are not enlarged, and palpation of the tumor is painless.
Malignant tumors at the beginning of their development are asymptomatic, hidden for the patient himself, and yet it is their early diagnosis that is important. In this regard, when examining people, especially over 35 years old, about vague complaints, starting weight loss, long-term continuous and increasing symptoms of the disease for no apparent reason, oncological alertness should appear. This concept includes:
1. suspicion of cancer;
2. Thorough collection of anamnesis;
3. the use of general and special methods of use;
4. in-depth analysis and generalization of the data obtained.
The main complaints of a patient with a malignant neoplasm are a violation of the general condition: loss of general tone at work, apathy, loss of appetite, nausea in the morning, weight loss, etc. These complaints may be joined by more local symptoms: the presence of a chronic disease of the stomach, rectum, the appearance of a seal in the mammary gland, etc. At first, these phenomena may not be accompanied by pain, but then, when the tumor begins to germinate the nerve trunks, pains appear that take more and more and a more torturous character. The malignant tumor grows rapidly. Nutrients for cells come from the whole body, causing nutritional deficiencies in other tissues and organs. In addition, despite the large number of blood vessels in a cancerous tumor, their inferiority often leads to malnutrition in certain areas of the tumor and the disintegration of these areas. The products of necrosis and decay are absorbed into the body, leading to intoxication, progressive weight loss, exhaustion, cachexia.
During the course of malignant tumors, 4 stages are distinguished:
1 tbsp. - the tumor does not go beyond the organ, small in size, without metastases;
2 tbsp. - a tumor of significant size, but does not go 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. - 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 according to the TNM system. The TNM system provides for classification according to three main indicators: T - tumor - tumor (its size, germination into neighboring organs), N - nodulus - the state of regional lymph nodes (density, adhesion to each other, infiltration of surrounding tissues), M - metastasis - hematogenous metastases or lymphogenous to other organs and tissues.
Survey methods.
1. Anamnesis. In the anamnesis, attention is paid to chronic diseases, the appearance and growth of tumors, 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 available for examination). Its size, character, consistency and relation to surrounding tissues are established. Determine the presence of manifestations, distant metastases, an increase in regional lymph nodes.
3. Laboratory research methods. In addition to a general analysis of blood and urine, all functional studies of the organ in which a tumor is suspected should be performed.
4. X-ray research methods. To diagnose a neoplasm, a variety of studies are performed: X-ray, tomography, kymography, angiography, etc. In some cases, these methods are basic for diagnosis and allow not only to identify the tumor, but also to clarify its localization, prevalence, to determine the displacement of the organ, etc. Computed tomography is widely used.
5. Endoscopic examination. In the study of hollow organs, cavities, endoscopy is widely used (rectoscopy, esophagoscopy, gastroscopy, bronchoscopy, cystoscopy). 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 examination. A biopsy (excision) followed by microscopic examination is often critical in making a diagnosis.
6. Cytological examination. Such a study allows, in some cases, to detect rejected tumor cells in gastric juice, lavage water, sputum, vaginal discharge.
7. In case of diseases of internal organs, when, despite all the applied research methods, the diagnosis of the disease remains unclear, and the suspicion of a tumor process has not yet been removed, they resort to diagnostic surgery (gluttony, thoracotomy, etc.).
General principles of tumor treatment.
Treatment of a benign tumor is surgical: excision together with a capsule, followed by histological examination. With small, superficially located benign tumors that do not bother 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;
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