End-stage ovarian cancer care
Comfort theory in ovarian cancer patients dying of Ovarian cancer is a common cancer of female genital mutilation one of the incidence of cervical cancer and after cancer of the uterus. Ovari...
Taxol combined platinum treatment of ovarian cancer care "Nursing Care of Patients Treated With Combination Oophoroma of Taxolr and Platinum" ovarian cancer in the female genital cancer i...
. In Division I from July 1996 to July 1998 to 15 cases of advanced ovarian cancer patients with Taxol and cisplatin in the treatment of satisfactory results.One, information and Methods
General information: The 15 patients, aged 38 to 60 years old. Epithelial ovarian cancer in 12 cases, three cases of ovarian cancer embryos.
Treatment: Taxol single dose of 210 to 270 mg (135 ~ 175/m2 body surface area), 5% glucose injection or 0.9% sodium chloride injection of 500 ml intravenous drip, drip within 3 h after cisplatin dose was given 80 ~ 100 mg (75 mg/m2 body surface area), by adding 0.9% sodium chloride injection of intravenous 100 ml each course of a day administration, and was given hydration three days, three weeks interval repeat a course. 15 patients received a total of 52 courses, averaging 3.5 treatment.
Taxol administration before 12 h and 6 h, respectively intramuscular injection of dexamethasone 20 mg, 30 minutes before intravenous infusion drip of Promethazine Hydrochloride 50 mg and 0.9% sodium chloride injection of 20 ml, cimetidine 300 mg and 0.9% sodium chloride injection of 20 ml, Dexamethasone 10 ~ 20 mg, to prevent allergic reactions.
Two results
15 cases of patients with complete remission (B-reviewed tumors disappeared, ascites eliminate up to three months and above) two cases, accounting for 13.3%; Partial response (tumor reduction) in 8 cases, accounting for 53.3%; Stability in three cases, 20%; Deterioration (swelling continued growth of) two cases, accounting for 13.3%. After treatment, the patient's appetite, general conditions in varying degrees of improvement. After the infusion of bone marrow suppression with 86.5% (45/52); Joints, muscle pain 92.3% (Wuhan); Neuritis around 42.3% (22/52); Gastrointestinal 76.9% (40 / 52); alopecia 100% (15/15). A follow-up in 11 patients with survival (73.3%); Two years survival seven cases (46.7%), 3-year survival of three cases (20%).
3, nursing
Psychological care 3.1
Patients with ovarian cancer, the majority of the treatment of advanced, and easy to metastasis and recurrence, the majority of patients had experienced repeated surgery and chemotherapy, some of the poor treatment of patients with confidence in addition to chemotherapy in patients with difficult to bring the language in the expression of feeling unwell, prone to anxiety, fear, frustration psychology; Taxol is expensive, with the economy on the right there is a certain pressure; Taxol from alopecia, women with the right mental image is a heavy blow. For their psychological reaction, both at home and abroad to patients on treatment efficacy of paclitaxel on the successful cases to establish the confidence to overcome the disease. Simultaneously with the drug Taxol and cisplatin in the treatment methods and possible adverse reactions and treatment methods, patients are mentally prepared for the treatments.
3.2 adverse reactions care
Taxol major adverse reaction anaphylaxis, drug-induced pain and alopecia. Cisplatin is the major adverse reaction gastrointestinal and renal toxicity.
3.2.1 Allergy Prevention: Taxol small dose can cause hypersensitivity, mild symptoms of the most common allergic skin flushing, urticaria. Performance severe allergic reaction to breathing difficulties, low blood pressure, shock and even vascular and nerve edema. In recent years, through changes in drug formulations and improved delivery methods, the occurrence of allergic reactions decreased to prevent allergic reactions, taken before 1 prophylactic administration of medication. ② before treatment by oxygen, electrocardiogram, and emergency medicine. ③ strictly controlled infusion rate, in 10 min infusion began, dropping 10gtt/min, in the absence of discomfort, velocity can be raised to 45 gtt / min, 3 h with the general drop in the End. ④ closely observe changes in vital signs, infusion, at 30 min infusion of a monitoring blood pressure, pulse, respiration, 15 min infusion began to be closely observed, asked whether sick patients, and found allergic reaction. ⑤ infusion at the end, the measurement of blood pressure, no abnormal reaction of tube removed again, Needle after signs of life, I care to a 24 h treatment. Most of the patients in this group facial flushing, mild skin rash, as symptomatic remission after treatment, no cases of severe allergic reaction.
3.2.2 drug pain care: 15 cases of 52 treatment, 48 patients after treatment Taxol infusion of a body or leg muscles, aching joints, the incidence of 92.3%, in general infusion pain after a 2 to 3 days, the earliest at 4 h after infusion of a sustained 4 ~ 6 d, 6 to 7 days or alleviate pain disappeared. Listen patiently in the care of patients with the complaint, explained to patients in pain is the body's role in drug response, eliminate their worries. Mild to moderate pain can be applied diclofenac sodium 50 mg Suppository, rectal administration, 3 times / d; Severe pain preferred release morphine preparation, the US Oral Morphine 30 mg, 2 times / d. The majority of patients with pain medicine, pain relief, mental health, diet, sleep improved significantly to ensure that the treatment is carried out smoothly.
3.2.3 alopecia care: paclitaxel chemotherapy in patients with alopecia 100%, the vast majority of patients in about 15 days after infusion began alopecia, and bring to them a heavy psychological pressure. Before treatment with drugs that cause temporary hair loss, treatment stopped, the hair growth will resume soon, so that it is psychologically prepared; With good guidance for hats, scarves, a set of items to get through alopecia period.
3.2.4 gastrointestinal care: cisplatin-induced vomiting is drugs, the patients after infusion of 40 cases of nausea, vomiting, severe vomiting direct impact on the consumption and normal digestion, and the large number of digestive fluid loss, resulting in water electrolyte balance disorders to patients brings immense suffering. We should try and help the solicitude and care of patients, the town of hormones and reduce the vomiting agent chemotherapy adverse reaction. Catering to light, fun to strengthen oral care, reduce adverse stimulate and promote appetite.
3.2.5 kidney toxicity Prevention and Care: The main cisplatin toxicity of the kidney toxicity after treatment fully hydrated and diuretic, a day of liquid should not be less than 3000 ml volume, the process of attention to the hydration fluid overload of cases and timely processing. Periodic measurement of serum electrolytes, kidney function, observed 24 h urine and urine color, with the water to encourage and promote excretion of toxic to prevent crystallization of uric acid, causing renal damage.
3.3 Preparation and attention to drug issues
Taxol infusion before injection in 5% glucose injection or 0.9% sodium chloride injection of 500 ml diluted by the drugs at room temperature (25 ° C) and 24 h indoor lighting stability. Nurses prepared, should wear gloves and masks to strengthen self-defense, such as paclitaxel solution was inadvertently contaminated skin, wash thoroughly with soap to reduce its toxicity.
Other chemotherapy drugs Taxol and the difference is not in contact with PVC plastics, and the current use of disposable syringes and infusion of mostly PVC products, therefore, can only use glass containers and glass syringes storage and take drugs, drip infusion devices, special infusion of polyethylene , infusion within the device with a pore size of 0.22 µ m filtration devices to prevent the solution of Taxol, a small particles enter the body.
Cisplatin is platinum compounds, before the infusion of 0.9% sodium chloride injection 100 ml diluted solution injection drugs and injection needles must use stainless steel needles, needles can not be used aluminum, platinum and aluminum to a metal oxide replacement, have dark brown precipitation [3], cause adverse consequences.
Two ovarian cancer patients undergoing chemotherapy psychological care
Ovarian cancer mortality of the first Habitat gynecologic malignancies, is a thorough treatment of cytoreductive surgery, postoperative chemotherapy supplemented by polymerization.
Chemotherapy patients in stage physical function, quality of life decreased markedly different degrees of psychological pressure. The tense psychological, can directly affect the treatment outcome is not conducive to the smooth progress of chemotherapy. Chemotherapy is the use of chemical substances at the molecular level and to correct various carcinogenic factor in blocking the abnormal proliferation of normal cells of genetic variation is promising in the treatment of cancer, attention to a very popular method of treatment. Right gynecologic malignancies, has been widely used in clinical chemotherapy and received very good results. But the chemotherapy drugs in inhibiting tumor cell growth, but also affect normal cell metabolism, toxicity caused a reaction. Now I Section 2003 to November 1 of 72 cases of ovarian cancer patients undergoing chemotherapy psychological observation, the main problems are psychological.
An analysis of the psychological factors
1.1 fear that the treatment caused a series of side effects, such as hair loss, bone marrow suppression, gastrointestinal reactions. Most patients lack of full understanding of their disease and understanding, and as for incurable cancer, cancer of a strong psychological fear of the loss of confidence in the performance of tension, fear and unease.
1.2 loneliness due to the social factors and the environment, while undergoing chemotherapy, tend to feel the loss of self-worth, feel lonely and helpless on the staff of speech, performance is extremely sensitive, paranoia and hope to gain more love and care.
Afraid of negative 1.3 chemotherapy treatment of chemotherapy effects on the body, it difficult to adapt to the chemotherapy fatigue, nausea, hair loss, pain and the efficacy of chemotherapeutic drugs, lack confidence and have given up the idea of treatment.
1.4 pessimism due to cancer and chemotherapy to disrupt their daily lives, seriously affected the cause of education development. Worried about their role in society after chemotherapy patients with a tremendous role contrast, a strong psychological pessimism, resulting depression, depression, loss of confidence in the fight against the disease.
1.5 anxiety as surgery and chemotherapy long worried that the economy is on the affordable, it can smoothly complete the entire course of chemotherapy, worried about what will be the result of chemotherapy, the patients have made a skeptical attitude, serious thoughts have to abandon chemotherapy.
1.6 depression patients on chemotherapy because of the lack of a proper understanding of psychological imbalance. Let's why I got cancer? Various questions, which they treat biased view of things, depression, self-closed, and others do not want to talk to any things are "indifferent" or suspected mentality.
Two psychological care
2.1 a good nurse-patient relationship should take the initiative to close the patient, do carefully, patience, love. Patients correct answer to the question raised by some chemotherapy on more successful cases. A sincere and cordial language for the patient to comfort, care operation gentle, detailed, accurate, orderly, the patients a sense of security, and use their own sophisticated technologies to the patient's trust, to eliminate the fear patients.
2.2 patients should have a high degree of compassion and responsibility pained by the pain of patients, the patients would like to think. The heart patients and patients communicate. In addition to nurses as a major supporter, should actively encourage their family members, friends, colleagues, often leading comfort and care, social assistance and care, so that patients can feel the love from all sides and the value of their existence, stimulate confidence in life to eliminate loneliness, establish to overcome diseases confidence.
2.3 on the physical effects of chemotherapy drugs, nursing patients on medication prior to the use of drugs and the possible toxicity of the reaction and response measures. If chemotherapy nausea and other symptoms, chemotherapy given before and after chemotherapy antiemetic agent; Li Shu as Deacon, Li Ting and rehabilitation, protection of gastric mucosa, reduce the side effects of chemotherapy. Let patients a sense of security could be arranged after treatment of patients respond to the spirit of a lesser moral support and increase the confidence of patients cured, the patients appropriate recommendations cosmetic and modified to increase their self-confidence, self-esteem maintenance.
240 patients currently use similar work, and living examples of a smooth own experience, allow patients to feel that he is still a useful one, to encourage patients to overcome the disease establish the confidence to meet the challenges of a new life.
2.5 patience to patients and their families, the need for the chemotherapy, and patients on chemotherapy and discuss common program, the timely treatment of this patient information, such as the effect of treatment, the disease causes, with the active treatment, and increase the confidence of the treatment. The issues raised by the patient, give clear, effective and positive reply, dispel their concerns and the anxiety of potential health effects, to encourage patients do regulate emotional activities, such as reading and newspapers and watching television, listening to music, walking and chess activities.
2.6 patient care initiative and talk to patients, care for, encourage and enlighten patients, patients seeking to improve the confidence to overcome the disease, fully mobilize the patient's family, the relatives of all the positive factors, with its request to assist health care workers. Access time to visit the patients condolences performance more care than in the past, considerate patients, the patients do not feel lonely, still live in happiness in the warmth and change other people's concern for their own power, thereby tap their own potential, to resist disease.
Three conclusions
Through chemotherapy in ovarian cancer patients after psychological care, we recognize that psychological factors in cancer patients with chemotherapy in patients with the role that can not be ignored. Cancer is different from other diseases, and its body damage caused by the spirit even more than the physical damage it causes. Chemotherapy at the same time in the psychological care to alleviate anxiety, establish confidence, optimism undergoing chemotherapy.
In well under psychological care, nurses have skilled technical operations, the proper use of the chemotherapy drug methods, and treatment complications, improve the efficacy of rehabilitation for patients. Mental state of the patients, before treatment to health education and strive for better results.
Three women into fashionable ovarian care doctors: no scientific basis for such care
Many women into beauty salons, have been recommended to do a new project - "ovarian care", some herbs mixed with massage oil in the abdomen, fever beautician said abdomen feeling is the drug is absorbed, Regulation of the endocrine function. Despite the "care" to a more than 200 yuan, but is related to the young and beautiful women are generally recommended to try. Today, this reporter interviewed the Beijing Jishuitan Hospital, director of obstetrics and gynecology Li Shaofen, she pointed out: this "ovarian care" without any scientific basis, not only ineffective may also cause cancer.
It is understood that beauty salons introduced "ovarian care" an essential oil is used in the human stomach and a navel and other parts massage through the skin surface coated penetration, which promote the absorption of ovarian. Oil is the main component of the Rose, Yilan, Pelargonium, Salvia, endocrine to adjust and maintain their youth, and the treatment of menstrual disorders. This approach really can have such effects?
Minister Li, ovarian female gonad important organ, and its main function is to ovulation and secretion of female hormones, including progesterone and estrogen. As women age, ovarian function will gradually decline, reduce the secretion of estrogen, which is a natural physiological laws. Ovarian care and beauty salons in the oil can penetrate into ovarian surface through internal to the maintenance of the treatment effect. Women of normal estrogen secretion is the law, thujone will break the female endocrine balance in the body, will cause serious endometrial hyperplasia, lead to cancer.
Experts also emphasized that ovarian estrogen secretion is the law of female friends is not necessary to add estrogen, aging, youth can keep on estrogen absorption method. Respect for the laws of nature, eat vitamin-rich food, rest, feeling comfortable is to maintain aging scientific manner. If women found their own endocrine, menstrual disorders, also should go to the hospital, doctors according to the concrete circumstances scientific and effective treatment.
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