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TEST

NURSING CARE FOR CANCER PATIENTS

Introduction

Conclusion

Literature

Introduction

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

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

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

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

1. Features of caring for cancer patients

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

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

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

If consultation with specialists from another medical institution is needed, then a doctor or nurse is sent with the patient to transport the documents.

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

What are the features of patient placement in the oncology department? We must try to separate patients with advanced tumors from the rest of the patient population. It is advisable that patients with early stages of malignant tumors or precancerous diseases do not meet patients with relapses and metastases.

In an oncology hospital, newly arrived patients should not be placed in wards where there are patients with advanced stages of the disease.

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

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

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

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

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

What is the diet for cancer patients?

Proper diet is important.

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

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

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

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

2. Features of organizing nurse care for cancer patients

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

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

Primary health care;

Ambulance, including specialized emergency medical care;

Specialized, including high-tech, medical care;

Palliative care.

Medical assistance is provided in the following conditions:

Outpatient;

In a day hospital;

Stationary.

Medical care for cancer patients includes:

Prevention;

Diagnosis of oncological diseases;

Treatment;

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

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

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

Primary health care includes:

Primary pre-hospital health care;

Primary medical care;

Primary specialized health care.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

2.1.5 Follow-up of cancer patients

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

During the first year - once every three months;

During the second year - once every six months;

In the future - once a year.

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

2.2 Organization of activities of the oncology clinic

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

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

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

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

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

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

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

2.3 Features of nurse care for cancer patients

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

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

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

Psychological and psychosocial assistance to patients;

Educational work with patients and their family members;

Participation in scientific research.

2.3.1 Features of the work of a nurse during chemotherapy

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

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

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

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

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

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

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

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

It usually occurs 7-10 days after chemotherapy and lasts 5-7 days. It is necessary to measure body temperature twice a day, and perform a CBC once a week. To reduce the risk of infection, the patient should refrain from excessive activity and remain calm, avoid contact with patients with respiratory infections, and avoid visiting places with large crowds of people.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Phlebitis (inflammation of the vein wall) is a local toxic reaction and is a common complication that develops after multiple courses of chemotherapy. Manifestations: swelling, hyperemia along the veins, thickening of the vein wall and the appearance of nodules, pain, striations of the veins. Phlebitis can last up to several months.

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

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

Extravasation (drug penetration under the skin) is a technical error by medical personnel.

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

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

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

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

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

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

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

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

6. Secure the catheter after installation with a bandage;

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

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

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

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

2.3.2 Nutritional features of an oncology patient

Dietary nutrition for an oncology patient should solve two problems:

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

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

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

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

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

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

4. Limit sugar and other refined carbohydrates;

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

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

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

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

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

10. Don't drink alcohol.

2.3.3 Carrying out pain relief in oncology

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

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

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

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

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

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

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

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

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

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

Non-drug treatment of pain. To combat pain, a nurse can use physical and psychological methods (relaxation, behavioral therapy).

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

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

A nurse caring for a patient with pain:

Acts quickly and compassionately when patient requests for pain relief;

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

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

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

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

Provides psychological support to patients and their

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

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

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

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

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

2.3.4 Palliative care for cancer patients

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

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

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

Modern principles of nursing care:

1. Safety (prevention of patient injury);

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

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

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

5. Infection safety.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conclusion

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

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

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

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

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

3) The activities of the nurse were analyzed;

4) A survey of patients was conducted;

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

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

Literature

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

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

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

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

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

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

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What are the characteristics of a nurse working with cancer patients?

A feature of caring for patients with malignant neoplasms is the need for a special psychological approach. The patient should not be allowed to find out the true diagnosis. The terms “cancer” and “sarcoma” should be avoided and replaced with the words “ulcer”, “narrowing”, “induration”, etc. In all extracts and certificates handed out to patients, the diagnosis should also not be clear to the patient. You should be especially careful when talking not only with patients, but also with their relatives.

Cancer patients have a very labile, vulnerable psyche, which must be kept in mind at all stages of care for these patients.

If consultation with specialists from another medical institution is needed, then a doctor or nurse is sent with the patient to transport the documents. If this is not possible, then the documents are sent by mail to the head physician or given to the patient’s relatives in a sealed envelope. The actual nature of the disease can only be communicated to the patient’s closest relatives.

What are the features of patient placement in the oncology department?

We must try to separate patients with advanced tumors from the rest of the patient population. It is advisable that patients with early stages of malignant tumors or precancerous diseases do not meet patients with relapses and metastases. In an oncology hospital, newly arrived patients should not be placed in wards where there are patients with advanced stages of the disease.

How are cancer patients monitored and cared for?

When monitoring cancer patients, regular weighing is of great importance, since a drop in body weight is one of the signs of disease progression. Regular measurement of body temperature allows us to identify the expected disintegration of the tumor and the body’s reaction to radiation. Body weight and temperature measurements should be recorded in the medical history or in the outpatient card.

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

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

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

What is the diet for cancer patients?

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

What are the features of feeding patients with stomach cancer?

Patients with advanced forms of stomach cancer should be fed more gentle foods (sour cream, cottage cheese, boiled fish, meat broths, steamed cutlets, crushed or pureed fruits and vegetables, etc.) During meals, it is necessary to take 1-2 tablespoons spoons 0,5-1 % hydrochloric acid solution.

Severe obstruction of solid food in patients with inoperable forms of cancer of the cardial part of the stomach and esophagus requires the administration of high-calorie and vitamin-rich liquid foods (sour cream, raw eggs, broths, liquid porridges, sweet tea, liquid vegetable puree, etc.). Sometimes the following mixture helps improve patency: rectified alcohol 96% - 50 ml, glycerin - 150 ml (one tablespoon before meals). Taking this mixture can be combined with the administration of a 0.1% atropine solution, 4-6 drops per tablespoon of water, 15-20 minutes before meals. If there is a threat of complete obstruction of the esophagus, hospitalization for palliative surgery is necessary. For a patient with a malignant tumor of the esophagus, you should have a sippy cup and feed him only liquid food. In this case, it is often necessary to use a thin gastric tube passed into the stomach through the nose.

Caring for a sick child has a number of features. The staff of children's departments must undergo special training. Separation from relatives, hospital stays, and medical procedures inevitably traumatize the child’s psyche. The task of the medical staff is to provide care that will minimize the negative impact of the hospital environment. When admitting a child to a hospital, it is necessary to gently distract him from parting with his family; find out about the child’s habits, the regime that was followed at home; There should be toys in the reception room (it is acceptable to take clean and safe washable toys).

The wards should be cozy; the arsenal of therapeutic agents should include toys, pictures, and funny books. Frequent ventilation is necessary in combination with air disinfection by ultraviolet irradiation with bactericidal lamps (children remaining in the ward wear special glasses). Beds should have devices that allow you to adjust the height of the headboard, and for young children - with lattice side walls, one of which is folding. Mattresses are better made of hair or sea grass or cotton wool. For small children, the mattress is covered with oilcloth, then with a sheet.

Children's departments must have verandas for daytime sleep in the fresh air; Children who are recovering are allowed to go for walks.

A daily routine appropriate to the age and condition of the sick child is of great importance.

In the evening, it is necessary to exclude all moments that excite the child’s nervous system. The diet depends on the age of the child and the nature of the disease: feeding should be done at the same time, in small portions, slowly; give more fluids (if there are no contraindications), vitamins; You can't force feed. Children should receive general hygienic or therapeutic baths (see Baths, for children). Seriously ill patients should wipe their face, neck, and skin folds in the morning and at night with a cotton swab dipped in warm boiled water. Infants are washed several times a day, after which the child’s body is thoroughly dried with a soft diaper, the folds of the skin are lubricated with boiled vegetable or Vaseline oil. Linen and clothing should be made of soft fabric in pleasant colors and carefully selected according to size and age. Educational work is important. For school-age children, with the permission of the attending physician, classes are organized according to the school curriculum.

The nurse keeps a special nursing sheet for each child, which notes appetite, stool and other information.

Tablets for young children should be crushed and mixed with sugar syrup. If the child does not open, you can lightly squeeze his nose with two fingers, while the child opens his mouth to inhale, and the medicine is poured into him. A seriously ill, weakened child needs to be picked up more often to avoid congestion in the lungs. In case of vomiting, the child should be quickly seated or placed on his side; When the vomiting stops, rinse his mouth and give him a few sips of cold water to drink. Measuring body temperature in young children has its own specifics (see Body thermometry).

The specifics of caring for sick children of different ages lie in the features of direct observation of a sick child, communication with him, methods of collecting material for laboratory research, and conducting medical procedures.

Creating a hygienic environment for a sick child consists of general hygienic requirements for the premises of children's hospitals, and the characteristics of hygiene for a newborn and infant.

For young children, small wards or boxes, closed and open, are needed. If an infectious disease is suspected, the child must be placed in an isolation ward with special equipment. For mothers hospitalized with their children, a bedroom and dining room must be allocated. For walking sick children, a veranda or special rooms with constantly open windows are allocated.

Beds for infants should have high drop-down or fold-down sides. A hard mattress made of horsehair, sponge, and sea grass is placed in the crib. Do not use mattresses made of down or feathers. Place a small flat pillow under your head.

The air temperature in the room for a premature baby is 22-26 C, depending on body weight, for a full-term baby - 20 C. Daily systematic ventilation of the rooms is necessary at any time of the year.

Clothing should not restrict the child's movements, but should be light and warm. It is convenient to use envelopes for swaddling premature babies. Free swaddling is indicated for children with normal thermoregulation function, regardless of their body weight, age and location (open incubator, bed).

The basis of care for newborns (full-term and premature) is adherence to the strictest cleanliness, and in some cases, sterility. Persons with acute and chronic infectious diseases are not allowed to care for newborns. Wearing woolen items and rings is prohibited.

Personnel are required to observe the rules of personal hygiene and, moreover, strictly, work in a gauze mask, changed every 3 hours. All employees of the department must have mucus from the nose and pharynx tested monthly for carriage of diphtheria bacilli and hemolytic streptococcus. The absence of staphylococci in hand washing is also checked once a month.

Care of the umbilical wound requires special attention, which should be carried out under strictly aseptic conditions. The newborn is toileted daily: the eyes are washed with sterile cotton wool soaked in a solution of potassium permanganate (1:10000) or a solution of furacillin (1:5000), in the direction from the outer edge to the inner; the nose is cleaned with cotton wicks soaked in boiled vegetable oil (Fig. 122); the child is washed and skin folds are lubricated; wash after each act of defecation.

A daily examination of the throat of a sick child is necessary. Every day, temperature, body weight, quantity and quality of bowel movements, the presence of regurgitation, vomiting, coughing attacks, asphyxia, and convulsions are recorded. Children are weighed in the morning, before the first feeding.

When prescribing a walk, the child’s body weight, age, time of year and local climatic conditions are taken into account. Premature babies can be taken for a walk at the age of over 3-4 weeks in the spring-summer period when they reach a weight of 2100-2500 g, in the autumn-winter period - when they reach a weight of 2500-3000 g. The first walk of these children in winter should not exceed 5 - 10 minutes, in summer - 20-30 minutes. Full-term children from 2-3 weeks of age are allowed walks in winter at an air temperature of - 10 C in the absence of wind. If the child has increased cyanosis, cough, pallor, and anxiety, the walk is stopped.

Organizing the feeding of a sick child requires special precision, consistency and skill from the staff. Feeding difficulties may be caused by underdevelopment of the sucking reflex, the presence of congenital deformities, the child’s refusal to eat, an unconscious state, etc. In such cases, feeding is done through a gastric tube, through a pipette, or from a spoon; parenteral and rectal nutrition is used.

Collecting material from children for laboratory research is difficult and requires special skills. Children under 5-6 years old do not cough up sputum. Therefore, at the moment when the child coughs, with a spatula, holding the root of the tongue, remove the sputum with a sterile swab, which is then inserted into a sterile test tube. In infants, sputum is removed from the stomach using a probe inserted into the stomach on an empty stomach.

Blood is taken for serological, biochemical and other studies by venipuncture. Feces for bacteriological examination are collected with a glass tube, fused at both ends, which is sterilized and inserted into the anus. The tube filled with feces is closed at both ends with sterile cotton wool, lowered into a test tube and sent to the laboratory. Feces for examination for worm eggs are collected in clean, clean, small glass containers. With a cleanly planed stick, feces are taken from 5-6 different places, then the dishes are tightly covered with clean paper.