Nursing care plan for a patient with lever cancer Introduction: Ms MCA, a 32-year-old female was evacuated from uinea to the international university hospital !hei"h #aid, Morocco on !eptem$er, %& 2'%&, at '3 Am with chief compliant of cramp and chest pain, $iological tests were normal $u t the liver ultrasound showed a pro$a$le hepatoma or liver metastases( !he was operated on May, Ma y, 2) 2'%' for left mastectomy with a*illary dissection and $ilateral oophorectomy ta"ing %' positive nodes of %+ collected following a multifocal invasive ductal carcinoma grade III, poorly differentiated with hormone receptor positive and .2 negative( /he lesion is classified classified 0/30N3M1( !he was admitted C# on '2'%' for % times and she was under chemotherapy with Nolvade* for & years( .eadmitted to the C# on '324%3 for control had a good condition, she reported chest pain, right $reast and lymph nodes unremar"a$le( /horaco-a$dominal C/ scan, scintigraphy and la$oratory tests were normal, she was ordered to continue Nolvade* % ta$day( Controlled at 5amsar hospital in uinea on '2%%%+ she complained of some cramps( /he locoregional e*am seemed normal( 6a$oratory tests, as well as chest 1-ray and liver ultrasound were normal( /horaco-a$dominal C/ scan was re7uested, the results did not show any a$normality( !even days prior to admission she was readmitted to 5amsar hospital in uinea for cramps and chest pain, $iological tests were normal however, the liver ultrasound showed a pro$a$le hepatoma or liver metastases(
//: -doliprane %1 3 d 0rimperan syrup if vmsmt /ramal &' %C0 8 92%'4
additiva
PATIENT’S PROFILE
Client’s name or Initials :
MCA
Age:
32 ;A.! <6=
Civil Status :
Married > 2 children
Religion:
Islam
Address:
Cona"ry, uinea
Birth ate and Pla!e:
%48+, Cona"ry
Ra!e"Nationalit# :
uinean
$sual Sour!e o% &edi!al Care:
Edu!ational attainment:
3rd ;A. I !C<<6
O!!u'ation:
/eacher
Chie% Com'laint :
Cramps and thoracic pain
Attending Ph#si!ian:
=.( Mohamed ?ouaa@a@i, M(=(
Admitting iagnosis:
!uspicion of hepatoma or liver metastases
ordons functional pattern of assessment istory of present illness !even days prior to admission ad mission the patient was readmitted to 5amsar hospital in uinea for cramps and chest pain, $iological tests were normal ho wever, the liver ultrasound showed a pro$a$le hepatoma or liver metastases( /hen she was evacuated to !hei"h #aid hospital of Morocco( Medical history of past health /he patient underwent a left mastectomy with a*illary dissection and $ilateral oophorectomy on May 2) 2'%', ta"ing %' positive nodes of %+ collected following a multifocal invasive ductal carcinoma grade III, poorly differentiated with hormone receptor positive and .2 negative( !he was admitted to !hie"h #aid ospital on Buly '2 2'%' for the %st time and she was under chemotherapy with Nolvade* for & years( .eadmitted to !hei"h #aid hospital on March 24 2'%3 for control, she reported chest pain, right $reast and lymph nodes unremar"a$le( /horaco-a$dominal C/ scan, scintigraphy and la$oratory tests were normal, she was ordered to continue Nolvade* % ta$day( Controlled at 5amsar hospital in uinea on '2%%%+ she complained of some cramps( /he locoregional e*am seemed normal( 6a$oratory tests, as well as chest 1-ray and liver ultrasound were
normal( /horaco-a$dominal C/ scan was re7uested, the results did not show any a$normality(
F$NCTIONAL F$NCTI ONAL PATTERN PATTERN Fun!tional Pattern
Nutritional 0attern
Be%ore (os'itali)ation * MCA stated that she
has a loss of appetite
uring (os'itali)ation !upplements and other
ther therap apie iess
to
A%ter (os'itali)ation
supp suppor ortt
optima optimall digest digestion ion and nutrition, and help you manage side effects( limination 0a 0attern
- 0e 0eed + to ) times a day - =efecated % time a day
* 0ees + to ) times a
day - =efecates % time a day
Activity*ercise
- pon interview, MCA
* !he gets some times
0attern
stated that she usually
out of her $ed for a
do some e*ercises(
wal"(
- A$le to do A=6s
- A$le to do A=6s
- MCA had sleep
- she sleeps 8 hours per
distur$ances due to pain
day
!leep.est 0attern
Cognitive0erceptual 0attern
-
Capa$le of reading
-
Capa$le of reading
and writing(
and writing(
- No difficulty or
- No difficulty or
pro$lems in vision
pro$lems in vision
or hearing,
or hearing,
-
Fun!tional Pattern
Be%ore (os'itali)ation
uring (os'itali)ation
!elf-perception!elf-
- 0atient MCA descri$es herself as a family
concept pattern
oriented person, "ind, hardwor"ing, and
A%ter (os'itali)ation
responsi$le(
.ole-relationship 0attern
- 0atient MCA has 2 children and she has a good relationship with her hus$and(
!e*uality-.eproductive
- MCA has a good se*ual relasionship with her
0attern
hus$and( And she has 2 children(
Coping!tress
-
/olerance /olerance 0attern Dalue lue?el ?elie ieff 0at 0atte tern rn
!he tal"s with her hus$and a$out her pro$lems
-
and concerns( - MCA MCA is a Mus Musli lim, m, and she she sta state te that that she she do do her her & prayers every day at time(
Nursing 0hysical Assessment Assessment MCA was alert and oriented to person, place and time( /he patients temperature was %'% E, pulse rate was )), respirations were %8, $lood pressure was %233, %2 33, o*ygen saturation on room air was %''F, apical pulse was )), lungs were clear, and the patient stated her pain level was five( /he patient has an ID line in her left arm( /he patients s"in was warm and dry with a moderate $ilateral handgrip( /he patients surgical incision was from the um$ilicus to suprapu$ic with staples and was intact intact with no erythema( erythema( /he patient patientss $owel sounds sounds were hypoactive hypoactive and stated no $owel movement today $ut had passed flatus( /he urine output from ')''-'8'' was 2''ml( /he patient was on a li7uid diet starting !eptem$er %) 2'%& and changed to a regular diet
on !eptem$er 2' 2'%&( /he patient ate 'F of her $rea"fast and stated she did not have much of an appetite( MCA appeared frail and thin with some general wea"ness( /he patients height was &G 9%('m and her weight was %'& l$s( 9+( "g( /he patient was am$ulatory and was a$le to perform independent activities of daily living(
IA+NOSTIC AN LABORATOR, FININ+S A!tual Findings: Pro!edure
Normal -alues
Red Blood Cell
+(&' H &(&' * %' %2 6
(emato!rit
Im'li!ations
.:/0 P& 01"2."2/
+(%3
=ecreased
'(3 H '(+ 6
'(3)
=ecreased
(emoglo3in
%%'('' H %&'('' gl
4)
=ecreased(
4hite Blood !elles
+(&' H %'('' * %' 4 6
+()
normal
Pro!edure
Normal -alues
A!tual Findings: 2:55 A& 01"2."2/
Im'li!a
Blood $rea Nitrogen
'(2- '(+ g6
'(2+2 gl
normal
Creatinine
)-%2 mg6
%2('4 mgl
Increased
Ioni)ed Cal!ium
%('& H %(2& mmol6
%(%% mmoll
normal
Potassium
3(& H &(% mmol6
+ (%
normal(
3 H 3) 6
60
Increased
' H 3& 6
78
Increased
ALT
AST
epatic serology was negative ?one $iopsy under C/ scan and scintigraphy: $one metastases of poorly differentiated carcinoma Immunola$eling: Anti$ody anti-C5 : negative Anti$ody Anti-. : positive Anti$ody Anti hercept : score 2 > inviting a control for in situ hy$ridiation
CLINICAL FININ+S SI+NIFICANT SI+NS AN S,&PTO&S: Liver metastases
J0ain in the upper a$domen on the right sideK it e*tends to the $ac" and shoulder J!wollen a$domen 9$loating JLeight loss J6oss of appetite and feelings of fullness JLea"ness or feeling very tired JNausea and vomiting J;ellow J;ellow s"in and eyes, and dar" urine from @aundice JEever
PROBLE& LIST LIS T AN PRIORITI9ATION ACT$AL PROBLE& RAN 2
PROBLE&
Im$alanced Nutrition less than $ody re7uirements
C$ES
Light +( "g 6oss of appetite Lea"ness
;$STIFICATION
Jto identify deficits in nutritional inta"e and ade7uacy
Nausea and vomiting
of nutritional state Jprovides calories for energy, sparing protein for healing Jto prevent edema and ascites formation Jdecrease feeling of fullness, $loating Jreduce discomfort from a$dominal distension and decrease sense of fullness produced $y pressure of a$dominal contents and ascites
5
Activity intolerance related to fatigue and wea"ness
-
Lea"ness emoglo$in count of 4)
-
g6 6ac" of energy Anemia with and .?C count of +(%3
on the stomach Jprovide $aseline for further assessment and criteria for assessment of effectiveness of interventions Jpromotes e*ercise and hygiene within patients level of tolerance Jstimulates patients interest in selected activities Jconserve energy Jprovides calories for energy
and protein for healing
6eft mastectomy
7
=istur$ed ?ody Image!elf-steem
6oss of hair
0atient is very sensitive to $ody changes and may e*perience feelings of guilt when cause is related to $ody emage(
POTENTIAL PROBLE& RAN 2
PROBLE&
C$ES
;$STIFICATION ( In order to prevent the
.is" for infective $irthing pattern
ris" for infective $irthing pattern, we must monitor
Ris< %a!tors ma# in!lude
respiratory rate, depth, and effort(
-Intra-a$dominal fluid collection 9ascites -=ecreased lung e*pansion, accumulated secretions -=ecreased energy, fatigue 5
-
.is" for acute confusion
•
Ina$ility of liver to deto*ify certain enymesdrugs
Adverse drug reactions or interactions 9e(g(, cimetidine plus antacids may may potentiate andor e*acer$ate confusion
N$RSIN+ CARE PLANS ASSES&ENT
N$RSIN+
PLANNIN+ =
N$RSIN+
C$ES
IA+NOSIS
O$TCO&E
INTER-ENTIONS
Su3>e!tive: I cant eat
$ecause of loss of appetite,G stated the pt(
Short term:
Im$alanced Nutrition less than $ody re7uirements
nausea and
After hours of nursing interventions, the pt will ver$alie understanding and demonstrate $ehaviors to maintain appropriate nutrition(
-
Long term: =emonstrate progressive weight gain toward goal with patient-appropriate normaliation of la$oratory values(
*perience no further signs of malnutrition(
sta$lished rapport
To gain cooper
with client and family(
-
- For ba observ
Monitored D!(
distress
-
vomiting evidenced
'F of her $rea"fast $y weight loss
-
Inde'endent:
-
related to anore*ia, O3>e!tive: 9> weight loss 9> /he patient ate
RA
-
Measure dietary inta"e
-
0rovide
$y calorie count(
informa
ncourage patient to
needs a Improv
-
eatK e*plain reasons for
diet is v
the types of diet( Eeed
0atient
patient if tiring easily, easily,
family i
or have !< assist
preferre
patient( Include patient patient
include
in meal planning to
possi$le
consider hisher preferences in food choices(
e'endent:
- Administered medications as prescri$ed $y =octor(
- For the pharm manag sympto
ASSES&ENT
N$RSIN+
PLANNIN+ =
N$RSIN+
C$ES
IA+NOSIS
O$TCO&E
INTER-ENTIONS
RA
INEFFECTI-E AIR4A, CLEARANC
ASSES&ENT C$ES
Su3>e!tive: MCA stated that she
has cramps( 0ain scale of & O3>e!tive: !he gets out of $ed
N$RSIN+
PLANNIN+ =
N$RSIN+
IA+NOSIS
O$TCO&E
INTER-ENTIONS
Activity intolerance related to fatigue and
Short term:
Inde'endent: - sta$lished rapport
After hours of
with pt and relatives( Monitored D!(
wea"ness as
nursing interventions,
evidenced $y rare
the pt will report
movements
improved sense of
ncouraged ade7uate and
energy O perform
fre7uent $ed rest Minimied environmental
rarely !he is frail with
A=6s
general wea"ness
-
R
. -
To ga
-
coope For b asses
-
distre To pr conse
stimuli, dim lighting and
emoglo$in count of
Long term:
4) g6
After % day of nursing
prom
6ac" of energy
interventions done,
conse
Anemia with and .?C
patient will $e a$le a$le to
count of +(%3
apply energy
ensure 7uiet environment
-
To fa
conservation techni7ues(
RIS FOR INFECTION
RIS FOR ALTERE ALTERE N$TN$TRITION: LESS LES S T(AN BO, RE?$IRE&ENTS ASSES&ENT C$ES
N$RSIN+
PLANNIN+ =
N$RSIN+
IA+NOSIS
O$TCO&E
INTER-ENTIONS
R
Su3>e!tive: I have lost my
appetiteG As ver$alied $y pt(
Ris< %or altered
Inde'endent: - =etermine pts a$ility
nutrition: less than 3od# re@uirements
ACTION
eneric tamo*if en =osage % ta$lette
- is an anti-
estrogen that prevents the effects of estrogens on tissues( /he precise .oute mechanism
INICAT ION
-
Lomen ta"ing Nolvad e* to decreas e the ris" of develop ing $reast cancer have develop ed cancer of the uterus, stro"e, and $lood clots in the lung(
-
Thes
to chew, swallow and
can a
taste food(
and/ nutri
O3>e!tive: 9> Anore*ia 9> ND R$+ NA&E
.
CONTRAINI CATION
=o N
A-ERSE REACTION
amenorrhea, vaginal
you are allergic to discharge, hot any ingredient in flash, fluid Nolvade* you are using Nolvade* to reduce your ris" of $reast cancer and you have a history of $lood clots in the lung or leg you are using Nolvade* to reduce your ris" of $reast cancer and you also ta"e certain anticoagulants 9eg, warfarin you are ta"ing anastroole
retention, vaginal hemorrhage, nausea, weight loss, and s"in changes(
Assess understanding
of individuals N$RSIN+ nutritional needs( RESPONSIBIL ITIES - =iscuss food Assess pts vital preferences O signs for $aseline intolerances( data especially - ncourage pt to C?C choose foods /each /each pt a$out appropriate for her the medications prescri$ed diet( action and - Administer anti possi$le adverse emetics as prescri$ed( reactions( ive a selection
-
. to d infor of pt.
-
To a clien
-
To st
-
To co and v great appe
of foods that pt li"es( Instruct patient to immediately report any adverse reactions( R$+ ST$,
R$+ NA&E
ACTION
Is a centrally acting synthetic opioid ?rand analgesic(( analgesic tramal Although =osage its mode of %/a$ H action is not &''mg completely understood, .oute from animal tests, at
eneric tramado l
INICAT ION
Tramadol Tramadol is used to treat moderate to severe pain.
CONTRAINICAT ION
- ypersensitivity, acute intoxication with any of the following: alcohol, hypnotics, centrally acting analgesics, opioids or psychotropic drugs. It may worsen central nervous system and respiratory depression in these patients.
A-ERS E REACTI ON
- ives,
N$RSIN+ RESPONSIBILI TIES
-
vital signs for
swelling of
$aseline data(
face, lips, tongue or
-
medications
=yspneaK
action and
mood
possi$le
swingsK
adverse
depressionK
reactions(
an*ietyK
-
=o not crush or chew,
hallucinati
swallow
onsK
whole(
=iinessK nausea
/each /each pt a$out the
throatK
irrita$ilityK
Asses patients
-
If advised to stop, taper dosage(
-
!tore at a room temperature area(
-
=o not handle heavy machinery
after ta"ing medication(
-
Instruct patient to immediately report any adverse reactions(
R$+ NA&E
eneric 0rednis one
ACTION
INICATI ON
- !uppresses - !6 the immune system $y reducing =osage activity and &mg volume of the .oute lymphatic
CONTRAINICA TION
-
ypersensitivity !ystemic fungal infection
A-ERS E REACTIO N
-
Eluid O electrol yte im$alan ces, Na retentio n, 5 lossK 0NK CEK insomni aK mood swingsK persona lity changes K Muscle wea"ne ssK
N$RSIN+ RESPONSIBILI TIES
- Assess pts vital signs for $aseline data( - Monitor I O < - Monitor pts sleeping pattern - /each /each pt a$out a$o ut the medications action and possi$le adverse reactions( - ncourage ade7uate $ed rest( - Advise pt to do $edtime routineK shower or a glass of warm mil" - If ordered to stop, taper dosage(
cere$ral innervation of the emetic center via inhi$ition of prostaglandi n synthesis(
petechi
- If medication is
aeK
stopped monitor
vertigoK
for withdrawal
headac
syndromeK fever,
heK
arthalgia, malaise
indigest
- .eport to
ion
physician any mental changeK
Classificatio n lucocortic oid
mood swings, personality changes( - Instruct pt to immediately report any adverse reactions(
R$+ NA&E
ACTION
eneric Neutralies Calciu hydrochlori m c acid in Car$on gastric ate secretions( It also ?rand inhi$its the
INICATI ON
- .elief of heart$urn O acid Ingestion -
CONTRAINICA TION
A-ERS E REACTI ON
N$RSIN+ RESPONSIBILI TIES
- ypersensitivity
- hivesK
-
- ypercalcemia
itchingK
Dital signs for
dyspneaK
$aseline data(
Assess pts
tightness
-
Monitor I O <
of chestK
-
/each /each pt a$out a$o ut
Caltrate action of 0lus pepsin $y increasing the p and =osage via % /a$ adsorption( Neutraliati .oute on of
ypocalce
swelling
the
mia
of mouth,
medications
face, lips
action and
or tongueK
possi$le
confusionK
adverse
polyuriaK
reactions(
loss of
0lace in a high
appetiteK
fowler sitting
mood
position of
changesK
=
NDK
-
constipati onK
Classificati on - Calciu m supple ment - Antacid
-
Instruct to do =?(
-
ncourage
stomach
ade7uate $ed
painK
rest(
wea"ness
-
.eport to physician any mental changesK mood changes(
-
Instruct to report any adverse reactions(
R$+ NA&E
eneric !evela mer
ACTION
- It contains multiple amines separated =osage $y one 8'' mg car$on from the .oute polymer
INICATI ON
CONTRAINICA TION
A-ERS E REACTI ON
N$RSIN+ RESPONSIBILI TIES
- !.=
- ypersensitivity
-$loatingK
-
- low phosphate
diarrheaK
vital signs for
levels
passing
$aseline data(
- Ciproflo*acin or
gasK /arry
mycophenolate
stoolsK
mofetil decreases the
heart$urnK
feces
medications effect
indigestio
characteristics(
nK NDK
-
-
Assess pts
Monitor I O
/each /each pt a$out a$o ut
a$dominal
the
painK
medications
a$dominal
action and
crampingK
possi$le
constipati
adverse
onK
reactions(
dyspneaK
-
acidityK
Instruct to ta"e with meals(
-
=o not $rea" or crush, if pt is a$le, medication should $e swallowed(
-
If missed dose, ta"e it immediately unless its almost time
for the ne*t Classificati on - 0hosphate ?inders
dose(
-
If there is presence of =
-
Instruct to do =?(
-
Instruct to report any adverse reactions(
R$+ NA&E
ACTION
eneric - $loc"s Captopr the action il of AC which =osage produces R /a$ H angiotensi 2& mg n II which causes .oute constrictio
INICATIO N
CONTRAINICA TION
-
- ypersensitivity
yperten sion
A-ERS E REACTI ON
N$RSIN+ RESPONSIBILI TIES
-
-
Assess pts
=iinessK
vital signs for
urinary
$aseline data(
changes,
-
Monitor IO<(
oliguria or -
Instruct to ta"e
polyuriaK
% hour $efore
n and narrowing Ere7uen of the cy $lood /I= vessels there$y increasing $lood pressure( ?y $loc"ing AC, production of angiotensi n II decreases allowing the $lood vessels to rela* and widen resulting in decrease $lood pressure(
!
meal(
-
/each /each pt a$out
or
the
tightnessK
medications
$radycard
action and
iaK
possi$le
$radypnea
adverse
K
reactions(
wea"nessK
-
Instruct to
feverK
increase fluid
chillsK
inta"e(
coughK
-
ncourage
flushingK
ade7uate $ed
loss of
rest(
taste
-
Instruct pt to
sensationK
immediately
itchingK
report any
loss of
adverse
appetite
reactions(
Classificat ion - AC inhi$itor R$+ NA&E
ACTION
INICATI ON
CONTRAINICA TION
A-ERS E REACTI ON
N$RSIN+ RESPONSIBILI TIES
eneric 0antopra ole
!uppresse s the final step in gastric acid productio n $y
- Increased acid in stomach
- ypersensitivity
-
-
- anti-diarrheal drugs
eadacheK
vital signs for
unless prescri$ed $y
feverK
$aseline data(
doctor(
stuffy
=osage +' mg .oute
noseK
-
Assess pts
Monitor I O <(
covalently $inding to the 9>, 5 >A/0ase enyme system at the secretory surface of the gastric parietal cell( Inhi$ition of $oth $asal and stimulated gastric acid secretion, irrespectiv e of the stimulus( /he $inding to the 9>, 5 >A/0ase results in a duration of antisecret ory effect that persists longer than 2+ hours for all doses tested
Classificat ion - 0roton pump
sneeingK
-
=o not crush
sore
or chew
throatK
swallow it
stomach
whole(
painK gasK
-
/each /each pt a$out a$o ut
NDK mild
the
diarrheaK
medications
@oint painK
action and
urinary
possi$le
changes
adverse
oliguria or
reactions(
polyuriaK
-
ncourage
convulsio
ade7uate $ed
ns
rest(
-
Instruct to report any adverse reactions(
inhi$itor
R$+ NA&E
eneric Eurosem ide ?rand
=osage +' mg .oute
ACTION
INICATI ON
- Inhi$its water rea$sorpti on in the nephron $y $loc"ing the sodium potassiumchloride cotranspor ter 9N5CC2 in the thic" ascending lim$ of the loop of enle( /his is achieved through competitiv e inhi$ition at the chloride $inding site on the cotranspor
Eluid retention yperten sion
CONTRAINICA TION
- ypersensitivity - ypotension
A-ERS E REACTI ON
N$RSIN+ RESPONSIBILI TIES
- diarrheaK
-
constipatio nK stomach
signs(
-
painK diinessK
Monitor vital
Monitor I O <(
-
ncourage
headacheK
ade7uate $ed
hyponatre
rest(
mia,
-
confusion, muscle
Assist in A=6s
-
/each pt
wea"ness,
a$out the
malaiseK
medications
hypocalce
action and
mia,
possi$le
muscle
adverse
tightness,
reactions(
overactive
-
Instruct
refle*esK
relative to not
wt lossK
leave pt
oliguriaK
unattended(
ter, thus preventing the transport of sodium from the lumen of the loop of enle into the $asolateral interstitiu m( Conse7ue ntly, the lumen $ecomes more hypertonic while the interstitiu m $ecomes less hypertonic , which in turn diminishes the osmotic gradient for water rea$sorpti on throughout the nephron( ?ecause the thic" ascending lim$ is responsi$l e for 2&F of sodium rea$sorpti on in the
loss of
-
Instruct to
appetiteK
immediately
@aundiceK
report any
tinnitus
adverse reactions(
nephron, furosemid e is a very potent diuretic(
Classificat ion - 6oop =iuretic
R$+ NA&E
eneric Acetylsali cylic AcidK A!A
ACTION
- Inhi$it the synthesis of prostaglandi ns, important mediators of =osage inflammatio 8' mg n( Antipyretic .oute effects are
INICATI ON
CONTRAINIC ATION
-
-
-
0ain reliever Inflamm ation Eever AC!
-
ypersensitivit y ypersensitivit y to N!AI=s
A-ERS E REACTI ON
- upset
N$RSIN+ RESPONSIBIL ITIES
-
signs(
stomachK heart$urnK
-
-
medications
tinnitusK
action and
mental
possi$le
changes,
adverse
confusion
reactions(
and
onsK rapid $reathingK NDK feverK
/each pt a$out the
headacheK
hallucinati
Monitor I O <(
drowsines sK mild
Monitor vital
-
=o not crush or chew, must swallow whole(
synthesis of the prostaglandi n intermediar y( Inhi$ition of platelet aggregation is attri$uta$le to the inhi$ition of platelet synthesis of throm$o*an e A2, a potent vasoconstric tor and inducer of platelet aggregation( /his effect occurs at low doses and lasts for the life of the platelet 98 days( igher doses inhi$it the synthesis of prostacyclin , a potent vasodilator and inhi$itor of platelet aggregation( Classificatio n - Analgesi cs - Anti-
tarry
-
Administer
stoolsK
with meal if
increased
it causes I
$leeding
distur$ances
time
in pt(
-
If pt will undergo surgery, tell surgeon physician that pt is ta"ing aspirin(
-
.eport to physician mental changes such as confusion and hallucination s(
-
If fever persists report to physician(
-
ncourage ade7uate $ed rest(
-
Assist in A=6s
-
Instruct pt to
-
R$+ NA&E
eneric /icagrel or
inflamm atory 0latelet aggregat ion inhi$itor s
ACTION
/icagrelor and its ma@or =osage meta$olite 4' mg reversi$ly interact .oute with the
immediately report any adverse reactions(
INICATI ON
CONTRAINICAT ION
- AC!
-
ypersensitivity Any active $leeding pro$lems
A-ERS E REACTI ON
-
N$RSIN+ RESPONSIBILI TIES
-
signs(
headacheK mild
-
/each /each pt a$out a$ou t the
diinessK
medications
coughK
action and
NDK
possi$le
diarrheaK
adverse
$leeding
reactions(
tendencies K $loody
Monitor Dital
-
!hould $e
n and platelet activation( /icagrelor and its active meta$olite are appro*imat ely e7uipotent( Classificati on - 0latelet inhi$itor
tarry
administered
stoolsK
with aspirin(
coughing
-
?leeding
up $loodK
precautions,
chest
avoid sharp
painK
edges $y
wea"nessK
putting
pale s"inK
padding(
feverK
-
ncourage
@aundiceK
ade7uate $ed
!
rest(
-
0rovide a therapeutic environment, room temp and $edsheets clean(
-
If patient has !
-
Assisst in A=6s
-
Instruct to immediately report any adverse reactions(
R$+ NA&E
ACTION
eneric - /he =omperid antiemetic one properties of domperidone ?rand are related to its dopamine receptor =osage $loc"ing % /a$ activity at $oth the .oute chemorecept
INICATI ON
CONTRAINICA TION
- Nausea O vomiting
- ypersensitivity
A-ER SE REACTI ON
-
N$RSIN+ RESPONSIBILI TIES
-
signs(
headacheK dry
-
-
medications
mastalgia
action and
K pruritusK
possi$le
stomatitis
adverse
K
reactions(
astheniaK
-
-
rest(
essK
a$domina
ncourage ade7uate $ed
nervousn
edemaK
0roper oral hygiene care(
irrita$ilit yK
/each pt a$out the
flushesK
NDK
Monitor I O <(
mouthK hot
Monitor vital
-
0rovide a safe and therapeutic
which among others - regulates nausea and vomiting( Classificatio n
-
Antiemetic - =opamin ergic $loc"ing agent
l crampsK
environment,
constipati
place side
onK
rails up,
malaiseK
ad@ust room
wea"ness
temp, 7uiet,
K dysuriaK
and dim lit(
palpitatio
-
ns
Assist in A=6s
-
Instruct relative to not leave pt unattended(
- Instruct pt to immediately report adverse reactions(
ISC(AR+E PLANNIN+ &edi!ation
-
!hould $e ta"en regularly as prescri$ed, strictly follow e*act dosage, time, O fre7uency, ma"ing sure that the patient and relatives fully understand the importance of ta"ing medications(
-
Instruct patient and relatives to immediately report any side effectsadverse reactions(
Eer!ise
-
-
*ercise at least 3' minutes daily( !hould $e promoted in a way $y stretching all $ody parts every morning( 0atient should $e encouraged to "eep active through light e*ercises(
-
Maintain rest periods in $etween activities(
Treatment -
emodialysis /reatment should still $e followed( 2 * a wee"(
(ealth Tea!hing
-
dhere to treatment treatment regimen. regimen. Adherence Adherence to treatment regimen is essential in order to prevent relapse( Most common cause of relapse is loss to compliance( Medications should $e administered at proper times and with proper dosages(
-
!est when you feel it is needed. !lowly needed. !lowly start to do more each day( .eturn to your daily activities as directed(
-
"rotect your skin from from #$ light. !unlight light. !unlight can ma"e your lupus symptoms worse( Avoid Avoid the sun $etween %' am a m and + pm, when the rays are strongest( Apply sunscreen with a !0E of 3' or more every 2 hours when you are outside( =o this even on cloudy days( Lear Le ar pants and long sleeves to cover your $ody( $od y( A hat with a wide $rim can protect your face, head, and nec"(
-
%at healthy foods( foods( ealthy foods include fruits, vegeta$les, whole-grain $reads, low-fat dairy products, $eans, lean meats, and fish(
-
%xercise. /his %xercise. /his will help decrease your symptoms and prevent depression( At least for 3' minutes(
-
aintain a healthy weight. As" weight. As" your primary healthcare provider how much you should weigh( As" him to help you create a weight loss plan if you are overweight(
-
'o not smoke. If smoke. If you smo"e, it is never too late to 7uit( As" for information a$out how to stop smo"ing if you need help(
-
anage your stress. !tress stress. !tress may slow healing and lead to illness( 6earn ways to control stress, such as rela*ation, deep $reathing, and music( /al" to someone a$out things that upset you(
Out Patient -
Eollow-up chec"-up as ordered $y the physician should $e greatly encouraged for the patient to determine if his progression on treatment, and if he will have to continue on his medicationstreatments which were ordered during hospitaliation(
-
Come $ac" 2* a wee" for hemodialysis(
iet -
-
Increase fluidwater inta"e, should $e 8 glassesday( ealthy foods include fruits, vegeta$les, whole-grain $reads, low-fat dairy products, $eans, lean meats, and fish(
S'iritual -
-
-
ncourage family and friends to pray and remain $y patients side( ncourage client to $uild a strong faith and intimacy with od through prayers( ncourage to attend mass and prayer sessions with family, family, for added emotional and spiritual support(
-
Advise to continue spiritual practices(
/he liver is located loca ted in the upper right-hand portion of the a$dominal cavity, cavit y, $eneath the diaphragm, and on top of the stomach, right "idney, and intestines( !haped li"e a cone, the liver is a dar" reddish-$rown organ that weighs a$out 3 pounds( /here are two distinct sources that supply $lood to the liver, including the following:Jo*ygenated f ollowing:Jo*ygenated $lood flows in from the hepatic artery Jnutrient-rich $lood flows in from the hepatic portal vein /he liver consists of two main lo$es, $oth of which are made up of thousands of lo$ules( /hese lo$ules are connected to small ducts that connect with larger ducts to ultimately form the hepatic duct( /he hepatic duct transports the $ile produced $y the liver cells to the gall$ladder and duodenum 9the first part of the small intestine( Cancer is uncontrolled replication of damaged cells( /his condition usually produces a mass called a tumor( Cancer is a direct result of either a mutation of the cellular =NA or some sort of damage to the cellular =NA( Eor the cancerous cells actually develop into tumor, it must $e a$le to grow and to replicate itself (A cancerous cell that cannot grow or ma"e a copy of itself will die or lic" dormant for an e*tended period( S Carcinogenesis is a multistage process that $egins when a carcinogen causes a genetic change or damages the =NA in a normal cell( /his ma"es the cell more vulnera$le to
other genetic changes( /his stage is called Tinitiation(T If the process ended here, and the cancerous cell did not grow and replicate, no cancer would form( /he ne*t stage of carcinogenesis is called Tpromotion(T /his occurs when the initiated cell is e*posed to an agent that enhances its growth into a larger mass( Lhen a tumor actually forms, it has all of the same $asic needs as a normal cell( ?ecause the tumor cells are genetically damaged, they are inefficient and ro$ normal cells of important o*ygen and nutrients( In addition, a malignant tumor grows uncontrolla$ly and can eventually interfere with the function of vital organs, such as the liver( Metastatic tumors form when large progressive tumors shed tumor cells( /hese tumor cells must $e a$le to grow and function apart from the primary tumor JMove throughout the $ody, $ody, usually through the circulatory system or system or the lymphatic system( system( J
9Male hormones used $y athletes to increase muscle can slightly increase liver cancer ris" with long-term useJ ?irth control pills
6iver Cancer !ymptoms J6iver cancer is sometimes called a Tsilent diseaseT $ecause in an early stage it often does not cause symptoms( owever, as the cancer grows, symptoms may include: J0ain in the upper a$domen on the right sideK the pain may e*tend to the $ac" and shoulder J!wollen a$domen 9$loating JLeight JLeight loss J6oss of appetite and feelings of fullness JLea"ness or feeling very tired JNausea and vomiting J;ellow s"in and eyes, and dar" urine fr om @aundice JEever
Nursing Management J Latch Latch out for potential pro$lem related to cardiopulmonary car diopulmonary involvement include vascular complications and respiratory and liver dysfunction( J Careful attention to meta$olic a$normalitiesJU 0atient undergo cryosurgery should monitored closely for: JS ypothermiaJS hemorrhage or $ile lea"JS myoglo$inuria may occur as a result of tissue necrosis J
( Nursing diagnosis JActivity intolerance related to fatigue and wea"ness 0lanning
J0atient will report decrease in fatigue and increased a$ility to participate in activities Intervention JAssess level of activity tolerance and degree of fatigue and malaise JAssist with activities and hygiene JAssist with selection and pacing of desired activities and e*ercise Jncourage rest when fatigued felt JAdvice diet high in car$ohydrates with protein inta"e .ationale Jprovide $aseline for further assessment and criteria for assessment of effectiveness of interventions Jpromotes e*ercise and hygiene within patients level of tolerance Jstimulates patients interest in selected activities Jconserve energy Jprovides calories for energy and protein for healing
valuation Jimproved nutritional status $y increased weight without fluid retention Jidentifies foods in car$ohydrates and within protein re7uirements Jreport improved appetite Nursing diagnosis J Im$alanced Nutrition less than $ody re7uirements related to a$dominal distention and loss of appetite 0lanning Jto meet nutritional re7uirements
Intervention JAssess dietary inta"e and nutritional status through diet history JAdvice diet high in car$ohydrates with protein inta"e JAdvice patient of low sodium foods J0rovide smaller, fre7uent meals Jlevate the head of the $ed during meals .ationale Jto identify deficits in nutritional inta"e and ade7uacy of nutritional state Jprovides calories for energy e nergy,, sparing protein for healing Jto prevent edema and ascites formation Jdecrease feeling of fullness, $loating Jreduce discomfort from a$dominal distension and decrease sense of fullness produced $y pressure of a$dominal contents and ascites on the stomach
Nursing iagnosis •
=istur$ed ?ody Image!elf-steem
&a# 3e related to •
?iophysical changesaltered physical appearance
•
ncertainty of prognosis, changes in role function
•
0ersonal vulnera$ility
•
!elf-destructive $ehavior 9alcohol-induced disease
Possi3l# eviden!ed 3# •
Der$aliation of changerestriction in lifestyle
•
Eear of re@ection or reaction $y others
•
Negative feelings a$out $odya$ilities
•
Eeelings of helplessness, hopelessness, or powerlessness
esired Out!omes •
Der$alie understanding of changes and acceptance of self in the present situation(
•
Identify feelings and methods for coping with negative perception of self(
Nursing iagnosis •
.is" for acute confusion
Ris< %a!tors ma# in!lude •
Alcohol a$use
•
Ina$ility of liver to deto*ify certain enymesdrugs
esired Out!omes •
Maintain usual level of mentationreality orientation(
•
Initiate $ehaviorslifestyle changes to prevent or minimie recurrence of pro$lem(
