Gastric cancer, the late care (a) Psychological Care
Advanced tumors, the majority of patients with different degrees of mental breakdown phenomenon, the psychological care is particularly important at this time. Health care workers should be concerned, caring, compassion patient, through language, attitude, facial expressions, gestures and actions to influence or change the patient's mood, fully understand their mental activity and pain in a timely manner by your doctor to give analgesics, technical operations to be agile, skilled , action to light, stable, minimize the suffering of patients, to seriously implement basic nursing care and life, as much as possible to meet their reasonable demands to make it a sense of security and trust, foster continued confidence in the fight against cancer to reach with The purpose of the treatment to relieve symptoms and prolong survival.
(B) of the nutritional therapy and dietary care
The interference of the tumor, emotional impact and the impact of cancer treatment options (surgery, radiotherapy, chemotherapy side effects) can cause loss of appetite. To this end, health care workers should be based on the patient's clinical presentation, appropriate care to supplement dietary nutrients, to maintain the body's normal physiological function.
1. To be able to oral feeding of patients should be encouraged to eat. Eat small meals often as the principle to the general protein per day 1. 5-2g/kg calculated daily calories over 167.5 – 188.41kJ/kg (40-45kca/kg) to maintain the metabolic needs of the body and tumors. Of dysphagia in patients with soft food or liquid diet is appropriate, may moderate consumption of dairy drinks in order to increase protein and calories.
2. On the patient can not eat by mouth
(1) nasal: nasal feeding content to appropriate elements of diet. Elements diet containing amino acids, simple sugars, fatty acids, vitamins, inorganic salts and trace elements. Preparation of the body can also be the condition of patients required nutrients.
(2) parenteral nutrition therapy (TPN): Total parenteral nutrition in the past, also called "parenteral nutrition", the use of peripheral vein or central vein to enter the patient concentrated form all the nutrients needed, including energy-rich All or part of the essential amino acids essential amino acids and essential fatty acids, vitamins, electrolytes and trace elements to supplement the body's energy needs, reduce catabolism, promote tissue synthesis and updates.
Gastric cancer, the late care (c) to strengthen primary care
Cancer patients can be due to surgery, chemotherapy resistance decreased, especially in advanced gastric cancer cachexia, as well as associated with liver, kidney, heart damage are prone to serious complications, it should earnestly implement the life of care, strengthen basic care, maintenance of clothing and bedding clean and dry, to prevent bedsores occur, improve oral care, the prevention of oral infection, and should keep warm, to prevent pulmonary complications.
(D) observe the condition
1. To observe the changes in vital signs in patients with advanced gastric cancer is often multi-system failure may occur, should be closely observed changes in vital signs, report doctors at any time if conditions change. Nurses to be familiar with early signs of failure of the system and take appropriate preventive measures to reduce complications.
2. Complication of gastric cancer patients due to the occurrence of gastric outlet obstruction translucent or chemotherapy, the population had severe post-operative rehabilitation of poor response or are prone to when the water and electrolyte imbalance and malnutrition, so to monitor pulse, blood pressure, skin elasticity, weight, urine output, recorded 24-hour access to the amount of nutrition given through the appropriate channels, be corrected. Gastric cancer, with the decline in nutritional levels, correspondingly weakened immune function, infection rate, prone to bad breath, ulcers, concurrent oral infections, lung infections, urinary tract infection and should therefore be to strengthen primary care.
3. Observe the response to chemotherapy drugs chemotherapy drugs often cause bone marrow suppression and gastrointestinal reactions, blood should be regularly reviewed. Large dose of medication side effects are more serious quickly, when the gastric mucosa can cause damage to stomatitis, anorexia, nausea, vomiting, diarrhea. In response to these conditions should do the appropriate care.
Gastric cancer, the late care (e) symptomatic care
1. The pain of cancer spread to the surrounding tissues and neural invasion, can cause upper abdominal pain or severe pain. The degree of pain, nature, reflection site and appear sooner or later the site of the lesion and the occurrence of illness. Pain should be appropriate to placebo, sedatives or analgesics, can be timed to give end-stage analgesic treatment. Anesthetic used with caution and pay attention to their side effects. Cancerous perforation, the pain got worse or unexpected whole abdominal pain, a doctor should be reported to do the appropriate treatment.
2. Vomiting prepyloric area of the tumor can cause partial obstruction of the output channels or complete obstruction, vomit overnight Sushi, often smell of corruption. Incomplete obstruction, diet management should be strengthened, but also can be used to increase gastrointestinal motility drugs, such as metoclopramide (metoclopramide), you bite Lin (domperidone), so as to promote gastric emptying. Complete obstruction of the event will have to fast and give decompression.
3. Bleeding of early gastric juice can occur, or the Ambassador continued positive occult blood tests, tumor ulceration and vascular invasion, it can cause heavy bleeding, vomiting of coffee-like liquid or schedule tarry stools. That patients with bleeding due to fasting, supine, pay attention to patients with emotional warmth and stability, and maintain fluid channels in order to ensure blood supply of fluids and drugs to stop bleeding. Observe vital signs, discharge volume and characteristics, and signs of continued bleeding.
(F) of gastric cancer patients with hospice care
Hospice care for end of life of patients and their families to provide comprehensive physical and psychological care. Ongoing care and end-stage care or rest belong to the scope of hospice care. The aim is to reduce as much as possible the patient dying physical, mental, psychological pain, increase patient comfort, improve patient quality of life, maintain the dignity of dying patients so that they can peacefully, comfortably and with dignity and without regret to spend their last journey.
1. Psychological care, please see the twenty-five chapters in section V of the content.
2. The symptoms of advanced cancer patients care most severe pain were tortured, and often there may be pain, nausea, vomiting, breathing difficulties, incontinence and other symptoms. Such as to alleviate these symptoms, the patient's pain can be reduced, and thus obtain comfort.
(1) Pain: Pain is common symptom of advanced cancer patients, organ involvement or because the tumor cells, bone marrow, or radiotherapy and chemotherapy response as a result of pain. Current pain control, there are two main methods, namely, drugs control and non-drug control. Also hypnosis and massage the skin has some effect. Pain is a subjective feeling, different people have different reactions to pain, while pain and is a complex phenomenon, requiring nurses to develop pain care program, accurate records must be carefully evaluated and observed form of pain, includes each area of pain episodes, time, extent, can alleviate the drugs and methods of pain control under the constant changes the patient care plan.
(2) Malnutrition: the chronic consumption of cancer patients, anorexia induced by chemotherapy and radiotherapy side effects such as nausea, vomiting, loss of appetite, oral disease, leading to physical weakness and ma
lnutrition. Therefore, according to patient preference, taste, nutritional needs and their families together to develop diet plans, regulating pattern variety, some color, flavor and beauty, easy to digest, nutritious diet. Encourage patients to Eat small meals often and food for patients to create a good environment, and with the grant to help improve patient Zhuxiaohuayao other appetite. Based on the patient regularly assess the nutritional status can be given to factors such as nutrition with the alternatives, as chosen by oral feeding, if necessary, intravenous hyperalimentation.
(3) the skin, mucous membrane of the care: patients dying because of physical weakness, and prolonged bed rest can lead to bedsores occur. Sheets should be kept neat, dry, turn over time for patients, sponge bath, massage pressure areas, and to conscientiously implement the morning, evening care, maintenance of patient hygiene, in order to enhance patient comfort. Can not eat or suffering for the patient to give oral disease oral care, unable to expectoration of terminal patients, the oral care in a timely manner through the elimination of sputum retention in the mouth, if necessary, by suction aspiration of sputum, head to the side to prevent accidental smoking and help mucus drainage, keep the airway open, keeping the nose clean put, gently wipe the swab can be used saline nose, and coated with lubricants. If the dying patient can not be closed eyelids, can drip oil gauze and chloramphenicol eye drops regularly and promptly wipe the eye secretions with saline cotton balls to keep terminal patients clean and comfortable.
Gastric cancer, the late care (4) excretion of care: constipation, diarrhea, urinary AIDS to stay, urinary incontinence, often caused great suffering to dying patients, prevention and early resolution of these issues can promote comfort and help to improve the quality of life of patients .