Nursing process with breast cancer. Medicine

Ministry of Health Republic of Tatarstan

State autonomous educational institution

secondary vocational education of the Republic of Tatarstan

"Nizhnekami medical college"

Specialty of therapeutic case

Remote protection

Deputy Director for UR.

O.V.Sizova

"__" _________________ 20__g.

Patrakova Alina Sergeevna

Course work

"Analysis of the nursing process in the treatment of breast cancer"

Leader: Gaysin Radik Masgutovich

Nizhnekamsk 2016-17.

Introduction 3

1. Theoretical part 4

4

1.2. Principles of treatment of RMH. 5

1.3. Stages of the nursing process 6

1.4. Features of preoperative care for the patient 9

1.5. Features of postoperative care for patients 11

2. Practical part 13

2.1. The first stage. 13

2.2. Stage second. 15

2.3. Stage Third. 19

Conclusion 30

application 31

List of used literature 42

Introduction

Breast cancer is one of the forms of malignant tumors, which is the most common among oncological diseases in women, rarely in men.

Recently, with improved diagnosis and accounting in 90%, cancer is fully cured, but only in the early stages. However, the problem is that many women ignore the recommendations of the oncologists and the mammologist in the annual examination of the breast and turn to specialists too late when to cure the disease is much harder.

The relevance of this work is: first, in increasing the number of patients with breast cancer; secondly, in the influence of heredity; Third, in the importance of the role of the care of a medical sister.

Purpose of the study:studying the peculiarities of the departure in the RMZH.

Tasks:

1. Consider the causes of malignant neoplasms;
2. Describe common clinical signs of breast cancer;
3. Familiarize yourself with the modern principles of the treatment of breast cancer;
4. Determine the peculiarities of patients with breast cancer in pre-and postoperative period.

Hypothesis: It is assumed that the nursing process plays a major role in organizing the care of patients with breast cancer disease.

Object study : Nursing process.

Subject of study: Nursing process with breast cancer.

1. Theoretical part

1.1. Breast cancer clinic and causes of its occurrence.

The causes of the occurrence of Cancer MZ are the following factors: sexuality; heredity; the presence of a woman in an anamnesis of the tumor of the ovary or other breast; age factor; increased ionizing irradiation (MRI, CT); Increased body weight; early (up to 11 years) first monthly; rejection of breastfeeding; Late first pregnancy (over 30 years old) or lack of pregnancies in general; abortions; Immunodeficiency in various reasons for their origin; menopause (at the age of 55); smoking, excessive alcohol consumption; the presence in the past injuries of the breast; Sugar diabetes, arterial hypertension.

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Course work

Topic: "Nursing Process with breast cancer"

Introduction
1. breast cancer
1.1. Risk factors for breast cancer
1.2. Forms and Stages of Breast Cancer
1.3. Pathogenesis, clinic, diagnosis of breast cancer
1.4. Treatment of RMW, forecast
1.5. Milk Self-Resets
2. Nursing process with breast cancer
2.1. Nursing process with breast cancer
2.2. Features of nursing care in the preoperative period in the RMZH
2.3.Sinsky care in the early postoperative period during RMG
2.4. Features of nursing care in the late postoperative period in the RMZH
3. Practical part
3.1. Observation of practice 1
3.2. Observation of practice 2
3.3. conclusions
4.Connect
5. Literature
6. Appendices

Introduction

Breast cancer is one of the most frequent forms of malignant tumors in women. The relevance of this problem is that in frequency, this localization ranks first among cancer in women, the second mortality. Moreover, recently there is an increasing increase in breast cancer frequency, which can be explained by improving diagnosis and accounting, as well as an increase in medical culture of the population. 80% Patients themselves accidentally discover the tumor, which almost half of the cases, unfortunately, refers to the already common stage. Only 20% Patients are actively identifying medical workers, but at an earlier stage.

Most of the actively identified patients are on the individual preventive inspection by doctors of different specialties. A significantly smaller number of patients are detected during mass preventive inspections.

From a polyclinic doctor, it is not necessary to establish an accurate diagnosis of breast disease. But the doctors of any specialty are gynecologists, therapists, surgeons, neuropathologists, dermatologists and others - should be an oncological alertness and, if possible, inspect during the reception of patients with dairy glands.

In case of suspected any pathology of the mammary gland, the doctor must send the patient to the oncologist, which is engaged in reaching and establishing an accurate diagnosis. Therefore, all general doctors should be sufficiently familiar with the pathology of the mammary glands.

Object study: Nursing process.

Subject of study: Nursing process with breast cancer.

Purpose of the study:studying the nursing process with breast cancer.

Tasks:

To achieve this goal of the study, it is necessary to study:

• etiology of breast cancer;
• features of pathogenesis at different stages;
• clinical picture of breast cancer;
• methods of diagnosis, self-diagnosis of breast cancer;
• principles for the treatment of breast cancer;
• stages of the nursing process;
• features of patients with breast cancer in pre- and postoperative periods;
• clinical cases from practice.

Research methods:

• scientific and theoretical analysis of medical literature on this topic;
• empirical - observation, additional research methods:
• organizational method;
• subjective method of clinical examination of the patient (collection of anamnesis);
• objective methods of patient survey (physical, instrumental, laboratory);
• biographical (analysis of anamnestic information, study of medical records);
• psychodiagnostic (conversation) ..................

About 25,000 new cases of breast cancer are diagnosed annually, and approximately 15,000 women die from it every year - more than from any other cancer. Over the past decade, the incidence of breast cancer among women of Belarus increased by 26.3%. Thus, the problem under consideration is one of the most sharp in modern clinical oncology.
The nursing process is a method of scientifically based and implemented in practice the medical sister of their duties to help patients. In practical health care from a medical sister, not only the presence of good technical training is required, but also the skills creatively refers to patient care, the ability to work with the patient with a person.
The first stage of the nursing process when caring for a patient with breast cancer is a patient examination. This is a targeted questioning, examination of the patient, assessing its condition. Having established the cause of human concern, the nurse determines the specific factors that cause violation of adaptation.
The second stage of the nursing process is to establish the problems of the patient who worry it at present and potential problems that may appear over time. The nurse should help a woman adapt in this situation, if possible, eliminate stimuli, setting a nursing diagnosis. For example, severe pain in the field of right-life breast caused by the chest survey; stressful condition due to the transaction; an increase in body temperature due to the presence of an inflammatory process in the field of the right-handed breast, manifested by dry lips, heat, total weakness; reduction of muscle tone due to the residual effect of previously introduced anesthesia drugs, manifested by inactive behavior in bed; Headache caused by the presence of an inflammatory response that manifests the deterioration of general well-being.
The third stage of the nursing process includes the planning of nursing care. Having reveaning stimuli, causing inadequate reactions in the patient, a medical sister together with a patient determines the short-term and long-term goals of care.
Planning the care of the patient, the medical sister performs them. This will be the fourth stage of the nursing process - the implementation of the plan of nursing interventions. Its purpose is to ensure appropriate patient care, that is, assisting the patient in fulfilling the vital needs, training and counseling, if necessary, the patient and members of his family.
There are 3 categories of nursing interventions: independent - actions made by a medical sister on their own initiative; dependent - is performed on the basis of the written prescriptions of the doctor and under its observation; Interdependent - provides for joint activities of a medical sister with a doctor and other specialists.
The fifth stage of the nursing process is an assessment of the effectiveness of nursing intervention. Its purpose is to evaluate the patient's reaction to nursing care, analysis of the quality of assistance rendered, the assessment of the results obtained and summarizes the results. Nursing intervention is effective only if the goal is achieved in the final adaptive methods. It is also necessary to assess psychological and behavioral systems, the degree of achievement by the patient's capabilities of self-turn.

RZhM is a malignant tumor, developing from the epithelium of fractions or their output ducts.

Dynamics of morbidity and mortality of the female population of Russia from breast cancer

EPIDEMIOLOGY

• 50% of all cases of RMW fall on the United States, Canada, Western Europe, where about 18% of the female population of the planet lives. The incidence is growing in all countries of the world, and mortality began to decline in some Western countries.
• The highest mortality in Denmark, the Netherlands, Ireland, Israel. Low incidence in Asia, Africa, South America.
• In 7-10% of women, RMG develops during life.
• The best rates of 5-year survival in the United States (84%), Australia (73%), Japan (74%). In Europe, 63-67%, in Russia 55%. In general, there are 5-year-old survival in the world 50-60%.

Mortality from breast cancer in different countries of the world in 2000.

Anatomy of the breast

• The pair body, located at the level of the III-IV rib, is a modified apocryne gland.
• Nipples, Areola, 4 quadrant, armpit proof.
• It consists of 15-20 rally, each of which has its own output duct, turning into "milk sinus", opening in 8-15 Milky holes.
• Enclosed in a connecting tissue case formed by leaflets of the surface fascia chest.
• Blood supply - a. Thoracica int. ET AXILLARIS, INTERCOSTALIS.

Lymphatic breast system

• Intorganic - lymphatic capillaries, vessels, plexus of the breast itself and its covering skin.
• Extraganized - removal lymphatic vessels - collectors and regional lymph nodes.

Breast Lymph Network

1 - Paramaammart:

a - Knot Barters;

b - node sorgus;

2 - axillary 2 level;

3 - axillary level 1;

4 - sublocks;

5 - axillary 3 level

(apical or connective);

6 - permissible;

7 - internal (parastinal);

8 - intergrontal (Rotter node);

9 - guarded;

10 - lymphatic vessels heading for epigastric area

• Axillary;
• Subclavian;
• Parastinal

• Mediastinal;
• Intercostal;
• Cross;
• Epigastric

(path of Gerota)

Risk factors RMW

• Paul, age
• Reproductive function factors
• Endocrine-metabolic factors
• Genetic factors
• Exogenous factors

• Injury, inflammation
• Viral theory.
• Paul, age

Reproductive function factors

• Early menarche (previously 13 years old)
• Late menopause (after 55 years)
• Duration of menstrual function
• Late first childbirth (after 30 years)
• Number of pregnancies and abortions
• Abortions, especially to the first birth
• The use of hormonal drugs, especially the ethane row during pregnancy
• Duration of lactation
• Evolution process

Endocrine-metabolic factors

• Obesity
• Liver diseases
• Thyroid diseases (hypothyroidism)
• Fibrozno-cystic disease
• Hyperplastic and inflammatory diseases of the female genital sphere
• Diabetes
• Hypertonic disease

Genetic factors

• Blood relatives on the maternal line
• Hyperexpression of the BRCA 1 gene, localized in 17 chromosome increases the risk of RMW to 50-80%.
• Hyperexpression of the BRCA 2 gene, localized in the 13 chromosome increases the risk of RMW to 40-70%.

Exogenous factors

• Ionizing radiation
• Alcohol consumption
• Excess animal fats in nutrition
• Chemical carcinogens
• Smoking

Pathogenesis RMW

• Increased etchers
• Reducing their disposal
• Increased content:

RE (receptors of ethane)

RP (Progestin receptors)

Prereach of the breast

• Intravertok papilloma;
• Domestic immune proliferates;
• Proliferative forms of fibrous-cystic diseases (especially with atiphey cells).

Features of the tumor RMZH

• Type of tumor growth
• Nodular forms (70-75%)
• Diffuse (20%):

- diffuse-infiltrative;

- edema-infiltrative;

- shell;

- inflammatory

(Mastito-like and Rog-like)

• Pedge Cancer (2-4%)
• Hidden (1-2%)

Prevalence of the tumor process(TNM, 2002, 6-edition)
T -primary tumor

N -regional lymphatic
knots

M -remote Metastase

MX - not enough data to determine remote metastases

M0 - No signs of remote metastases

M1 - There are distant metastases.

Brain

The lymph nodes

Morphologycancec Breast

• Carcinoma in situ:

Intra-prototype cancer

Intradole cancer

• Infiltrating:

Infiltrating Duct Cancer,

Infiltrating pioneer cancer,

Inflammatory

• Breast Pedge Cancer

Degree of malignancy tumor

C.teply tumor differentiation

• GX - Cannot establish a degree of differentiation
• G1 - High Differentiation Degree
• G2 - moderate degree of differentiation
• G3 - Low Differentiation Degree
• G4 - undifferentiated tumor

Receptor tumor status

• ER ± ("+" - more than 10 fmol / 1 mg of protein)
• HER -2 / NEU
• Transmembrane glycoprotein - receptor
• Localized in chromosome 17Q21
• Hyperexpression correlates with a bad forecast

Principles of metastasis of RMH.

• The hypothesis W.halted on the point of stage metastasis (from the primary tumor to the lymph nodes I-II-III of the order, then hematogenous dissemination of the tumor).
• Hypothesis B.Fisher. RMW at the stage of clinical manifestation is a systemic disease (lymphogenic and hematogenous dissemination of tumor cells occurs simultaneously).

Diagnosis of RMW

• Clinical
• Instrumental
• Diagnosis of metastasis

Clinical diagnosis of RMW

• Anamnesis;
• Inspection;
• Palpation of the mammary glands.

Anamnesis

• Anamnesis of the disease;
• Transferred and accompanying diseases of genitals, liver, thyroid gland, etc.;
• Gynecological and reproductive history;
• Sexual function;
• Socio-consumer characteristics and professional factors;
• Family diseases: endocrine, exchange, oncological.

An inspection of the mammary glands

• Constitutional features;
• Inspection of the mammary glands (size, shape, symmetry, configuration disorders, juice condition, condition of the skin, extension of blood vessels);
• Examination zones of regional metastasis;
• Condition of the nipple, selection, s-m crawle, s - m.
• Skin symptoms - scilitating, platforms, lemon crusts.

Symptom site

• Symptom Krause
• Changes in the form of MZ.
  
• Cancer Pedge
• Skin germination and tumor disintegration
• Inflammatory form of RMW

Palpation of mammary glands

• 6-14 days cycle,
• Vertical and horizontal position (C-M Koenig),
• Surface orientation palpation;
• Deep palpation
• Characteristics of the tumor node,
• Palpation of regional lymph nodes,

Instrumental diagnostics

• X-ray examination: Cordless Mammography (diagnostic value of 75-95%), aiming mammography, axillography, pneumaticistography, dotography;
• Ultrasound (diagnostic value 85%);
• CT scan;
• Magnetic resonance imaging;
• Positron emission tomography;
• Thermography;
• Microwave radiothermometry;
• Scintigraphy (P 32);
• Puncture tone-game aspiration biopsy (up to 70-85%);
• Trepan biopsy;
• Receptor status - ER, PR, HER-2 / NEU.
• Historically - transylllumation.

Diagnosis of metastasis

• Ultrasound of ragionic lymph nodes;
• Axillary and headed phlebography;
• Lymphography, lymphoscintigraphy (AU 198 and TC 99);
• Scanning skeleton bones;
• Scanning and / or ultrasound liver;
• Uzi small pelvis organs;
• Study of tumor markers - CA 153

Diagnostic efficiency

• Stage I Stage - 81%,
• Stage II - 98%,
• III Stage - 99%.
• The final stage of diagnosis is a histological study of the drug remote during operation.

Methods of treatment of RMH.

• The main stages of the evolution of the surgical treatment of breast cancer
• up to 1867: excision of the tumor.
• 1867: Removal of breast and axillary lymph nodes Moore, 1867).
• 1895: removal of a single block of breasts together with both breast muscles and lymph nodes, a plug-in, axillary, subband regions (Halsted W., 1895; MEYER W., 1895). Standard radical mastectomy.
• 1948: Removal of breasts together with a small breast muscle, lymph nodes and a plug-in, axillary, subband regions (Patey V., Dysonw., 1948). Modified radical mastectomy.
• 1949: Removal by a single block - breast, breast muscles together lymphatic nodes and a fiber of subclavian, axillary, sublock, parasolosnal regions (Margottini M., Bucalossi P., 1949; Holdin S.A., 1955; Bazhenova A.P., 1961; Veronesi U., 1962, etc.). Extended radical mastectomy.
• 1951: Removal of the mammary gland, breast muscles with lymph nodes, fiber of connectible, axillary, sublock, parasol, mediastinal, prescipical areas (Urban J., 1951; Wangensteen O., 1952, etc.). Super radical mastectomy.
• 1965. Removal of a single block of breasts together with a fiber, armpit lymph nodes, subband regions (Madden, 1965). Modified radical mastectomy.
• Since the 70s of the 20th century, organ-bearing operations began to perform; Various options for radical resection (LAMPECTOMIC, TUMORECOMMY) U.VERONESI, L988,1997.
• 1992: Definition of alarm lymphatic node (Morton, 1992).

Reconstructive plastic surgery

• Primary mammoplastic
• Delayed mammoplasty
• There are two main methods of imitation of form and breast volume: endoprosthetics or reconstructive operation using autogenic tissues

Palliative surgical interventions

• In patients with a local prostrated inoperable or metastatic process for vital testimony (bleeding or abscessive disintegrating tumor), palliative operational interventions can be performed.
• Palliative operation performed in a patient who does not have remote metastases or with the remaining prospects for suppressing disseminated disease, if possible, should be all signs of a radical operation.
• It is absolutely possible that after carrying out adjuvant treatment, the first patient will be radically cured, and the second will be given years of life.

Radiation therapy RMW

• Preoperative (40-45 gr)
• Postoperative (40-45 gr)
• Radical (60-70 gr)
• Palliative (2-24 gr)

Any "early" from a clinical point of view of cancer is late from a biological point of view.

Chemotherapy RMW

• Neoaduvante (inductive)
• Adewant
• With disseminated cancer

Neoadjuvant therapy in RMW (HT or GT)

• it is carried out to surgical intervention;
• part of the patients translates from non-culturally in operational state;
• part of the patients allows you to perform organ-bearing operations;
• may reduce the risk of metastases;
• serves as a tumor sensitivity indicator to the treatment conducted.

Drug treatment

• adjuvant chemotherapy is applied in most cases and the minimum number of courses is considered to be 6. The best combination is the use of anthracycles with taxanes (AC + Taxana) (C.Hudis, USA, 2005)
• for the elderly patients, it is possible to use CMF, AC with subsequent tape

Evolution of hormone therapy
RMH.

Hormone therapy RMH.

• Anti-estrogen

tamoxifen (Nalwadex, Zitazonium)

tEMIFEN (Foreston)

raloxyphen (Evista)

fazlodex (Fulvestrantrant)

• Aromatase inhibitors

steroid (Former, Eccendan (Aromazine))

nontery (Fraprazole, Letrozol (Femar) Aminoglutymeid (Citadren), Anastrazol (Arimidex))

• Progestins

megayis, Fallout, Province

Adjuvant therapy of RMG Hercetty

• 56% increase in non-dedicional survival
• 50% reduction in the risk of developing remote metastases
• Nonspecific immunotherapy RMH.
• Preinvasive cancer
  Salted Cancer in Situ

Outdoor localization

• Sectoral resection
• Radiation therapy for milk gland

Central and Internal Localization

• Sectoral resection
• Rady therapy for dairy gland and regional zones
• Preinvasive cancer
  In situ ducting cancer and Pedge Cancer
• Radical mastectomy with preservation of breast muscles with primary or delayed mammoplasty

Disseminated RMW

• On average, U.⅓ — ½ Patients with RMG at various times (sometimes after 20-30 years) after primary treatment there comes generalization of the disease.
• In shareIII-IV.art. Russia has to go∽ 40% of primary cases.
• The overwhelming majority of patients disseminated RMW need systemic drug therapy.
• The average life expectancy of patients after the generalization of the process varies from 2 to 3.5 years.
• Basic principles of drug therapy Disseminated RMZH
• In the presence of two methods with the same estimated efficiency, preference should be given less toxic.
• In the absence of convincing signs of the progression of the tumor should not be transferred to another type of treatment.
• When planning treatment, the results of previous therapy should be taken into account, as well as subsequent therapeutic measures.

Indicators of the total 5-year survival of patients with RMG, depending on the stage of the disease

Work number:

Year of adding:

Workload:

List of abbreviations 3.
Introduction 4.
1. breast cancer 6
1.1. Etiology and pathogenesis of breast cancer 6
1.2. Treatment of breast cancer 13
2. Organization of the nursing process 17
2.1. Study of the prevalence of breast cancer 17
2.2. Nursing process with breast cancer 21
2.3. Organization of nursing assistance in breast cancer 23
2.4. Breast cancer prevention 33
Conclusion 37.
List of references 39.

Presentation and speech

Excerpt from work:

Some theses from work on the topic of the nursing process with breast cancer


List of abbreviations
MZ - Milk Iron
RMW - breast cancer
DDMG - Diffuse Dysplasia Breast
COC - Combined Oral Contraceptives
Ultrasound - Ultrasonic Study

Introduction
The relevance of research. Pathological processes occurring in the body of a woman before, during pregnancy and after childbirth, affect the health of the fetus and newborn. These processes can be provoked by extragenital, genital, infectious diseases and operational interventions. Women with benign diseases of the mammary glands deserve special attention to special attention, since this pathology arises against the background of hormonal changes that threaten the offensive of pregnancy, its development, the birth of a healthy child and mother's health.
Milk glands are never in a state of morphofunctional stability. They are part of the reproductive system of women as a classic "target organ" for hormones such as estrogens, prozterone, prolactin, gonadotropic and thyroid hormones, corticosteroids, insulin.
Due to the wide range of hormonal influences, lactic iron has a greater tendency to the development of various pathological dormsal processes - mastops, which can be a risk factor for the development of breast cancer. The frequency of malignant diseases of the mammary glands in Russia since 1995 ranks first among all malignant neoplasms of the female population of reproductive age. In the presence of proliferative forms, the risk of cancer development increases: at three to five times according to I. I. Smolanki (2007); at 25-30 times according to V. I. Tarutinova (2006) and V.I. Starikova (2006).

Conclusion
So, the breast tumor belongs to the "visual localization" tumors, that is, an affordable direct inspection that, with the right organization of diagnostic measures, it allows them to identify them at an early stage, reducing the mortality rate, improving the forecast and reducing disability. Early diagnosis of breast tumors makes it also significantly reduced costs of treatment of patients by reducing the terms of hospitalization and disability (due to a decrease in the volume of operation), reducing the primary access to disability, the lack of need for restoration reconstructive operations, in expensive chemotherapeutic treatment in the presence of metastatic lesions. . Screening studies of the breast should be carried out by a solid method among the entire female population over 35-40 years, it is in this age group that the screening is proved.
World experience shows that due to the active implementation of screening programs in Western Europe and North America, the possibility of detecting the I stage of the disease in 70-80% and, accordingly, recovery from breast cancer is 60-80% of women.
If in the Russian Federation, mortality from the RMS continues to increase, accounted for up to 50% of the incidence rate, then in most countries of Europe and North America there is a tendency to reduce mortality from breast cancer (up to 30% of the incidence rate).

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