NURSING CARE PLAN

PATIENT
WITH GYNECOLOGY CHEMOTHERAPY

Ni Ketut Alit A
Nursing Faculty Airlangga University
Surabaya East Java

REFERENCES

Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care, The

Nurse and The Family 5th ed , St Luis : CV Mosby Company.

Black, J.M. & Matassarin E, (1997). Medical Surgical Nursing:

Clinical Management for continuity of care. J.B. Lippincott.co.

Smeltzer, S.C., & Bare, B. (2003). Brunner and Suddarth's Textbook

of Medical-Surgical Nursing (10th ed.). Philadelphia: Lippincott
Williams & Wilkins.

Ignativicius & Bayne. (2001). Medical and Surgical Nursing.

Philadelphia: W.B. Saunders Company.

Luckman & Sorensen. (2000). Medical Surgical Nursing. Philadelphia:

W.B. Saunders Company.

Journals and article related to..

TERMINOLOGY
Neoplasm
new plasmaabnormal tissue growth with rapid
growth
Benign
no metastasis
Malignant
local invasion and destructive growthwicked
Metastasis
spread form primary via lymphatic and/or circulatory
system

DEFINITIONS
1. Cancer is a disease of the cell
2. Large group of diseases characterized by:
a. Abnormal cell structure (no differentiation)

b. Uncontrolled growth (proliferation)

c. Ability to spread (metastasis)
d. Ability to invade normal tissue (lack contact inhibition)

SURGERY
Curative
Prophylactic
Diagnostic
Staging
Palliative
Adjuvant or Supportive
Reconstructive/Rehabilitative

RADIATION
Highest energy rays that can kill any cell or tissue
May be external source (brachytherapy)
Curative
Palliative
60% will receive XRT
Divided into doses or fractions
(Preserve normal cellular growth)

CHEMOTHERAPY

Cytotoxic drugs that destroy cancer cells or prevent

cellular replication by interfering with DNA and RNA
and vital cellular proteins

Goal is to reduce the number of cells to a small

number that can be (theoretically) handled by the
immune system

PRINCIPLES OF CANCER
TREATMENT
CURE
CONTROL

PALLIATION

GENITAL CANCER

Cervical
Endometrial
Ovarian
Testicular
Breast

CANCER BACKGROUND

1.
2.
3.
4.
5.
6.

Family of complex diseases

Affect different organs and organ systems
Normal cells mutate into abnormal cells
Eventually harm and destroy host
Historically, cancer is a dreaded disease
Cancer accounts for about 25% of death.

SIDE EFFECT OF CHEMOTHERAPY

MYELOSUPPRESSION
NEUTROPENIA
THROMBOCYTOPENIA

ANEMIA

NEUTROPENIA/LEUKOPENIA

Assess risk factors

(Age, renal and liver function, nutrition, bone marrow, other

medications, prior chemotherapy and/or radiation)

Manifestations include

fever >38 C or 100.4F (no classic signs)

cough, SOB

skin redness or tenderness, (mouth, perianal, rectal)

urinary symptoms (dysuria frequency, hematuria,

hesitancy)

indwelling devices (VADs, pain, edema, swelling,

induration at site)

sepsis (hypotension, agitation, decreased urine)

PREVENTION

No fresh fruits or vegetables, no pepper, live

plants or potting soil

No exposure to live vaccines or pet excreta

Avoid others with colds

Strict hand washing and personal hygiene

Mouth care at least 4 times daily

No trauma or invasive procedures

Prevent constipation and pressure sores

Management:
BC lines and peripheral, urine, sputum
Good physical assessment
Antibiotics immediately (broad spectrum coverage)
Patient education
Vital signs at least every 4 hours or more
Assess for chills, cough, pain

THROMBOCYTOPENIA
Assess

risk factors

chemotherapy / radiation
DIC

disease infiltration

NSAID's

petechaie

hemorrhage (skin, GI, GU)

headaches, confusion, somnolence

Management

Institute bleeding precautions <50,000/mm3

Decrease activity and no lifting or straining/Valsalva

High fiber, increase fluids, stool softeners

No razors, nail clippers, douching, tampons, watersoluble lubricants, no flossing, guiac/hemocult, pad
counts

Maintain SBP <140mm/Hg

No IM injections, apply pressure to all sites, no

NSAIDS, administer platelets per protocol

Educate patients signs and symptoms

ANEMIA=DECREASED RED BLOOD CELLS

Assess

for

chemotherapy

kidney damage

tumor infiltration

bleeding, hemorrhage

age, appetite

Management:

Rest, slow position changes

Oxygen

Iron

Transfusion

Patient education on signs and symptoms

GI SYMPTOM
60% patients experience nausea and
vomiting, etc..
Patterns

Anticipatory (starts and may last several hours to days)

Acute (0-24 hours)
Delayed (1-4 days)

medications, stress management

Assess for weight loss, albumin, hydration

OTHER NOTABLE SIDE EFFECTS

Up to 80% develop mouth sores

Skin reaction : hypersensitivity, hyper pigmentation,

photo sensitivity, Ulceration

Hair loss : damage is to shaft (thinning and breakage),

damage to roots (complete alopecia), loss begins about
2 weeks after treatment, regrowth may take up to 3-5
months after treatment

NURSING CARE- NURSING DIAGNOSIS

Anxiety
1. Therapeutic interactions with client and family.
2. Availability of community resources for terminally ill.
B. Disturbed Body Image
1. Includes loss of body parts ; loss of energy, ability to be productive
2. Fear of rejection, stigma
C. Anticipatory Grieving
1. Facing death and making preparations for death.
2. Offer realistic hope that cancer treatment may be successful

NURSING CARE- NURSING

DIAGNOSIS
D.
E.
F.
G.

Risk for Infection

Risk for Injury
Altered Nutrition: less than body requirements
Impaired Tissue Integrity