Ms.

Santias 9/2/13
Care of client with problems in cellular Eat well (diet rich in fruits and veggies, limit
aberrations food in high fat)
Be active (moderate physical activity &
Principles of various modalities maintain a healthy weight)
1.Health promotion the process of enabling people to
increase control over, and to improve their health
2.Disease Prevention the deferral or elimination of
specific illnesses and conditions by one or more
interventions of proven efficacy SCREENING, DIAGNOSIS, STAGING
3.Curative tending to overcome disease and portion Screening
recovery - Checking for cancer in people who have no symptoms
4.Restorative to bring back to a state of health, - Help doctors find and treat some types of cancer early
soundness or vigor - Screening tests are widely used to check for cancers of
the breast, cervix, colon, and rectum.
Principles of Management o Mammogram
1 Determination and management of cause (risk o Pap test/smear
factors) o Fecal occult blood test
2. Definitive management (surgery, chemo, radio o Sigmoidoscopy
therapy, biotherapy) o Colonoscopy
3. Blood component replacement (px on chemo = o Endoscopy
bone marrow depression)
o Double-contrast barium enema
4. Oxygen therapy (hydrogen peroxide & ozone ->
o Digital recital exam
nasal, suppository) inc. amnt of ozone = inc.
immunity
Diagnosis
5. Hydration
- If the symptom or screening test result
6. Prevention of infection
suggests cancer, the doctor must find out
7. Supportive management
whether it is due to cancer or to some other
8. Prevention of complications
cause
9. Rehabilitation
- Personal and family history, physical exam, lab
10.Drug therapy
tests, x-ray., or other tests or procedures may
be ordered.
Risk factors
- test of blood (BMA), urine or other fluids
Growing older (over 65 y.o)
- imaging procedures (x-rays, CT scan),
Tobacco (nicotine)
radionuclide scan)
Sunlight (UV radiation) - biopsy (with: needle, endoscope, surgery)
Ionizing radiation (rays from outer space,
radioactive fallout, radon gas, x-rays, radiation a) Bone Marrow Aspiration
therapy) - is the soft tissue inside the bones that helps
Certain chemical and other form blood cells. It is found in the hollowed
substances(asbestos, benzene, benzinide, parts of most bones.
cadmium, nickel, vinyl chloride) - Iliac crest bone/sternum site = adult
Some viruses and bacteria (HPV, Hepa B & C - Shin bone =child
virus, HIV, H. pylori) - Is the removal of the small amount of bone
Certain hormones (estrogen) marrow in liquid form for examination. For
Family history of cancer (gene mutation) example, for bone marrow biopsy or bone
Alcohol marrow culture
Poor diet, lack of physical activity, or being - Other names are: iliac crest tap or sternal tap
overweight or trephine biopsy

Management Indications of BMA

Quit smoking, medicine or nicotine
replacement therapy (patch, gum, lozenges
nasal spray, inhalation)
Limit time in the sun (avoid mid-morning to
late afternoon sun); wear long sleeves, long
pants, wide brimmed hat sunglasses; use
sunscreen (al least SPF 15); stay away from
sunlamps and tanning booths
Test home for high radon gas levels,
put on shields during x-rays
Avoid or reduce contact with harmful
substances at work and at home (pesticides,
used engine oil, paint, solvents)
Do not share needles; vaccination
Drink alcohol in moderation or dont drink (W=
1 drink/day; M= 2 drinks/day)
- The test is performed if you have abnormal
types or numbers of red or white blood cells or
platelets on a CBC. The test is used to diagnose
the ff:
o Anemia
o Infections
o Leukemia
o Other blood disorders
BMA procedure
- Before procedure
1. The nurse must check the BP and the heart
rate because bone marrow can be painful
2. The patient must be given a local anesthesia to
keep him/her comfortable. If the patient is
really anxious about pain. A sedative drug can
be given through IV.
Ms. Santias 9/2/13
3. The area where the biopsy needle will be
inserted must be clean and then marked
4. The biopsy sample is usually collected from the
top ridge of the back of the hip bone. (posterior
iliac crest)
5. In babies and very young children, the sample
may be taken from the lower leg bone, just
below the knee
6. The patient must lie on his/her abdomen or
side, and the body will be draped with cloth so
only the
- During the procedure
1. The bone marrow aspiration is usually done
first. The doctor makes a small incision to make
it easier to insert the needle. A hollow needle is
inserted through the bone and into the bone
marrow.
2. Using a syringe attached to the needle. The
doctor pulls back on the plunger to draw a
sample of the liquid portion of the bone marrow
in to the needle. You may fell a brief sharp
pain.
- After the procedure
1. After the bone marrow exam, pressure is
applied to the area where the needle was
inserted to stop the bleeding
2. If with anesthesia, patient will be asked to lie
on his back for 10-15mins.
Nursing interventions before BMA
After the procedure:
1. Ensure the patient that he/she may feel some
tenderness for a week or more after the
procedure
2. Keep the bandage on and dry for the next 24
hours
3. Advise the patient not to take a shower or bath
or swim or use a hot tub bath within 48 hours
4. If bleeding soaks through the bondage or
doesnt stop with direct pressure, contact your
doctor.
If you experience:
- Persistent fever
- Worsening pain or discomfort
- Swelling at the procedure site
- Increasing redness or drainage at the
procedure site
b.) PET Scan
- A positron emission tomography is an imaging test
that uses a radioactive substance called a tracer to
look for disease in the bod
Indications of PET Scan
Can reveal size, shape, position and some
functions of the organs:
This test can be used to:
o Check for brain function
o Diagnose cancer; heart problems and
brain disorders
o See how far cancer has spread
o Show areas in which there is poor blood
flow to the heart
PET scan
The tracer is given through a vein (IV). Most
often on the inside of the elbow. The tracer
travels through the blood and collects in organs
and tissues. This helps the radiologist see
certain areas of concern more clearly.
Patient will need to wait nearby ass the tracer
is absorbed by the body. This takes about 1
hour
Tracer contains glucose
Then patient will lie on a narrow table that
slides into a large tunnel-shaped scanner. The
pet picks up detects signals from the tracer. A
computer changes the signal into 3D pictures.
The Images are displayed on a monitor for the
doctor to read
Patient must lie during the test. Too much
movement can blur images and causes errors
How long it takes depends on
Precautions
- The amount of radiation that is similar to the
CT scan
- Pregnant or breast feeding women. Infants or
babies developing In the womb are more
sensitive to radiation because their organs are
still developing.
- People with allergic reaction to their tracer
material. Some people may have pain, redness,
swelling
- The nurse should instruct the patient to refrain
from using tobacco and ingesting caffeine for 4
hours before the procedure (vasoconstrictor)
- The patient should also be reassured that
radiation exposure is at safe and acceptable
levels, similar to those of other diagnostic x-ray
studies
Staging
- Based on tumor size, & whether the cancer has
spread to the lymph nodes or other parts of the
body
Definitive Management
Surgery
- oldest form of cancer treatment. About 60% of
cancer patient swill undergo surgery, either by
itself or in combination with other therapies
- removal of tumor and some tissue around it also
removal of some nearby lymph nodes
- side effects depend mainly on the size and location
of tumor, and type of operations
- time to recover is different for each type of surgery
and for each person
a. Curative Surgery
- simply involves removal of a cancerous tumor.
It works best on localized cancers that havent
yet spread to other parts of the body, asnd is
often followed by radiation therapy or
Ms. Santias 9/2/13
chemotherapy to make sure all cancerous cells
have been removed
types:
- Robotic
b.) Preventive surgery
- Used to keep cancer from occurring
- Colon cancer
- Breast cancer
c.) Reconstructive surgery
- Returns the body to normal or near-normal
appearance or function following cancer
treatment
d.) Diagnostic Surgery (biopsy)
- In this procedure, the surgeon removes some
or all of tumor for examination to determine if
the growth is cancerous
- A biopsy can be done in several ways
- Fine needle aspiration
- Incisional or excisional
Incision- removal of a piece of large tumor
Excision- removal of the entire mass or tumor
e.) Palliative Surgery
- Is only use to ease the pain, disability or other
complications that come with advanced cancer.
Palliative surgery may improve quality of life,
but is not cure or anti-cancer treatment
f.) Debulking surgery
- Is done when removing all of a tumor would
cause too much damage to nearby tissues.
Much of the tumor iss removed and the
remaining tumor is treated with chemotherapy
or radiation therapy
- in a larger incision than is necessary in the
g.) Staging surgery
- is used to determine the extent of a cancer
VI.
h.) Supportive surgery
- is used to help with other cancer treatments.
For example, some chemotherapy devices
require a port (connecting device) to be
inserted under the skin
- Portacat portable catheter
Common surgeries for cancer
1. Lobectomy
- a type of lung cancer surgery in which one
lobe of a lung is removed (right lung =3 lobes,
left lung =2 lobes)
- Occasionally performed for other conditions
such as tuberculosis severe COPD or trauma
that interrupts major blood vessels near the
lungs
- Most commonly performed when the tumor is
confined to a single lobe
3. Mastectomy
- Oldest known treatment for breast cancer
- Removal of the entire breads
- Types
- Simple or total mastectomy
- Modified radical mastectomy
- Radical or Halstead Mastectomy
- Skin Sparing
I. Simple or total Mastectomy
- Removal of all breast tissue and skin, including
nipple and areola
- Lymph nodes and chest muscles are not
included
II. Modified Radical Mastectomy
- Removal of the nipple and areola, most of the
breast skin, the breast tissue and the lymph
nodes in the armpit area
- No muscles is removed
III. Radical or Halstead Mastectomy
- Removal of the nipple and areola, breast skin,
and may also remove a part of the chest wall
muscle underneath the breast
- Lymph nodes in the axilla also are removed
and tested
IV. Skin Sparing Mastectomy
- Breast tissue, nipple and areola are removed,
and most of the breast skin is retained
- The remaining skin is closed over the
reconstruction
- For women who are planning on immediate
reconstruction
V. Nipple Sparing Mastectomy
- Incision to remove the breast tissue is made
around the areola, thus preserving both nipples
and areola
- Like the skin sparing procedure, this may result
traditional procedure, especially if the breast is
large in size
Total skin sparing mastectomy
- Also known as subcutaneous mastectomy
- Not only preserves the skin of the breast, but
the nipples and areola too
- The incision to remove the breast tissue =can
be [placed in the fold under the breast where it
cannot be easily seen once healed, or made
around the areola
4. Nephrectomy
- A surgical procedure for the removal of the
kidney
5. Prostate surgery or prostatectomy
- Removal of the prostate gland; an invasive
procedure that can be performed by a single
incision ot the lower abdomen (retropubic) or
perineum (perineal), or by a series of small
incision (laparoscopic)

2. Pneumonectomy
- A type of lung cancer surgery in which an
entire lung is removed as treatment for lung
cancer
- Other lung left is functional
- Affected side - Position of choice
6. Colectomy
- A surgical procedure performed to remove the
large intestine (large bowel resection)
- Can be partial or total
RADIATION THERAPY/RADIOTHERAPY
- Uses high-energy rays to kill cancer cells
Ms. Santias 9/2/13
- Breaking in the replication of DNA
o External radiation comes from a large
machine outside the body; 5 days/week for
several weeks
- (2-5 weeks or 8 weeks)
o Internal radiation
(implant/brachytherapy ) radiation comes
from radioactive material placed in seeds,
needles, thin plastic tubes put in or near the
tissue; patient stays in hospital; implants
remain in place for several days
o Systemic radiation radiation comes from
liquid or capsules containing radioactive
material that traces throughout the body
ex. Strontium 89 and Iodine 131
External Radiation Therapy
- Is a treatment that uses radiation (x-ray
energy) to treat cancer,. External radiation
therapy is used to shrink the tumor or kill
cancer cells
- Seeker
What happens before first external beam radiation
treatment?
- You will have a 1 to 2 hour meeting with your
doctor or nurse before you begin radiation
therapy. At this time, you will have a physical
exam, or talk about your medical history, may
have imaging tests
- Your doctor or nurse will discuss external beam
radiation therapy, its benefits and side effects
and ways you can care for yourself
If you agree, you will be scheduled for a treatment
planning session called a simulation. At this time:
1. A radiation oncologist and a radiation
dosimetrists and medical physicists will define
your treatment area (also called a treatment
port or treatment filed and calculate radiation).
This refers to the [places in your body that will
get radiation. You will be asked to lie very still
while x-rays or scans are taken to define the
treatment area.
2. The radiation Therapists will then put small
marks (tattoos or dots of colored pink) on your
skin to mark the treatment area lifetime
3. You may need a body mold. This is a plastic or
plaster form that helps keep you from moving
during treatment.
4. If you are getting radiation to the head, you
may need a mask. The mask has air holes, and
holes can be cut for your eyes, nose and
mouth.
Internal Radiation
- Is a form of treatment where a source of
radiation iss put inside your body
2 forms:
1. Brachytherapy
2. Liquid radiation
What happens before the first internal beam radiation
therapy?
Brachytherapy
- Most brachytherapy is put in place through a
catheter, which is small, stretchy tube.
Sometimes it is put in place through a larger
device called an applicator. When the patient
decides to have brachytherapy, the doctor will
place the catheter or applicator into the part of
the body that will be treated.
- Patient may be hospitalized on the first
brachytherapy session
- Patient maybe sedated or area maybe numbed
to prevent pain
- If awake, patient will be asked to lie very still
while the catheter or applicator is placed.
- (Lithotomy position)
- Not indicated to leukemia and lymphoma (only
chemotherapy)
- Once your treatment plan is complete,
radiation will be placed inside the catheter or
applicator.
- The radiation source may be kept in place for a
few minutes, many days, or the rest of your
life.
- How long the radiation is in placed depends on
which type of brachytherapy you get, your
type of cancer, where the cancer is in our body,
your health and other cancer treatments you
have.
- Depends on how old your source is
Radiation process
1. Initial consult
2. Informed Consent
3. CT simulation
4. Tattoos
5. Technical planning
6. Set-up
7. Confirmation
Radiation Process
- Initial consultation with a radiation oncologist;
discuss role and type of therapy answer question of
patient; detailed history and physical exam will be
performed
- Informed consent signed once patient has full
understanding of proposed treatment, risk, side-
effects, and possible treatment options; can be
withdrawn anytime for any reason.
- Ct simulation ct scan of region to be treated is
done; in certain cases, an mri or pet/ct scan will be
also done
- Tattoos put marks (dots using india ink) or
patient to outline treatment fields, generally
between 4 & 8 tattoos
- Technical planning details from simulation
procedure are to radiation dosimetrists and
medical physicist who will perform highly technical
calculations that will be used to set treatment
machine (linear accelerator)
- Set-up proper positioning at treatment table
Ms. Santias 9/2/13
- Confirmation physician checks patient and
position if correct
- Daily treatment once or twice daily for a number
of weeks, 5-10 minutes per treatment
- On-treatment examinations repeat x-ray films
taken at least once a week
- End of treatment visit follow- up care
Brachytherapy
Low-dose grate (LDR) implants.
- In this type of brachytherapy, radiation stays in
place for 1-7 days.
- LDR Brachy iss used for permanent
brachytherapy, often called seed implantation
- Can b e used to treat
High-dose rate (HDR) implants
- In this type of brachytherapy, the radiation
source is in place for 10 20 minutes at a time
and then taken out. Treatment is done twice a
day or 2-5 days or once a week for 2-5 weeks.
- HDR brachytherapy uses a single high activity
iridium-192 source for temporary implants
Permanent Iplants
- Patient need to limit your time around other
people when the radiation is first put I place.
Be extra careful not to spend time with children
or pregnant women. As time goes by, almost
all of the radiation will go away, even though
the implant stays in the body.
Stereotactic Radiosurgery
- Allows precisely focused, high-dose x-ray
beams to be delivered to a small, localized
area of the brain
- A head frame or face mask used for this
treatment allows very precise setup,
localization and treatment of the tumor
- One session
- Low side effects because of precise targets
o More expensive than radiation therapy
o Not available
Gamma Knife Therapy
- Cobalt-60 therapy has been used to treat
cancer for almost 60 years
- Under local anesthesia, the patient is
positioned on a table with a special rigid frame
covering the head. Cobalt-60 therapy unit
directs approximately 200 beams of gamma
radiation at the patients tumor
Saftey measures
Your body will give off radiation once the
radiation source is in place. With
brachytherapy, your body fluids (urine, sweat,
saliva) will not give off radiation. With liquid
radiation, your body fluids will give off radiation
for a while
If the radiation you receive is very high-dose, safety
measure may include
o Staying in a private hospital
Nurses and other hospital staff will provide all
the care needed, but they ay stand at a
distance and talk with the patient from the
doorway to the room.
Visitors will also need to follow safety measure,
which may include
o Not being allowed to visit when the
radiation is first put in
o Needing to check with the hospital staff
before visitors go to room
o Keeping visits short (30 mins or less
each day). The length of visits depends
on the type of radiation being used and
the part of the body being treated
o Standing by the doorway rather than
going inside your room
o Not having visits from children younger
than 18 and pregnant women
What happens after treatment with LDR or HDR
implants?
Patient will get medicine for pain before the
catheter or applicator is removed
The area where the catheter or applicator
might be tender for few moths
There is no radiation I n the body after the
catheter or applicator is removed, It is safe for
people to be near even young children and
pregnant women.
For 1-2 weeks, patient may need to limit
activities that take a lot of effort (severe
fatigue)
Radiation
Radiation kills cancer cells, but can also
damage healthy cells. Patient may have
nausea and vomiting, diarrhea or blood in your
BM. After treatment, patients may feel more
tired, weak or have an increased risk of
infection. External radiation therapy may cause
the skin to be dry, red or darker than usual.
Patient may get sores on skin.
Patient may have thinning or loss of hair.
Organs close to where the radiation is aimed
may be harmed and not work as well, or stop
working completely. Females may become
infertile after radiation therapy.
Radiation Precautions for health care workers
Nurses who are pregnant must not be assigned
to radiotherapy patients.
It is the physicians responsibility to have all
therapy patients housed in a private room if
they have received sealed source implants or
have been administered more than 30
millicuries of a radionuclide.
The most desirable room is the isolation room,
followed by the end rooms with side walls on
the outside of the building.
Film badges or other radiation dosimeters will
be provided for personnel caring for the
radiation therapy patient; these must be worn
during the entire sift. Each person must sign for
his or her own film badge and not wear anyone
Ms. Santias 9/2/13
elses. These will be collected after the patient
is discharged.
A radiation dosimeter or badge does not
protect the worker form radiation, but passively
detects and measures radiation to which you
have been exposed.
The primary occupational whole body dose
limit is 5,000 millirems per year, effective dose
equivalent. Those limit to the extremities
(hands, fingers, etc.) is 50,000 millirems per
year.
Do not neglect the patient, but do not linger
unnecessarily either
Keep as much distance as possible between
the patient and yourself while working in the
room; further away the patient is less the
exposure rate will be.
________________________________________________________
- Othern Ames: biologic agents, biologics, biologic
response modifies, or immunotherapy
- Another type of systemic therapy
- Helps the immune system fight cancer; use
substances that occur naturally in the body
- Given through: mouth, iv,sc, im
- Biologics: interferon, interleukin, colony stimulating
factors, monoclonal antibodies, vaccines, gene
therapy
- Some are used to treat side effects of other
treatments (Epogen)
- Side effects: rash, changes in BP, breathing
problems, chills. N/v, body aches, loss of appetite
CHEMOTHERAPY
- use of drugs that kill cancer cells
- mainstay in the treatment of malignancies
- goal: kill cancer cells while using a dose that
causes the least harm to the bodys healthy cells
- major advantage is its ability to treat widespread
or metastatic cancer
- usually given in cycles; patients receive treatment
for 1 or more days, with recovery period of several
days or weeks before next treatment session
- -treatment may be in an outpatient unit, at the
doctors clinic, or at home; some may need to stay
in a hospital.
-
Used to:
o cure the cancer
o prevent the cancer from spreading
o destroy cells that have spread beyond the tumor
o decrease the size of the tumor
o relieve symptoms, such as pain from the cancer

Drugs can be given:

- Through an injection into vein (intravenous, IV)
- By mouth (pill, liquid)
- By a shot into the muscle (IM)
- Or applied to the skin (topically)

Side effects
o constipation
o diarrhea
o fatigue
o hair loss/ alopecia
o hand-foot syndrome
o loss of appetite
o thrombocyntyopenia, low platelet count
o anemia
o neutropenia
o mouth sores
o n/v
o peripheral neuropathy
o dyspnea

Treatment process
- Initial consultation with oncologist to confirm the use
of chemotherapy. To determine the kin of
chemotherapy plan to be used, and to answer any
question the patient may have; detailed history and
physical examination will be performed

- Informed consent signed by

BIOTHERAPY/BIOLOGICAL THERAPY
- Treatment planning
 Ms. Santias 9/2/13
- Schedule based on a number of factors, such as:
o type of cancer and its stage
o type of drugs used
o other treatments received
o response to treatment
- If chemotherapy is received through h a needle in the
vein, note for: burning, coolness, pain or another
unusual sensation where the needle is inserted into
the skin, as felt by patient; tell the doctor about any
swelling, redness of the skin, or discomfort after
treatment.
Follow Up Care
In general, follow-up appointments occur between
2 and 6 weeks after the completion of
chemotherapy
Progress of patient will be followed and to be seen
by oncologist on a regular basis
While patient my able seeing other physicals it is
important that they participate in the follow-up
process so that any chemo-related problems can
be identified
Prevention of infection
Infection germs enter the body and multiply,
causing illness, organ and tissue damage, or
diseases; bacteria and viruses cause infections
Bacteria comes from the air, water, soil, or food
during the course of medical treatment; most
bacteria come from the body; common bacterial
infections include pneumonia, bronchitis, and ear
infections
Viruses are passed from one person to another;
common viral infections include common cold,
herpes, and flu
the immune system helps the body protect itself from
getting an infection
cancer and chemo therapy can damage this system,
reducing the numbers of infection-fighting white blood
cells, making it harder for the body to fight infections
During chemotherapy:
Prepare: watch out for fever
Temp of 38c or higher for more than 1 hour or 38.3
or higher for any length of time
Prevent: clean your hands
before, during, and after cooking food; before
eating
after going to the bathroom; changing diapers
or helping a child use the bathroom; blowing
the nose, coughing or sneezing; touching or
cleaning up after a pet or touching trash
Protect: know the signs and symptoms of infection
During chemotherapy treatment, body may not be
able to fight off infections like it used to
When white blood cells counts are low, infection
symptoms must be taken seriously
Infections during chemotherapy can lead to
hospitalization or death
White blood cell count is likely to be the lowest,
usually between 7 and 12 days after each
chemotherapy dose is fined, and my last up to tone
week
Signs and symptoms of infections
- Fever
- Chills and sweats
- Change in cough or a new cough
- Sore through or new mouth sore
- Sob; nasal congestion
- Stiff neck
- Burning or pain with urination: increased
urination
- Unusual vaginal discharge or irritation
- Redness, soreness, or swelling in any area,
including surgical wounds and ports,
- Diarrhea; vomiting
- Pain in abdomen or rectum; new onset of pain
SUPPORTIVE MANAGEMENT
Supportive and palliative care palliative care, comfort
care, supportive care, or support management help
patients cope with symptoms or side effects
Key points
o Confront care given to patients who has serious or
life threating disease such as cancer from the time
of diagnosis and throughout the course of illness.
o Usually provided by specialist working with a team
of other health care professionals
o Begins at diagnosis, continues during care
treatment and beyond
o Addresses emotional, psychical, practical, and
spiritual issues; family members may also receive
palliative care
o Improves the quality of life of patients and family
members, as well as the physical and emotional
symptoms of cancer and its treatments.
Comprehensive palliative care will take the following
issues into account for each patient:
Physical
common physical symptoms include pain,
fatigue, loss of appetite, nausea, vomiting,
SOB, and insomnia
can be relieved with medicines or by using
other methods, such as nutrition therapy,
physical therapy, or deep breathing techniques
chemotherapy, radiation therapy, or surgery
may be used to shrink tumors that are causing
pain and other problems.
Emotional and coping
palliative care specialists can provide resources
to help patients and families deal with the
emotions that come with a cancer diagnosis
and cancer treatment
depression, anxiety, and fear are the concerns
that can be addressed
experts may provide counseling, recommend
support groups, hold family meetings, or make
referrals to mental health professionals.
Practical
Ms. Santias 9/2/13
Patients financial and legal worries, insurance
questions, employment concerns, and concerns
about completing advance directives
To ease burden: team assist in coordinating the
appropriate services
Direct patients and families to resources that
help with financial counseling, understanding
medical forms or legal advice, or identifying
local and national resources
Spiritual
With a cancer diagnosis, patients and families
often look more deeply for meaning in their
lives
Some find the disease bring them more faith,
whereas others question their faith as they
struggle to understand why cancer happened
to them
An expert in palliative care can help people
explore their beliefs and values so that they
can find a sense of peace or reach a point of
acceptance that is appropriate for their
situation
Prevention of complications
Cancer complications
Depending on the patients health and the stage of
the tumor, cancer complications can be painful,
inconvenient, life-changing and even fatal
Because of this, many of the adjuvant therapies
and alternative remedies for cancer focus on
reducing its complications and the physical and
emotional distress they cause.
Treating complications not only improves a patients
quality of life, but may increase the chances of
survival
Most Common Cancer Complications:
o Mental/emotional (depression, anxiety, sadness,
grief)
o Physical (pain: visceral, somatic, neuropathic)
o Metastasis: causes the majority of deaths related
to cancer
o Other physical complications: fever, nausea and
vomiting, pruritus; lymphedema; malignant pleural
effusion; sexual issues, such as erectile dysfunction
and vaginal dryness; hypercalcemia; fatigue; sleep
disorders
Rehabilitation
Cancer rehabilitation a process that assists the
cancer patient to obtain maximal physical, social,
psychological, and vocational functioning within the
limits created by the disease and its resulting
treatment
Objectives
- Psychosocial support
- Optimization of physical functioning
- Vocational counseling
- Optimization of social functioning
Multidisciplinary approach
o Collaborative effort of professional members of the
interdisciplinary team working with the patient and
of an accompanying support network
o Physician, nurse, social worker, psychologist,
physical therapist, occupational therapist, speech
therapist, dietician, vocational counselors.
Approaches/paradigms
Preventive interventions
- Lessen effect of expected disabilities and
emphasize patient education
- Include approaches to improve patients
physical functioning and general health status
- Psychological counseling before treatment can
assist with early identification of adjustment
issues to allow for prompt intervention
Restorative interventions
- Procedures that attempt to return patients to
previous levels of physical, psychological,
social, and vocational functioning
- Postoperative ROM exercises for patients
undergoing mastectomy and reconstructive
surgery for head and neck cancer represent
this category of interventions
Supportive interventions
- Designed to teach patients accommodate
disabilities and minimize debilitating changes
from ongoing disease
- Teaching patients how to use prosthetic devise
after amputation, instructing on use of other
devices and procedures that assist in self-
management, self-care abilities, and
independent functioning
- Provision of emotional support associated with
adjustment issues while the patient is learning
to cope with physical lifestyle changes.
Palliative interventions
- Goals focus on minimizing or eliminating
complications and providing comfort and
support
- Include pain control, prevention of contractures
and pressure sores, prevention of unnecessary
deterioration from inactivity, and psychological
support for patient and family members.
Surgical procedures
1. Major
Lobectomy
- A type of lung cancer surgery in which one lobe
of a lung is removed (right lung =3 lobes, left
lung =2 lobes)
- Occasionally performed for other conditions
such as tuberculosis severe COPD or trauma
that interrupts major blood vessels near the
lungs
- Most commonly performed when the tumor is
confined to a single lobe
Types:
a. Open lobectomy: a lobe of the lungs is
removed through a long incision on the side of
the chest (thoracotomy)
b. VATS (video-assisted thoracoscopic surgery)
lobectomy: a lobe of the lung is removed
Ms. Santias 9/2/13
through a few small incisions in the chest with
the assistance of instruments and a camera
a. -Considered for stage 1 lung cancer
with fairly small tumors (usually less
than 3-4cm); may result in fewer
complications
When is a lobectomy done?
- The type of lung cancer surgery will depend on
several factors, including:
-The location of the tumor
-The size of the tumor
-Whether or not the tumor has spread to
nearby tissues
-The general state of health of client
-How well the lungs are functioning prior to
surgery
Preparation:
Prior to lobectomy, client should be as healthy
as possible, will be able to breathe comfortably
after a lobe of the lung is removed
In addition, careful history, physical and blood
test, breathing tests (pulmonary function tests)
will be done to check lung function prior to
surgery
Depending upon the age and physical condition
of client, tests to check the heart is done as
well
Careful review all of medications during pre-
operative visit (stopping some medicines for a
period of time prior to surgery)
-Quit smoking as soon as possible before
surgery to reduce risk for complications and
increases the chance to successful surgery
During lobectomy - the procedure:
-A general anesthetic given
-Open lobectomy a lobe of the lung is removed
through a long incision along the side of the chest
-VATS lobectomy a lobe is removed with the use of a
camera and special instruments through several small
incisions in the chest
-Before closing the incisions, a chest tube is inserted
into the surgical area to allow excess fluid and air to
drain outside of the chest of a period of time
After lobectomy recovery:
Following lobectomy, client will be monitored in
the ICU for a day or so before going to a
regular hospital room
A respiratory therapist will assist client to take
deep breaths and breathe into an incentive
spirometer
The nurse will help client to get up and move
about as soon as able
Hospital stay between 4 and 7 days,
depending on the type of lobectomy that was
done
Complications:
-Some potential complications may include:
o Need for respiratory for a prolonged
period
o Infections, such as pneumonia
o Bleeding
o Stroke
o Problems related to anesthesia
o Kidney problems or failure
o Persistent pain at incision site
o Lobar torsion (part of the lung that
remains after surgery becomes
twisted)
o Heart problems, such as a heart attack
or irregular heart rhythms
o Persistent air leak, requiring the chest
tube to be left in place longer than 3-4
days
o Blood clots in the legs (DVT) or
traveling to the lungs (pulmonary
embolus)
Prognosis
Prognosis following a lobectomy depends on
many factors: which lobe is removed, stage of
cancer, sex (women tend to do better than
men), and general health prior to surgery
In one study, the 5-year survival rates for stage
1 lung cancer were 95% for VATS lobectomy
and 82% for open lobectomy (this difference
didnt mean that VATS lobectomy was superior,
however, since patients with more extensive
cancers were treated with an open lobectomy)
When successfully done for early stage lung
cancer, offers a chance for long-term survival
without recurrence
Pneumonectomy
A type of lung cancer surgery in which an
entire lung is removed as treatment for lung
cancer
Performed occasionally for other conditions,
such as TB, severe COPD< or trauma that
interrupts major blood vessels near the lungs
Usually reserved for those people who have
adequate lung functions and will be able to
tolerate living with only one lung
Types:
a. Standard Pneumonectomy either the right
lung or the left lungi s removed
b. Extrapleuralpneumonectomy one of the lungs
is removed along with part of the diaphragm,
the membrane lining the chest cavity (pleura),
and part of the membrane lining the heart
(pericardium); most often done for
mesothelioma (cancer that begins in the lining
surrounding the lungs)
When is a pneumonectomy done?
- The type of lung cancer surgery the doctor
recommends will depend upon several factors,
including
-The location of tumor
-The size of you tumor
-Whether or not the tumor has spread to
nearby tissues
-General state of health of client
-How well the lungs are functioning prior to
surgery
Preparation
Ms. Santias 9/2/13
Tests to rule out any metastasis of the cancer
may include: bone scan (spread of the cancer
to bone), a brain scan (rule out brain
metastases), and an abdominal scan (evaluate
liver and other organs)
Pulmonary function tests (evaluate the healthy
lung and determine its ability to deliver
adequate oxygen to the body alone)
Test to make sure heart is functioning well
Careful history, physical exam, and lab work
Medications that can increase bleeding, such
as warfarin (coumadin), aspirin, or anti-
inflammatory medications such as Advil
(ibuprofen), etc. will be discontinued for a
period of time before surgery
Client will have to quit smoking as soon as
possible prior to surgery
NPO for at least 8 hours (night before surgery)
Morning of surgery: IV will be inserted
BP, HR, and oxygen levels are monitored
throughout surgery
During Pneumonectomy the procedure
a general anesthetic will be given in the OR
an ET tube will be placed to allow ventilator to
breathe for the patient during surgery
a long incision will be made along the side
following the curve of the ribs
the surgeon will spread the ribs and may
remove a portion of a rib to gain access to the
lung
0when the lung is adequately exposed, the
surgical team will collapse the lung that
contains the cancer
major blood vessels (arteries and veins)
traveling to the lung will be tied off, and the
bronchus leading to the lung will be tied off and
sewn shut
After Pneumonectomy Recovery
Patient will be taken to the recovery room for
close monitoring for several hours or may be
taken directly to the ICU
First day: breathing may be assisted with a
ventilator which causes some anxiety
(medications to keep patient very drowsy are
given until tube is removed)
When ventilator is removed a respiratory
therapist will assist patient to cough and use
and incentive spirometer (exercise lungs, help
keep small air sacs open)
When patient is able, the nurse assists in
sitting, getting up and walking (regain
strength, reduce blood clots)
Most people spend at least 6-10 days in the
hospital following surgery
Some return to work after 8 weeks, but the
doctor will give special restrictions (avoid any
heavy lifting)
It will take time for the remaining lung to take
over; SOB may persist for several months
following surgery
Complication
-Some potential complications may include:
-Need for respiratory for a prolonged period
after surgery
Infections (pneumonia); bleeding
Bronchopleural fistula connective b/w
the bronchus that was cut and the
space between the pleura
Heart problems (heart attack or
abnormal heart rhythms)
Stroke
Blood clots in the legs (DVT) or
traveling to the lungs (PE)
Empyema - pus in the space b/w the
membranes lining the lungs
Post pneumonectomy syndrome
symptoms cause by organs in the chest
filling the space that is left vacant from
lung removal
Persistent pain incision or where the
ribs were cut
Prognosis
-Depends on many factors
Lung removed (better for left than right
pneumonectomy)
-Stage of cancer
Gender (women tend to do better than
men
Type of lung cancer (best for
individuals with bronchioloalveolar
cancer (BAC)))
General health prior to surgery
-Recurrence is not common after a
pneumonectomy, cancer may recur in
distant regions of the body
Mastectomy
- Oldest known treatment for breast cancer
- Removal of entire breast and may include the
removal of skin and muscle
Types
1. Simple or Total Mastectomy
-Removal of all the breast tissue and skin,
including nipple and areola
-Lymph nodes and chest muscles are left
undisturbed
2. Modified Radical Mastectomy
-Removal of the nipple and areola most of the
breast skin, the breast tissue and the lymph
nodes in the armpit area (axilla)
-No muscle is removed
3. Radical or Halstead Mastectomy
-Removal of the nipple and areola, the breast
skin and tissue, and may also remove a part of
the chest wall muscle underneath the breast
-Lymph nodes in the axilla also are removed
and tested for cancer
4. Skin Sparing Mastectomy
- Breast tissue, nipple and areola are removed,
and most of the breast skin is retained
- The remaining skin is closed over the
reconstruction site
- For women who are planning on immediate
reconstruction
5. Nipple Sparing Mastectomy
Ms. Santias 9/2/13
- Incision to remove the breast tissue is made
around the areola, thus preserving both the
nipple and areola
- Like the skin sparing procedure this may result
in a larger incision than is necessary in the
traditional procedure, especially if the breast is
large in size
6. Total Skin Sparing Mastectomy
- Also know as subcutaneous mastectomy
- Not only preserves the skin of the breast, but
the nipple and areola, too
- The incision to remove the breast tissue can be
placed in the fold under the breast where it
cannot be easily once healed, or the incision
may be made around the areola
Risks
-Mastectomy greatly reduces, but does not eliminate
the risk of breast cancer
-Risks for any surgery:
Blood clots in the legs that my travel to the
lungs
Breathing problems
Infection in the surgical wound, pneumonia,
bladder, or kidney
Blood loss
Heart attack or stroke during surgery
Reactions to medications
-Risks for breast removal:
Skin loss or long-term wounds on the chest wall
Bleeding in to the area where the breast used
to be; sometimes a second operation is needed
to control bleeding
-Risks when lymph nodes are removed during surgery:
Should pain and stiffness occurs in most
women, some may have severe stabbing or
burning pain; they may also feel pins and
needles where the breast used to be and
underneath the arm
-Swelling of the arm (lymphedema) on the
same side as the breast that is removed;
not common, but can be an ongoing
problem
-Damage to nerves may cause numbing
on the inside of the arm or weakness in
muscles or the back and chest wall
Preparation
Before the procedure: blood and imaging Tests
(CT scans, bone scans, and chest x-ray)
During the week before the surgery:
o -Several days before the surgery
patient to stop taking aspirin, ibuprofen
(Advil, Motrin), naproxen (Aleve,
Naprosyn), vitamin E, clopidogrel
(Plavix), warfarin (Coumadin), and
other drugs that make it hard for the
blood to clot
-On the day of surgery:
o -NPO post midnight (night before the
surgery)
o -Pre-op medications (taken with small
sip of water)
o -Shower (night before or morning of the
procedure)
After the procedure
Patient stays in the hospital for 1-3 days,
depending on the type of surgery y (simple
mastectomy, may go home on the same day)
Most women go home after 1-2 days
Longer stay if patient had breast reconstruction
Many women go home with drains in their
chest, removed later during an office/clinic visit
Patient may have pain around incision site after
surgery
Fluid may collect in the armpit (seroma),
relatively common and usually goes away on
its own, but may need to be drained
Recovery
Begins in the PACU, where the patient is
monitored while the anesthesia drugs wear off
Patient is then taken to a hospital room and
monitored for any problems for 34-48 hours
after surgery
During recovery, the first 2-3 days will be the
most painful, with pain easing somewhat each
day thereafter (avoid any activity that includes
bouncing movement, such as running)
Lifting is discouraged, as is raising the arms
above the head (put strain on the incision and
cause increased pain)
Depression is a problem for many patients
o -Make recovery difficult
o -Also heighten fatigue that patient feels
after surgery as well as chemotherapy
and radiation
o -Physically, a patient with no surgical
complications should be able to return
to vigorous activity within 6-8 weeks, if
additional treatments do not cause too
much fatigue; returning to sex life is
also possible, if desired
o -Patients who opt not to have
reconstruction may need prosthetics
that that create a balance between a
natural breast and a breast that has
been removed
Prognosis
- Most women recover well after mastectomy
- In addition to surgery, patient may need other
treatments for breast cancer, which may
include:
o Hormonal therapy
o Radiation therapy
o Chemotherapy
Nephrectomy a surgical procedure for the removal of
a kidney or section of a kidney
Purpose
Performed on patients with severe kidney
damage from disease, injury, or congenital
conditions: cancer of the kidney (renal cell
carcinoma); polycystic kidney disease (cysts or
sac-like structures displace healthy kidney
tissue); and serious kidney infections
Also used to remove a healthy kidney form a
donor for the purposes of kidney
transplantation
Ms. Santias 9/2/13
Description
- involve removal of a small portion of the kidney
or the entire organ and surrounding tissues
a. partial nephrectomy only the diseased or
infected portion of the kidney is removed
b. radical nephrectomy involves removal of the
entire kidney, a section of the ureter, adrenal
gland, and fatty tissue surrounding the kidney
c. simple nephrectomy performed for living
donor transplant purposes, requires removal of
the kidney and a section of the attached ureter
d. Laparoscopic nephrectomy
- a form of minimally invasive surgery that
utilizes instruments of long, narrow rods to
view, cut, and remove the kidney
- the surgeon views the kidney and surrounding
tissue with a flexible videoscope
-thevideoscope
e. Hand-assisted laparoscopic nephrectomy
- a modified laparoscopic technique,
may be also used to remove the kidney
- allows surgeon to place hand in
abdominal cavity using special surgical
glove that also maintains a seal for the
inflation of the abdomen cavity
Diagnosis/Preparation
prior to surgery, blood samples will be taken
from the patient to type and cross match in
case transfusion is required during surgery
a catheter will be inserted in to the patients
bladder
surgical procedure will be described to the
patient, along with possible risks
after care
patient may experiences discomfort in area of
the incision; may also experience numbness,
caused by severed nerves, near or on the
incision
pain relievers are administered following the
surgical procedure aned during the recovery
period on an as-needed basis
deep breathing and coughing may be painful
(due to the proximity of the incision to the
diaphragm); breathing exercises are
encouraged to prevent pneumonia
patients should not drive an auto mobile for a
minimum of 2 weeks
Risks
possible complications include infection,
bleeding (hemorrhage), and post-operative
pneumonia.
there is also a risk of kidney failure in a patient
with impaired function/disease in the remaining
kidney
Normal results
normal results are dependent on the purpose
of the procedure and the type of nephrectomy
performed
immediately following the procedure, it is
normal for patients to experience pain near the
incision site, particularly when cough or
breathing deeply
renal function of the patient is monitored
carefully after surgery
If the remaining kidney is healthy, it will
increase its functioning over time to
compensate for the loss of the removed kidney
Length of hospitalization depends on the type
of nephrectomy procedure:
o Patients who have undergone a
laparoscopic radical nephrectomy may
be discharged 2-4 days after surgery
o Traditional open nephrectomy patients
are typically hospitalized for about a
week
-Recovery time vary, on average fro m3-6
weeks
Prostate surgery or Prostatectomy
Removal of the prostate gland; an invasive
procedure that can b performed by a single
incision to the lower abdomen (retropubic) or
perineum (perineal), or by a series of small
incisions (laparoscopic/robotic)
Open prostatectomy: procedure for removal of
an enlarged prostate gland
Purpose
-Primary indication is benign prostatic hyperplasia
(BPH), a condition whereby benign or noncancerous
nodules grow in the prostate gland
Description
- Prostate gland: composed of smooth muscle
cells, glandular cells, a stromal cells that give
the gland structure; produces hormone
(dihydrotestosterone) (DHT)
- Glandular cells produce milky fluid that mixes
with seminal fluid and sperm to make semen
- BPH is currently thought ot be caused by (DHT)
which is synthesized from testosterone by a
prostatic enzyme, 5-alpha reductase
- generally, surgery is indicated for persons
which moderate to severe symptoms,
practically if urinary retention is intractable or
if the enlarged prostate is related to recurrent
UTIs, blood in the urine, bladder stones, or
kidney problems
Contrainidactions to open prostatectomy include:
Previous prostatectomy
Prostate cancer
A small fibrous prostate gland
Previous pelvic surgery that may obstruct
access to the prostate gland
a. Retropublic Prostatectomy
- Accomplished through a direct incision of the
anterior prostatic capsule, the overgrowth of
glandular cells is removed
- Cystoscopy is performed prior to the open
prostatectomy
Ms. Santias 9/2/13
- Patient lies on this back on the operating table,
prepared and draped
- Following cystoscopy, patient is changed to a
Trendelenberg position
Advantages of retropubic prostatectomy:
Direct visualization of the prostatic tumor
Accurate incisions in the urethra, which will
minimize the complication of urinary
continence
Excellent anatomic exposure and visualization
of the prostate
Clear visualization to control bleeding after
tumor removal
Little or no surgical trauma to the urinary
bladder
b. Suprapubic prostatectomy
- Also called transvesical prostatectomy
- A procedure to remove the prostatic
overgrowth via different surgical route.
- Incision lower anterior bladder wall
- Allows for direct visualization of the bladder
neck and bladder mucosa; ideally suited for
persons who have bladder complications, as
well as obese men
- Major disadvantage: visualization of the top
part of the tumor is reduced; additionally,
hemostasis may be more difficult due to poor
visualization after removal of the tumor
- Using a scalpel, a lower midline incision is
made from the umbilicus to the pubic area
Aftercare
Inpatient hospital stay of 4-7days
Immediately after the operation: surgeon must
closely monitor urinary output and fluid status
1st day after surgery: most patients are given a
clear liquid diet and asked to sit up 4x
Morphine sulfate: given via patient controlled
analgesic pump or IV to control pain
2nd postoperative day: urethral catheter is removed
if urine does not contain blood
Oral pain medications: begun if patient can
tolerate a regular diet
3rd postoperative day: pelvic drain is removed if
drainage is les than 75ml/24hr
Patient should gradually increase activity
-Full activity is expected to resume within 4-6
weeks after surgery
Risks
Several weeks after pen prostatectomy,
patients may have urgency and urge
incontinence
Severity of bladder problems depends on the
patients preoperative bladder status
Erectile dysfunction occurs in 3-5% of patients
undergoing the procedure
Retrograde (backward flow) ejaculation occurs
in approximately 50-80% of patients
Most common non-urologic risks include: PE, MI
(heart attack), DVT and CVA (stroke)
Incidence of any one of the potential adverse
effects is less than 1%
Normal results
Hematuria: typically resolved within 2 days
after surgery
Patient begins regular diet and moderate
increases in activity soon after surgery
Pre-surgical activity level: restored within 4-6
weeks after surgery
Colectomy
- A surgical procedure preformed to remove the
large intestine (large bowel resection)
- May be required to remove the organ that sits
at the end of the digestive system in order to
prevent the spread of disease or to treat a
condition that affects the colon
- Can be partial or total
- Operative procedures include: preparations of
the procedure, the surgery and addition
surgery required to reconnect the digestive
system
Preparation
Colon: cleaned out completely, usually though
use of a laxative (promotes diarrhea necessary
to cleanse the intestines)
Patient drinks a prescribed solution over a
period of a couple hours
Medications that can cause complications
during the surgery must be continued
Patient must fast from eating food fro up to 24
hours before the operation
Since bacteria are present in the colon, an
antibiotic prior to surgery to avoid infection
must be taken.
Surgery performed under general anesthesia
a. Open colectomy requires an incision in the
abdomen; surgeon can reach in and inspect the
colon to remove as much as is necessary to
treat the paitent; damaged intestines are cut
and removed through the incision
b. Laparoscopic colectomy minimally invasive
procdure that only requires severeal small
incision on the abdomen; surgeon rusn a video
camera into the incision (produces pictures on
a scere in the OR form which hthe doctor
operates); infected or diseased colon parts are
pulled though the inceisons and cut foo;
remaining colon is then pushed back in through
the same incisions
Types
a. Total colectomy entire colon is removed
b. subtotla colectomy a portion is removed;
another team uses when only a portion of the
colon is removed is hemicolectomy
-Generally surgeons what to sapre as uch of
the colon as possible to preserve as much
normal function as possible
Complications
Risks of complication is based on the patients
general health, the type of colectomy
Ms. Santias 9/2/13
undergone and the approach the surgeon used
to perform the operation
In general, complications include:
o Bleeding
o Blot clots in the legs (DVT)
o Infection
o Injury to organs near you colon such as
bladder and small intestines
o Tears in the sutures
Recovery
Requires at least 2-3 days of hospital
confinement
Patient cannot leave the hospital until they
have a bowel movement to make sure
everything is working properly
Liquids and food are slowly introduced as
the patient can tolerate them
Patients receive instructions on how to care
for their bag and hole if theyve been fitted
with colostomy bag
Most people are very weak following a
colectomy and require a weak or 3 of
continued rest at home and regain their
strength
Colostomy a surgical procedure that brings a portion
of the large intestine through the abdominal wall to
carry feces
Purpose
- treat various disorder of the large intestine:
cancer. Obstruction, inflammatory bowel
disease, ruptured diverticulum, ischemia, or
traumatic injury
a. Temporary colostomy divert stool from injured
of diseased portions of the large intestine,
allowing rest and healing
b. Permanent colostomy distal bowel must be
removed or is blocked and inoperable;
colorectal cancer: most common indication (10-
15 of patients)
Description (3 types)
a. end colostomy
- functioning end of the intesting (the section of
bowel that remains connected to the upper
GIT) is brought out onto the surface of the
abdomen forming the stoma by cuffing the
intestine back on itself and suturing the end to
the skin
- surface of the stoma is actually the lining of
the intesting, usually appearing moist and pick
- Distal portion of bowl
b. Double-barrel colostomy
- creation of 2 separate stomas on the
abdominal wall
- proximal (nearest) stoma is the function end that
ins connected to the upper GIT and will drain stool
- The distal stoma, connected to the rectum and also
called mucous fistula, drains small amounts f
mucus material
- most often temporary colostomy performed to rest
an area of bowel,, and to be later closed.
c. Loop colostomy
- brings a loop of bowel through an incision in the
abdominal wall
- loop is held in place outside the abdomen by a
plastic rod slipped beneath it
- an incision is made in the bowel to allow the pass
of stool though the loop colostomy
- the support rod is removed approx. 7-10 days after
surgery, when healing has occurred that will
prevent the loop of bowel form retracting into the
abdomen
- most often performed for creation of temp stoma
to diver stool away from an area od intestine that
has been blocked or ruptured.
Preparation
patient will be required to sign a consent
blood and urine studies, along with various x-
rays and EKG may be ordered as necessary
if possible, patient should visit an enterostomal
therapist, who will mark an appropriate place
on the abdomen for the stoma and offer
preoperative education on ostomy
management
to empty and cleanse the bowel, the patient
may be placed on a low- residue diet for
several days prior to surgery
liquid diet may be ordered from tat least the
day before surgery, NPO after midnight
a series of enemas and/or oral preparations
(GoLytel or Colyte) may be ordered top empty
the bowel of stools
oral anti-infective (neomycin,
erhtromykanamycin sulfate may be ordered to
decrease bacteria in the intestine and help
prevent post-operative infection)
NGT is inserted on the day of surgery or during
surgery to remove gastric secretions and
prevent nausea and vomiting
a urinary catheter may also
Aftercare
postoperative care involves monitoring of BP,
pulse, respirations, and temperature
patient is instructed how to support the
operative site during DPE and coughing, and
given pain meds PRN
fluid intake and output is measure, and the
operative site is observed for color and amount
of wound drainage
NGT will remain in place, attached to low,
intermittent suction until bowel activity
resumes
1st 24-48 hours after surgery, the colostomy
will drain bloody mucus
fluids and electrolytes are infused IV until the
diet of patient can gradually be resumed,
beginning with liquids
within 72 hours, passage of gas and stool
though the stoma begins; initially, stool is
liquid, gradually thickening as the patient
begins to take solid foods
Ms. Santias 9/2/13
patient is usually out of bed in 8- 24 hours after
surgery and discharged in 2-4 days
during the hospital stay patient and care givers
will educate on how to care for the colostomy
regular assessment and meticulous care of the
skin surround the stoma is important to
maintain an adequate surface on which to
attach the pouch
routine irrigation of the stoma results in
regulation of bowel function, patient may only
need a dressing or cap over the stoma
anenterostomal therapist visits the patient in
the hospital or at home after discharge to help
patient with stoma care
dietary counseling will be necessary for the
patient to maintain normal bowel function and
to avoid constipation, impaction, and other
discomforts

Complications:
excessive bleeding
surgical wound infection
thrombophlebitis
pulmonary embolism
psychological complications: fear of the
perceived social stigma attached to wearing a
colostomy bag; patient may be depressed and
have feelings of low self-worth (change in
lifestyle and appearance)
-counseling and education regarding surgery
and the inherent lifestyle change are often
necessary

-Stomal complications:
a. necrosis of stomal tissue caused by inadequate
blood supply (visible 12-24 hours after the
operation), may require additional surgery
b. prolapse (stoma increases length above the
surface of the abdomen) from an overly large
opening in the abdominal wall or inadequate
fixation of the bowel to the abdominal wall;
surgical correction is required when blood
supply is compromised
c. retraction (stoma is flush with the abdomen
surface or has moved below it) caused by
insufficient stomal length; may be managed
buy use of spceailpuiching supplies, elective - recover instruction to the patient from the doctor
revision of the stoma is also an option or nurse; the following suggestions can help speed
d. stenosis (narrowing at the opening of the recovery:
stoma), often associated with infection around walk as soon as able to circulate blood and
the stoma or scarring; mild stenosis can be prevent cloths
removed under local anesthesia, serves work with doctor and or nurse to manage pain
stenosis may require surgery for reshaping the perform deep breathing exercise to prevent
stoma
pneumonia and altecalexis if the doctor
e. parastomal hernia (bowel causing bulge in the
recommends It;
abdominal wall next to the stoma), occurs due
do not smoke
to placement of the stoma where there
talk with nurse or hospital dietitian about getting
abdominal wall is weak or an overly large
opening in the abdominal wall was made; use the right nutrition and returning to regular foods
of an ostomy support belt and special pouching ask doctor about engaging in physical activity
supplies may be adequate; if severe defect in after surgery
the abdominal wall should be repaired and the PT may become an important part of recovery;
stoma moved to another location can begin as early as the day following surgery
Some patients are given a home exercise
program to continue their progress, but is
Ms. Santias 9/2/13
important to follow the specific directions given Be alter of complications: excessive bleeding,
by the doctor infections, and allergic reactions to anesthesia or
If there is fever, excessive drainage from surgical drugs, including nausea, SOB, dizziness
incision, redness, excessive swelling at incision
sit, or persistent nausea, and vomiting,
call/consult with surgeon