cancer - Karya Tulis Ilmiah

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CANCER
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CANCER
DEFINISI
1. Cancer is a disease that attacks the basic life process of the cell, altering the cell genome (the total genetic complement of the cell)
and leading to wild and spreading growth of the cancereous cells.
The cause of the altered genome is mutation of one or more genes ; or mutation of a large segment of a DNA strand containing many
genes or loss of large segments of chromosomes (Guyton, 1981).
2. Cancer is not a single disease with one cause ; rather it is a group of distinct desease with different causes, manifestations,
treatments and prognosis (Brunner).
EPIDEMIOLOGI
? ? pasien kanker ? di Amerika, Eropa, Asia
? Kulit hitam > kulit putih
? Vegetarian < non vegetarian
? Faktor penyebab utama : Lingkungan : sosial
? Fisik : radiasi, perlukaan/lecet
? Kimia : makanan, industri, farmasi, rokok
? Genetik : payudara, uterus
? Virus : umumnya pada binatang
Karakteristik dari neoplasma
Benigna Malignant
1. Grow Slowly
2. Usually encapsuled
3. Grow by expandion; do not infiltrate surrounding tissues
4. Do not spread but remain localized
5. Do not tend to recur when removed surgically
6. Cell usually closely resemble those of normal tissue from which they arise
7. Produce minimal tissue destruction
8. Do not produce typical cahexia
9. Do not cause death to host except when located in areas where they produce pressure or obstruction to vital organ 1. Grow rapidly
2. Rarely encapsuled
3. Infiltrate surrounding tissues; tumor process extended out in all direction; poorly differentiated from normal tissue
4. Spread via lymph stream and/or blood and set up secondary tumor in distant sites
5. Frequently tend to recur after surgical removal as a result of infiltration into surrounding tissue
6. Cell usually do not resemble those of normal tissue from which they are arise
7. Produce extensive tissue destruction as result of infiltration and metastatic lession
8. Produce typical cancer cachexia-anemia, weakness, loss weight and so on
9. Always cause death unless removed surgically before they metastasize
? From Bouchard, R., and Owens, N. F.; Nursing care of the cancer patient, 3rd ed., St. Louis, 1976, The C.V. Mosby Co.
Types of tumors
Type of cell or tissue Benign tumor Malignant tumor
Epithelium
Skin, outer layers
Skin, pigmented layer (melanoblast)
Glandular epithelium
Papilloma
Nevus
Adenoma
Squamous cell carcinoma
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Malignant melanoma
Adenocarcinoma
Muscle Myoma Myosarcoma
Connective tissue
Fibroblast
Cartilage
Bone
Fatty tissue
Fibroma
Chondroma
Osteoma
Lipoma
Fibrosarcoma
Chondrosarcoma
Osteosarcoma
Liposarcoma
Endothelial tissue
Blood vessels
Lymph vessels
Hemangioma
Lymphangioma
Hemangiomasarcoma
Lymphangiosarcoma
Nerve tissue
Neuroglia
Medullary epithelium
Astrocytoma
Glioblastoma
Medulloblastoma
Lymphoid and hematopoetic tissue
Lymphosit
Myelocytes
Lymphosarcoma
Lymphatic leukemia
Multiple myeloma
Myeloid leukemia
JENIS/LOKASI KANKER
1. Payudara
2. Kolon rektum
3. Laring
4. Paru
5. Leukemia
6. Pankreas
7. Prostat
8. Gaster
9. Uterus
10. Serviks
11. Lain : Hodgkin's, Thyroid dll
PROMOTIF, PREVENTIF ? PENDIDIKAN KESEHATAN
C ? Change in bowel or bladder habits
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A ? A sore that does not heal
U ? Unusual bleeding or discharge
T ? Thickening or lump in the breast & etc
I ? Indigestion or dificulty in swallowing
O ? Obvious change in wart or mole
N ? Nagging cough or hoarsenes
PERAN PERAWAT
Promotif s.d rehabilitatif
1. Memberi dukungan klien ? prosedur diagnostik
2. Mengenali kebutuhan psiko sosial dan spiritual
3. Memenuhi kebutuhan cairan dan nutrisi klien
4. Memberi bantuan bagi klien yang mendapat pengobatan anti kanker/terhadap keganasan
5. Membantu klien fase penyembuhan/rehabiltasi
6. Membantu klien untuk tindak lanjut pengobatan
7. Berpartisipasi dalam koleksi data penelitian/registrasi kanker
DIAGNOSTIK
1. Riwayat keperawatan & penyakit, sosial, pemeriksaan fisik
2. Biopsi ? patologis
3. Pemeriksaan darah, darah lengkap, thrombosit, kimia darah: elektrolit & LFT & BUN & chreatinin
4. Imaging : foto toraks, scan-nuklir, CT-scan, MRI.
MANAJEMEN : PENDEKATAN MULTI DISIPLIN
Tindakan pengobatan : pembedahan, kemotherapi, radiasi, imunotherapi, atau kombinasi
Jenis pembedahan :
1. Biopsi
2. Rekontruksi
3. Paliatif
4. Adjuvant
5. Pembedahan primer otak
6. Reseksi metastasis
7. Profilaksis : polip
8. Kuratif
KEMOTHERAPI
Penggunaan obat anti kanker yang bertujuan mematikan sel kanker
Indikasi dan prinsip :
1. Sebanyak mungkin mematikan sel kanker seminimal mungkin mengganggu sel normal
2. Dapat digunakan untuk : pengobatan, pengendalian, paliatif
3. Jangan diberikan jika bahaya/komplikasinya lebih besar dari manfaatnya
4. Obat kemotherapi umumnya sangat toksik ? teliti/cermat evaluasi kondisi pasien
5. Obat dapat diberikan melalui berbagai cara
?
Tindakan pengamanan ditujukan :
1. Pengamanan diri dengan mengurangi eksposur inhalasi
2. Pengaman diri mengurangi eksposur kontak kulit
3. Pengamanan diri mengurangi eksposur melalui makanan/oral
4. Pembuangan secara aman alat/bekas yang digunakan, urine, muntah (ekskresi cairan tubuh)
KOMPLIKASI KEMOTHERAPI
? Efek samping :
- nausea, vomiting
- alopecia
- rasa (pengecap) menurun
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- mucositis
? toksik
- hematologik : depresi sumsum tulang, anemia
- ginjal, hepar
PENGKAJIAN KEPERAWATAN
A. Sistem Integumen
1. Perhatikan : nyeri, bengkak, flebitis, ulkus
2. Inspeksi kemerahan & gatal, eritema
3. Perhatikan pigmentasi kulit
4. Kondisi gusi, gigi, mukosa & lidah
B. Sistem Gastrointestinalis
1. Kaji frekwensi, mulai, durasi, berat ringannya mual & muntah setelah pemberian kemotherapi
2. Observasi perubahan keseimbangan cairan & elektrolit
3. Kaji diare & konstipasi
4. Kaji anoreksia
5. Kaji : jaundice, nyeri abdomen kuadran atas kanan
C. Sistem Hematopoetik
1. Kaji Netropenia
? Kaji tanda infeksi
? Auskultasi paru
? Perhatikan batuk produktif & nafas dispnoe
? Kaji suhu
2. Kaji Trombositopenia : < 50.000/m3 ? menengah, < 20.000/m3 ? berat 3. Kaji Anemia ? Warna kulit, capilarry refill ? Dispnoe,
lemah, palpitasi, vertigo D. Sistem Respiratorik & Kardiovaskular 1. Kaji terhadap fibrosis paru yang ditandai : Dispnoe, kering,
batuk non produktif ? terutama bleomisin 2. Kaji tanda CHF 3. Lakukan pemeriksaan EKG E. Sistem Neuromuskular 1. Perhatikan
adanya perubahan aktifitas motorik 2. Perhatikan adanya parestesia 3. Evaluasi refleks 4. Kaji ataksia, lemah, menyeret kaki 5. Kaji
gangguan pendengaran 6. Diskusikan ADL F. Sistem genitourinari 1. Kaji frekwensi BAK 2. Perhatikan bau, warna, kekeruhan
urine 3. Kaji : hematuria, oliguria, anuria 4. Monitor BUN, kreatinin DIAGNOSA KEPERAWATAN 1. Resiko terjadi infeksi
berhubungan dengan netropenia 2. Resiko perlukaan berhubungan dengan trombositopenia 3. Lemah berhubungan dengan anemia 4.
Perubahan nutrisi : kurang dari kebutuhan berhubungan dengan efek samping 5. Perubahan selaput mukosa berhubungan dengan
stomatitis 6. Perubahan gambaran diri berhubungan dengan alopecia INTERVENSI KEPERAWATAN 1. Mencegah infeksi 2.
Mencegah perdarahan 3. Mengurangi kelelahan 4. Meningkatkan nutrisi 5. Mengurangi stomatitis 6. Meningkatkan koping pada
perubahan gambaran diri THERAPI RADIASI Terapi radiasi menggunakan energi tinggi & getaran ion. Dapat menimbulkan
kerusakan molekul sel dan perubahan biokimia : mematikan sel kanker Jenis therapi radiasi : ? Teletherapi : cobalt, lineacc ?
Brakhitherapi : dosis tinggi lebih terlokalisasi ? Intra operative radioterapi, hipertermia Pertimbangan klinis : ? Indikasi : digunakan
tersendiri atau kombinasi ? Perencanaan pengobatan Komplikasi : Komplikasi tergantung dari lokasi, jenis radiasi, dosis, status
kesehatan klien 1. Efek samping akut 1 ? 6 bulan - eritema - lemah & lunglai - nausea, muntah, diare - oral : kering, mucositis,
xerostomia - dispnoe, pnemonia - sistitis 2. Efek samping kronis > dari 6 bulan
- Kulit : fibrosis, kehitaman permanen atropi
- Gastro intestinal : fibrosis, obstruksi, ulkus, striktur
- Oral : xerostomia, pengecapan menurun, caries gigi
- Paru : fibrosis
- Ginjal : nefritis, fibrosis
- Kanker lain 5 ? 7% leukemia
Pengkajian
1. Sistem terkait
2. Emosi/psikologis klien
Intervensi Keperawatan
1. Mempertahankan perawatan kulit secara optimal
- informasikan tentang reaksi kulit
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- jangan menggunakan lotion, minyak kosmetik pada lokasi therapi hanya tepung maizena
- hindari, penekanan, penggosokan, garuk
2. Memastikan terlindungi dari efek radiasi
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