Nursing 211

N211: Health Differences Across the Lifespan I Radiation therapy may be used preoperatively to shrink the tumor, this improving resectability. It may also be used postoperatively as an adjuvant therapy to treat residual disease or areas that were unresectable. Chemotherapy can be used in conjunction with surgery and/or radiation therapy to treat residual disease, recurrent disease, unresectable tumors, and metastatic disease. Chemotherapy agents include combinations of 5-Fluorouracil (5-FU) and mitomycin (Mutamycin); 5-FU and levamisole (Ergamisol); 5FU and leucovorin (Wellcovorin). Nursing Interventions Includes preparing the client for surgery, prepare client for bowel preparations, which may include laxatives, and gut lavage with polyethylene glycol (Golytely). Provide high calorie, high vitamins and high mineral diet; small frequent meals. Monitor weight, intake and output. Assess for signs of dehydration. Monitor lab values such as hemoglobin, hematocrit, serum albumin, and electrolytes. Administer antiemetics. Assess pain using pain scale with ratings 1-10. Encourage energy conservation techniques. Allow patient to express feelings regarding diagnosis. Assess number, amount and consistency of stools. Provide a high fiber diet with adequate fluids and encourage activity as tolerated to promote bowel motility. The characteristics of stool following the creation of an ostomy (stoma) are: • Ileostomy: liquid dark green stool progressing to yellow • Ascending colostomy: liquid stool that is greenish then brown • Transverse colostomy: liquid to semi formed brown • Descending colostomy: semi formed to almost normal brown 3.13 Liver Cancer Liver Cancer (Hepatoma) most commonly occurs as a metastasis from the lung, breast, kidney and GI cancers. Primary liver cancer is not common and carries a poor prognosis. Tumors arise in the liver cells (hepatocellular) or bile duct (cholangiocellular). Tumors can be diffuse, nodular, or a single nodule; compress surrounding cells and can invade the blood supply, causing necrosis and hemorrhage. Most primary hepatic cancers arise from cirrhosis, hepatitis B or C, aflatoxin (toxin from Aspergillus mold exposure), chronic alcohol consumption and nonalcoholic fatty liver. Nursing Assessment Includes right upper quadrant pain or mass; feeling of fullness in the epigastric region; fatigue, malaise, anorexia and weight loss. Later signs include ascites, fever, jaundice, variceal bleeding, liver failure and splenomegaly. Diagnostics


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