Care of Patients With Cancer of The Liver [PDF]

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CARE OF PATIENTS WITH CANCER OF THE LIVER

Liver cancer • Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized

organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.

• Several types of cancer can form in the liver. The most common type of liver cancer is

hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.

• Risk factors include: chronic infection of hepatitis B or C virus ;liver cirrhosis; inherited

liver diseases such as hemochromatosis and Wilson’s disease; diabetes; nonalcoholic fatty liver disease; exposure to aflatoxins; and excessive alcohol consumption.

What are Aflatoxins? • Aflatoxins are a family of toxins produced by certain fungi that are found on agricultural crops such as maize (corn), peanuts, cottonseed, and tree nuts.

PATHOPHYSIOLOGY • Liver cancer happens when liver cells develop changes (mutations) in their DNA. A cell's DNA is the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.

• Sometimes the cause of liver cancer is known, such as with chronic hepatitis infections. But sometimes liver cancer happens in people with no underlying diseases and it's not clear what causes it.

ASSESSMENT Subjective Cues • • •

Fatigue • Loss of appetite Generalized weakness • • Anorexia. •

• • Upper abdominal pain

Objective cues Weight loss due to the caloric needs of the tumor, taking away from the needs of the body. Abdominal swelling Jaundice White chalky stool

MEDICAL MANAGEMENT- PHYSICIAN’S ORDER Special Notation • Surgical removal of affected area of the liver or liver transplant • Radiation therapy to decrease tumor size. • Oxygen therapy to supplement the needs of the body. • High-protein, highcalorie diet to meet the needs of the body.

Laboratory /diagnostic examination • CT scan shows mass • Biopsy will show cell type: • Needle biopsy through liver tissue for peripheral tumors. • Tissue biopsy from liver for deeper tumors. • Bone scan or CT scans shows metastasis of the disease. • Ultrasound of the liver • Serum AFP , amylase, lipase •

Medication • Chemotherapy often with a combination of drugs:

• cyclophosphamide, doxorubicin, vincristine, etoposide, cisplatin • may see relapse after treatment • Administer antiemetics to combat side effects of chemotherapy: • ondansetron, prochlorperazine • Administer analgesics for pain control: • morphine, fentanyl Administer Diuretics as needed to combat fluid retention:

Aldactone or lasix

IV fluid IV as ordered

Nursing Care Plan

Nursing Diagnosis

Intervention

Risk for infection

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Maintain or teach asepsis for dressing changes and wound care, peripheral IV and central venous management, and catheter care and handling. Wash hands and teach patient and SO to wash hands before contact with patients and between procedures with the patient. Instances when to wash hands: Before putting on gloves and after taking them off. Before and after touching a patient, before handling an invasive device (foley catheter, IV catheter, and so on) regardless of whether or not gloves are used. After contact with body fluids or excretions, mucous membranes, nonintact skin, or wound dressings. If moving from contaminated body site to another site during the care of the same individual. After contact with inanimate surfaces and objects in the immediate vicinity of the patient. After removing sterile or nonsterile gloves. Before handling medications or preparing food.

Encourage intake of protein-rich and calorie-rich foods. Encourage fluid intake of 2,000 to 3,000 mL of water per day, unless contraindicated.

Evaluation Patient remains free of infection, as evidenced by normal vital signs and absence of signs and symptoms of infection. Early recognition of infection to allow for prompt treatment. Patient will demonstrate meticulous hand washing technique.

Excess Fluid Volume related to compromised regulatory mechanism

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Measure I&O, weigh daily, and note gain of more than 0.5 kg/day. Monitor for cardiac dysrhythmias. Auscultate heart sounds, noting development of S3/S4 gallop rhythm Measure abdominal girth. Encourage bed rest when ascites is present. Provide frequent mouth care; occasional ice chips (if NPO). Monitor serum albumin and electrolytes (particularly potassium and sodium). Administer mediation as ordered

Demonstrate stabilized fluid volume, with balanced I&O, stable weight, vital signs within patient’s normal range, and absence of edema.

Altered Nutrition: Less Than Body Requirements

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Ascertain patient’s dietary program and usual pattern then compare with • recent intake. Discuss eating habits and encourage a diabetic diet (balanced diet) as prescribed by the doctor. • Consult dietician and/or physician for further assessment and recommendation regarding food preferences and nutritional support. Provide liquids containing nutrients and electrolytes as soon as the patient • can tolerate oral fluids then progress to a portion of more solid food as tolerated. Observe for signs of hypoglycemia: changes in LOC, cold and clammy skin, rapid pulse, hunger, irritability, anxiety, headache, lightheadedness, shakiness. Regular exercise Refer the patient to an exercise physiologist, physical therapist, or cardiac rehabilitation nurse for specific exercise instructions.

Ingest appropriate amounts of calories/nutrients. Display usual energy level. Demonstrate stabilized weight or gain toward usual/desired range with normal laboratory values.

Acute pain

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Suggest use of non-pharmacological techniques as appropriate. Encourage increased oral fluid intake (2-3 liters if no contraindications).. Encouraged the use of analgesic (e.g., acetaminophen) or antispasmodics (e.g., phenazopyridine) as prescribed Determine timing or precipitants of “breakthrough” pain when using around-the-clock agents, whether oral, IV, or patch medications. Provide nonpharmacological comfort measures (massage, repositioning, backrub) and diversional activities (music, television) Encourage use of stress management skills or complementary therapies (relaxation techniques, visualization, guided imagery, biofeedback, laughter, music, aromatherapy, and therapeutic touch). Provide cutaneous stimulation (heat or cold, massage).

Client will use pharmacological and nonpharmacological pain relief strategies. Client will report satisfactory pain control at a level less than 3 to 4 on a scale of 0 to 10.

Risk for Ineffective Therapeutic Regimen Management

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Investigate the patient’s prior efforts to manage the HIV care regimen. Evaluate the patient’s self-management skills, including the ability to maintain medication administration Assess for factors that may negatively affect success with following the regimen. Assess the patient’s financial resources for health care. Determine and ensure that patient’s knowledge about the symptoms, causes, treatment, and prevention of hyperglycemia.

Patient demonstrates knowledge of diabetes self-care measures.

Risk for • Impaired Skin Integrity. • • • • • •

Use foot cradle on the bed. Use space boots on ulcerated heels, elbow protectors, and pressure-relief mattresses. Wash feet daily with mild soap and warm water. Check water temperature before immersing feet in the water. Inspect feet daily for erythema or trauma. Change socks or stockings daily. Encourage the patient to wear white cotton socks. Use gentle moisturizers on the feet. Cut toenails straight across after softening toenails with a bath. The patient should not walk barefoot.

Patient’s skin on legs and feet remains intact while the patient is hospitalized. Patient will demonstrate proper foot care.

Anticipatory Grieving

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Expect initial shock and disbelief following diagnosis of cancer and traumatizing procedures (disfiguring surgery, colostomy, amputation). Provide open, nonjudgmental environment. Use therapeutic communication skills of Active-Listening, acknowledgment, and so on. Encourage verbalization of thoughts or concerns and accept expressions of sadness, anger, rejection. Acknowledge normality of these feelings. Visit frequently and provide physical contact as appropriate, or provide frequent phone support as appropriate for setting. Arrange for care provider and support person to stay with patient as needed. Determine way that patient and SO understand and respond to death such as cultural expectations, learned behaviors, experience with death (close family members, friends), beliefs about life after death, faith in Higher Power (God).

Identify and express feelings appropriately. Continue normal life activities, looking toward/planning for the future, one day at a time. Verbalize understanding of the dying process and feelings of being supported in grief work.