Liver Cancer Case Study
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Transcript of Liver Cancer Case Study
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Nursing care plan for a patient with lever cancer
Introduction:
Ms MCA, a 32-year-old female was evacuated from uinea to the international university
hospital !hei"h #aid, Morocco on !eptem$er, %& 2'%&, at '3 Am with chief compliant of cramp
and chest pain, $iological tests were normal $ut the liver ultrasound showed a pro$a$le hepatoma
or liver metastases( !he was operated on May, 2) 2'%' for left mastectomy with a*illary
dissection and $ilateral oophorectomy ta"ing %' positive nodes of %+ collected following a
multifocal invasive ductal carcinoma grade III, poorly differentiated with hormone receptor
positive and .2 negative( /he lesion is classified 0/30N3M1( !he was admitted C# on
'2 ' %' for % times and she was under chemotherapy with Nolvade* for & years(
.eadmitted to the C# on '3 24 %3 for control had a good condition, she reported chest pain,
right $reast and lymph nodes unremar"a$le(
/horaco-a$dominal C/ scan, scintigraphy and la$oratory tests were normal, she was ordered to
continue Nolvade* % ta$ day(
Controlled at 5amsar hospital in uinea on '2 %% %+ she complained of some cramps( /he loco-
regional e*am seemed normal( 6a$oratory tests, as well as chest 1-ray and liver ultrasound were
normal( /horaco-a$dominal C/ scan was re7uested, the results did not show any a$normality(
!even days prior to admission she was readmitted to 5amsar hospital in uinea for cramps and
chest pain, $iological tests were normal however, the liver ultrasound showed a pro$a$le
hepatoma or liver metastases(
//: -doliprane % 1 3 d 0rimperan syrup if vmsmt
/ramal &' %C0 8 92% '4
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additiva
PATIENT’S PROFILE
Client’s name or Initials : MCA
Age : 32 ; A.! 2 children
Religion: Islam
Address : Cona"ry, uinea
Birth ate and Pla!e: %48+, Cona"ry
Ra!e"Nationalit# : uinean
$sual Sour!e o% &edi!al Care:
Edu!ational attainment: 3rd ; A. I !C
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ordon s functional pattern of assessment
istory of present illness
!even days prior to admission the patient was readmitted to 5amsar hospital in uinea for
cramps and chest pain, $iological tests were normal however, the liver ultrasound showed a
pro$a$le hepatoma or liver metastases( /hen she was evacuated to !hei"h #aid hospital of
Morocco(
Medical history of past health
/he patient underwent a left mastectomy with a*illary dissection and $ilateral oophorectomy on
May 2) 2'%', ta"ing %' positive nodes of %+ collected following a multifocal invasive ductal
carcinoma grade III, poorly differentiated with hormone receptor positive and .2 negative(
!he was admitted to !hie"h #aid ospital on Buly '2 2'%' for the %st time and she was under
chemotherapy with Nolvade* for & years(
.eadmitted to !hei"h #aid hospital on March 24 2'%3 for control, she reported chest pain, right
$reast and lymph nodes unremar"a$le(
/horaco-a$dominal C/ scan, scintigraphy and la$oratory tests were normal, she was ordered to
continue Nolvade* % ta$ day(
Controlled at 5amsar hospital in uinea on '2 %% %+ she complained of some cramps( /he loco-
regional e*am seemed normal( 6a$oratory tests, as well as chest 1-ray and liver ultrasound were
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normal( /horaco-a$dominal C/ scan was re7uested, the results did not show any a$normality(
F$NCTIONAL PATTERN
Fun!tional Pattern Be%ore (os'itali)ation uring(os'itali)ation
A%ter(os'itali)ation
Nutritional 0attern * MCA stated that she
has a loss of appetite
!upplements and other
therapies to support
optimal digestion and
nutrition, and help you
manage side effects(
limination 0attern - 0eed + to ) times a day
- =efecated % time a day
* 0ees + to ) times a
day
- =efecates % time a
day
Activity *ercise
0attern
- pon interview, MCA
stated that she usually
do some e*ercises(
- A$le to do A=6s
* !he gets some times
out of her $ed for a
wal"(
- A$le to do A=6s
!leep .est 0attern - MCA had sleep
distur$ances due to pain
- she sleeps 8 hours per
day
Cognitive 0erceptual
0attern
- Capa$le of reading
and writing(
- No difficulty or
pro$lems in vision
or hearing,
- Capa$le of reading
and writing(
- No difficulty or
pro$lems in vision
or hearing,
-
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Fun!tional Pattern Be%ore (os'itali)ation uring(os'itali)ation
A%ter(os'itali)ation
!elf-perception !elf-
concept pattern
- 0atient MCA descri$es herself as a family
oriented person, "ind, hardwor"ing, andresponsi$le(
.ole-relationship
0attern
- 0atient MCA has 2 children and she has a good
relationship with her hus$and(
!e*uality-.eproductive
0attern
- MCA has a good se*ual relasionship with her
hus$and( And she has 2 children(
Coping !tress
/olerance 0attern
- !he tal"s with her hus$and a$out her pro$lems
and concerns(
-
Dalue ?elief 0attern - MCA is a Muslim, and she state that she do her &
prayers every day at time(
Nursing 0hysical Assessment
MCA was alert and oriented to person, place and time( /he patient s temperature was %'% E,
pulse rate was )), respirations were %8, $lood pressure was %23 3, o*ygen saturation on room
air was %''F, apical pulse was )), lungs were clear, and the patient stated her pain level was
five( /he patient has an ID line in her left arm( /he patient s s"in was warm and dry with a
moderate $ilateral handgrip( /he patient s surgical incision was from the um$ilicus to suprapu$ic
with staples and was intact with no erythema( /he patient s $owel sounds were hypoactive and
stated no $owel movement today $ut had passed flatus( /he urine output from ')''-'8'' was
2''ml( /he patient was on a li7uid diet starting !eptem$er %) 2'%& and changed to a regular diet
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on !eptem$er 2' 2'%&( /he patient ate 'F of her $rea"fast and stated she did not have much of
an appetite( MCA appeared frail and thin with some general wea"ness( /he patient s height was
& G 9%( 'm and her weight was %'& l$s( 9+ ( "g ( /he patient was am$ulatory and was a$le to
perform independent activities of daily living(
IA+NOSTIC AN LABORATOR, FIN IN+S
Pro!edure Normal -alues
A!tual Findings:
Im'li!ations.:/0 P&01"2."2/
Red BloodCell +(&' H &(&' * %' %2 6
+(%3 =ecreased
(emato!rit '(3 H '(+ 6 '(3) =ecreased
(emoglo3in %%'('' H %&'('' g l 4) =ecreased(
4hite Blood!elles +(&' H %'('' * %' 4 6
+() normal
Pro!edure Normal -alues
A!tualFindings:
Im'li!a2:55 A&01"2."2/
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Blood $rea Nitrogen '(2- '(+ g 6 '(2+2 g l normal
Creatinine )-%2 mg 6 %2('4 mg l Increased
Ioni)ed Cal!ium %('& H %(2& mmol 6 %(%% mmol l normal
Potassium 3(& H &(% mmol 6 +(% normal(
ALT3 H 3) 6 60 Increased
AST ' H 3& 6 78 Increased
epatic serology was negative?one $iopsy under C/ scan and scintigraphy: $one metastases of poorly differentiated carcinoma
Immunola$eling:Anti$ody anti-C5 : negativeAnti$ody Anti-. : positiveAnti$ody Anti hercept : score 2 > inviting a control for in situ hy$ridi ation
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CLINICAL FIN IN+S
SI+NIFICANT SI+NS AN S,&PTO&S:
Liver metastases
J0ain in the upper a$domen on the right sideK it e*tends to the $ac" and shoulder
J!wollen a$domen 9$loating
JLeight loss
J6oss of appetite and feelings of fullness
JLea"ness or feeling very tired JNausea and vomiting
J;ellow s"in and eyes, and dar" urine from @aundice
JEever
PROBLE& LIST AN PRIORITI9ATION
ACT$AL PROBLE&
RAN
PROBLE& C$ES ;$STIFICATION
2 Im$alanced Nutrition less than $ody re7uirements
Light + ( "g6oss of appetiteLea"ness
Jto identify deficits in
nutritional inta"e and ade7uacy
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Nausea and vomiting of nutritional state
Jprovides calories for energy,
sparing protein for healing
Jto prevent edema and ascites
formation
Jdecrease feeling of fullness,
$loating
Jreduce discomfort from
a$dominal distension and
decrease sense of fullness
produced $y pressure of
a$dominal contents and ascites
on the stomach5 Activity intolerance
related to fatigue
and wea"ness
- Lea"ness- emoglo$in count of 4)
g 6- 6ac" of energy- Anemia with and .?C
count of +(%3
Jprovide $aseline for further
assessment and criteria forassessment of effectiveness
of interventions
Jpromotes e*ercise and
hygiene within patient s level
of tolerance
Jstimulates patient s interest in
selected activities
Jconserve energy
Jprovides calories for energy
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and protein for healing
-
7 =istur$ed ?odyImage !elf- steem
6eft mastectomy6oss of hair
0atient is very sensitive to $odychanges and may e*periencefeelings of guilt when cause isrelated to $ody emage(
POTENTIAL PROBLE&
RAN
PROBLE& C$ES ;$STIFICATION
2.is" for infective
$irthing patternRis< %a!tors ma# in!lude
-Intra-a$dominal fluidcollection 9ascites
-=ecreased lung e*pansion,accumulated secretions
-=ecreased energy, fatigue
( In order to prevent theris" for infective $irthing
pattern, we must monitorrespiratory rate, depth, andeffort(
5 .is" for acute
confusion • Ina$ility of liver to
deto*ify certain
en ymes drugs
- Adverse drug reactions orinteractions 9e(g(, cimetidine
plus antacids may potentiateand or e*acer$ate confusion
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N$RSIN+ CARE PLANS
ASSES&ENT
C$ES
N$RSIN+
IA+NOSIS
PLANNIN+ =
O$TCO&E
N$RSIN+
INTER-ENTIONS
RA
Su3>e!tive: I can t eat
$ecause of loss of
appetite,G stated the
pt(
O3>e!tive:9> weight loss9> /he patient ate
'F of her $rea"fast-
Im$alanced
Nutrition less than
$ody re7uirements
related to anore*ia,
nausea and
vomiting evidenced
$y weight loss
Short term:
After hours of nursinginterventions, the ptwill ver$ali eunderstanding anddemonstrate $ehaviorsto maintain appropriatenutrition(
Long term: =emonstrate
progressive weight gaintoward goal with
patient-appropriatenormali ation ofla$oratory values(
*perience no furthersigns of malnutrition(
Inde'endent:
- sta$lished rapport
with client and
family(
- Monitored D!(
- Measure dietary inta"e
$y calorie count(
- ncourage patient to
eatK e*plain reasons for
the types of diet( Eeed
patient if tiring easily,
or have !< assist
patient( Include patientin meal planning to
consider his her
preferences in food
choices(
e'endent:
- Administered
medications as
prescri$ed $y =octor(
- To gain
cooper
- For ba
observ
distress- 0rovide
informa
needs a- Improv
diet is v
0atient
family i
preferre
include
possi$le
- For the
pharm
manag
sympto
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ASSES&ENT
C$ES
N$RSIN+
IA+NOSIS
PLANNIN+ =
O$TCO&E
N$RSIN+
INTER-ENTIONS
RA
INEFFECTI-E AIR4A, CLEARANC
ASSES&ENT C$ES N$RSIN+
IA+NOSIS
PLANNIN+ =
O$TCO&E
N$RSIN+
INTER-ENTIONS
R
Su3>e!tive:MCA stated that she
has cramps(0ain scale of &O3>e!tive:!he gets out of $ed
rarely!he is frail with
general wea"ness
emoglo$in count of
4) g 6
6ac" of energy
Anemia with and .?C
count of +(%3
Activity intolerance
related to fatigue and
wea"ness as
evidenced $y rare
movements
Short term:
After hours of
nursing interventions,
the pt will report
improved sense of
energy O perform
A=6 s
Long term:
After % day of nursing
interventions done,
patient will $e a$le to
apply energy
conservation
techni7ues(
Inde'endent:- sta$lished rapport
with pt and relatives(- Monitored D!(
ncouraged ade7uate and
fre7uent $ed restMinimi ed environmental
stimuli, dim lighting and
ensure 7uiet environment
.- To ga
coope- For b
asses
distre- To pr
conse
- To fa
prom
conse
RIS FOR INFECTION
RIS FOR ALTERE N$TN$TRITION: LESS T(AN BO , RE?$IRE&ENTS
ASSES&ENT C$ES N$RSIN+
IA+NOSIS
PLANNIN+ =
O$TCO&E
N$RSIN+
INTER-ENTIONS
R
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Su3>e!tive: I have lost my
appetiteGAs ver$ali ed $y pt(
O3>e!tive:9> Anore*ia9> N D
Ris< %or altered
nutrition: less than
3od# re@uirements
Inde'endent:- =etermine pts a$ility
to chew, swallow and
taste food(
- Assess understanding
of individuals
nutritional needs(
- =iscuss food
preferences O
intolerances(
- ncourage pt to
choose foods
appropriate for her
prescri$ed diet(- Administer anti-
emetics as prescri$ed(
.- Thes
can a
and/
nutri
- . to d
infor
of pt.
- To a
clien
- To st
- To co
and v
great
appe
R$+ST$ ,
R$+A&E
ACTION IN ICATION
CONTRAIN ICATION
A -ERSEREACTION
N$RSIN+RESPONSIBIL
ITIES
nericmo*if
sage
$lette
uteal
e7uen
- is an anti-estrogenthat
prevents theeffects ofestrogenson tissues(/he precisemechanismof its a!tionis un"nown,
$ut one possi$ilityis that it
$inds and $loc"sestrogenreceptors onthe surfaceof cells,
preventingestrogensfrom
$inding andactivatingthe cell(
- Lomenta"ing
Nolvade* todecrease theris" ofdeveloping
$reastcancerhavedevelopedcancerof theuterus,stro"e,and
$loodclots inthelung(
=o N
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R$+NA&E ACTION IN ICATION CONTRAIN ICATION A -ERSEREACTI
ON
N$RSIN+RESPONSIBILITIES
enerictramadol
?randtramal
=osage%/a$ H&''mg
.oute
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after ta"ing
medication(
- Instruct patient
to immediately
report any
adverse
reactions(
R$+NA&E
ACTION IN ICATION
CONTRAIN ICATION
A -ERSE
REACTION
N$RSIN+RESPONSIBILI
TIES
eneric0rednisone
=osage&mg
.oute
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Caltrate0lus
=osage
% /a$
.oute
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R$+NA&E
ACTION IN ICATION
CONTRAIN ICATION
A -ERSE
REACTION
N$RSIN+RESPONSIBILI
TIES
eneric!evelamer
=osage8'' mg
.oute
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Classification- 0hosphate?inders
for the ne*t
dose(
- If there is
presence of
=
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-A/0ase
en ymesystem atthesecretorysurface ofthe gastric
parietal cell(Inhi$itionof $oth
$asal and
stimulatedgastricacidsecretion,irrespective of thestimulus(/he
$inding tothe 9 >,5 > -
A/0aseresults ina durationofantisecretory effectthat
persistslongerthan 2+hours forall dosestested
Classification- 0roton
pump
snee ingK
sore
throatK
stomach
painK gasK
N DK mild
diarrheaK
@oint painK
urinary
changes
oliguria or
polyuriaK
convulsio
ns
- =o not crush
or chew
swallow it
whole(
- /each pt a$out
the
medications
action and
possi$le
adverse
reactions(
- ncourage
ade7uate $ed
rest(
- Instruct to
report any
adverse
reactions(
http://www.rxlist.com/script/main/art.asp?articlekey=19488http://www.rxlist.com/script/main/art.asp?articlekey=19488
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inhi$itor
R$+NA&E
ACTION IN ICATION
CONTRAIN ICATION
A -ERSE
REACTION
N$RSIN+RESPONSIBILI
TIES
enericEurosemide
?rand
=osage+' mg
.oute
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ter, thus preventingthetransportof sodium
from thelumen ofthe loop of
enle intothe
$asolateralinterstitium(Conse7uently, thelumen
$ecomesmorehypertonicwhile theinterstitium
$ecomeslesshypertonic, which inturn
diminishestheosmoticgradientfor waterrea$sorptionthroughoutthenephron(?ecausethe thic"ascendinglim$ isresponsi$le for 2&Fof sodiumrea$sorption in the
loss of
appetiteK
@aundiceK
tinnitus
- Instruct to
immediately
report any
adverse
reactions(
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nephron,furosemide is a very
potentdiuretic(
Classification- 6oop=iuretic
R$+NA&E
ACTION IN ICATION
CONTRAIN ICATION
A -ERSE
REACTION
N$RSIN+RESPONSIBIL
ITIES
enericAcetylsalicylicAcidKA!A
=osage8' mg
.oute
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synthesis ofthe
prostaglandinintermediar
y( Inhi$itionof plateletaggregationisattri$uta$leto theinhi$ition of
plateletsynthesis ofthrom$o*ane A2, a
potentvasoconstrictor andinducer of
plateletaggregation(/his effectoccurs atlow dosesand lasts for the life of
the platelet98 days (igher
dosesinhi$it thesynthesis of
prostacyclin, a potentvasodilatorandinhi$itor of
plateletaggregation(
Classification- Analgesi
cs- Anti-
tarry
stoolsK
increased
$leeding
time
- Administer
with meal if
it causes I
distur$ances
in pt(
- If pt will
undergo
surgery, tell
surgeon
physician
that pt is
ta"ing
aspirin(
- .eport to
physician
mental
changes such
as confusion
andhallucination
s(
- If fever
persists
report to
physician(
- ncourage
ade7uate $ed
rest(
- Assist in
A=6 s
- Instruct pt to
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inflammatory
- 0lateletaggregation
inhi$itor s
immediately
report any
adverse
reactions(
R$+
NA&E
ACTION IN ICATI
ON
CONTRAIN ICAT
ION
A -ERS
EREACTI
ON
N$RSIN+
RESPONSIBILITIES
eneric/icagrelor
=osage4' mg
.oute
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n and plateletactivation(/icagrelorand its
activemeta$oliteareappro*imatelye7uipotent(
Classification- 0lateletinhi$itor
tarry
stoolsK
coughing
up $loodK
chest
painK
wea"nessK
pale s"inK
feverK
@aundiceK
!
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R$+NA&E
ACTION IN ICATION
CONTRAIN ICATION
A -ER SE
REACTION
N$RSIN+RESPONSIBILI
TIES
eneric=omperidone
?rand
=osage% /a$
.oute
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which -among others- regulatesnausea andvomiting(
Classification
- Anti-emetic
- =opaminergic
$loc"ingagent
l crampsK
constipati
onK
malaiseK
wea"ness
K dysuriaK
palpitatio
ns
environment,
place side
rails up,
ad@ust room
temp, 7uiet,
and dim lit(
- Assist in
A=6 s
- Instruct
relative to not
leave pt
unattended(
- Instruct pt toimmediatelyreport adversereactions(
ISC(AR+E PLANNIN+
&edi!ation
- !hould $e ta"en regularly as prescri$ed, strictly follow e*act dosage, time, O fre7uency,
ma"ing sure that the patient and relatives fully understand the importance of ta"ing
medications(
- Instruct patient and relatives to immediately report any side effects adverse reactions(
E er!ise
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- *ercise at least 3' minutes daily(
- !hould $e promoted in a way $y stretching all $ody parts every morning( 0atient should
$e encouraged to "eep active through light e*ercises(
- Maintain rest periods in $etween activities(
Treatment
- emodialysis /reatment should still $e followed( 2 * a wee"(
(ealth Tea!hing
- dhere to treatment regimen. Adherence to treatment regimen is essential in order to
prevent relapse( Most common cause of relapse is loss to compliance( Medications should
$e administered at proper times and with proper dosages(
- !est when you feel it is needed. !lowly start to do more each day( .eturn to your daily
activities as directed(
- "rotect your skin from #$ light. !unlight can ma"e your lupus symptoms worse( Avoid
the sun $etween %' am and + pm, when the rays are strongest( Apply sunscreen with a
!0E of 3' or more every 2 hours when you are outside( =o this even on cloudy days(
Lear pants and long sleeves to cover your $ody( A hat with a wide $rim can protect your
face, head, and nec"(
- %at healthy foods ( ealthy foods include fruits, vegeta$les, whole-grain $reads, low-fat
dairy products, $eans, lean meats, and fish(
- %xercise. /his will help decrease your symptoms and prevent depression( At least for 3'
minutes(
- aintain a healthy weight. As" your primary healthcare provider how much you should
weigh( As" him to help you create a weight loss plan if you are overweight(
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- 'o not smoke. If you smo"e, it is never too late to 7uit( As" for information a$out how to
stop smo"ing if you need help(
- anage your stress. !tress may slow healing and lead to illness( 6earn ways to control
stress, such as rela*ation, deep $reathing, and music( /al" to someone a$out things that
upset you(
Out Patient
- Eollow-up chec"-up as ordered $y the physician should $e greatly encouraged for the
patient to determine if his progression on treatment, and if he will have to continue on his
medications treatments which were ordered during hospitali ation(- Come $ac" 2* a wee" for hemodialysis(
iet
- Increase fluid water inta"e, should $e 8 glasses day(
- ealthy foods include fruits, vegeta$les, whole-grain $reads, low-fat dairy products,
$eans, lean meats, and fish(
S'iritual
- ncourage family and friends to pray and remain $y patients side(- ncourage client to $uild a strong faith and intimacy with od through prayers(- ncourage to attend mass and prayer sessions with family, for added emotional and
spiritual support(- Advise to continue spiritual practices(
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/he liver is located in the upper right-hand portion of the a$dominal cavity, $eneath the
diaphragm, and on top of the stomach, right "idney, and intestines( !haped li"e a cone, the
liver is a dar" reddish-$rown organ that weighs a$out 3 pounds( /here are two distinct sources
that supply $lood to the liver, including the following:Jo*ygenated $lood flows in from the
hepatic artery Jnutrient-rich $lood flows in from the hepatic portal vein /he liver consists of
two main lo$es, $oth of which are made up of thousands of lo$ules( /hese lo$ules are
connected to small ducts that connect with larger ducts to ultimately form the hepatic duct(
/he hepatic duct transports the $ile produced $y the liver cells to the gall$ladder and
duodenum 9the first part of the small intestine (
Cancer is uncontrolled replication of damaged cells( /his condition usually produces a mass
called a tumor( Cancer is a direct result of either a mutation of the cellular =NA or some sort
of damage to the cellular =NA( Eor the cancerous cells actually develop into tumor, it must $e
a$le to grow and to replicate itself (A cancerous cell that cannot grow or ma"e a copy of itself
will die or lic" dormant for an e*tended period(
S Carcinogenesis is a multistage process that $egins when a carcinogen causes a genetic
change or damages the =NA in a normal cell( /his ma"es the cell more vulnera$le to
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other genetic changes( /his stage is called Tinitiation(T If the process ended here, and the
cancerous cell did not grow and replicate, no cancer would form( /he ne*t stage of
carcinogenesis is called Tpromotion(T /his occurs when the initiated cell is e*posed to an
agent that enhances its growth into a larger mass( Lhen a tumor actually forms, it has all of
the same $asic needs as a normal cell( ?ecause the tumor cells are genetically damaged, they
are inefficient and ro$ normal cells of important o*ygen and nutrients( In addition, a
malignant tumor grows uncontrolla$ly and can eventually interfere with the function of vital
organs, such as the liver(
Metastatic tumors form when large progressive tumors shed tumor cells( /hese tumor cells
must $e a$le to grow and function apart from the primary tumor JMove throughout the $ody,
usually through the circulatory system or the lymphatic system ( J
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9Male hormones used $y athletes to increase muscle can slightly increase liver cancer ris"
with long-term use J
?irth control pills
6iver Cancer !ymptoms
J6iver cancer is sometimes called a Tsilent diseaseT $ecause in an early stage it often does not
cause symptoms( owever, as the cancer grows, symptoms may include: J0ain in the upper
a$domen on the right sideK the pain may e*tend to the $ac" and shoulder J!wollen a$domen
9$loating JLeight loss J6oss of appetite and feelings of fullness JLea"ness or feeling very
tired JNausea and vomiting J;ellow s"in and eyes, and dar" urine from @aundice
JEever
Nursing Management
J Latch out for potential pro$lem related to cardiopulmonary involvement include vascular
complications and respiratory and liver dysfunction( J Careful attention to meta$olic
a$normalitiesJU 0atient undergo cryosurgery should monitored closely for: JS ypothermiaJS
hemorrhage or $ile lea"JS myoglo$inuria may occur as a result of tissue necrosis
J
(
Nursing diagnosis
JActivity intolerance related to fatigue and wea"ness
0lanning
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J0atient will report decrease in fatigue and increased a$ility to participate in activities
Intervention
JAssess level of activity tolerance and degree of fatigue and malaise
JAssist with activities and hygiene
JAssist with selection and pacing of desired activities and e*ercise
J ncourage rest when fatigued felt
JAdvice diet high in car$ohydrates with protein inta"e
.ationale
Jprovide $aseline for further assessment and criteria for assessment of effectiveness
of interventions
Jpromotes e*ercise and hygiene within patient s level of tolerance
Jstimulates patient s interest in selected activities
Jconserve energy
Jprovides calories for energy and protein for healing
valuation
Jimproved nutritional status $y increased weight without fluid retention
Jidentifies foods in car$ohydrates and within protein re7uirements
Jreport improved appetite
Nursing diagnosis
J Im$alanced Nutrition less than $ody re7uirements related to a$dominal distention and loss
of appetite
0lanning
Jto meet nutritional re7uirements
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Intervention
JAssess dietary inta"e and nutritional status through diet history
JAdvice diet high in car$ohydrates with protein inta"e
JAdvice patient of low sodium foods
J0rovide smaller, fre7uent meals
J levate the head of the $ed during meals
.ationale
Jto identify deficits in nutritional inta"e and ade7uacy of nutritional state
Jprovides calories for energy, sparing protein for healing
Jto prevent edema and ascites formation
Jdecrease feeling of fullness, $loating
Jreduce discomfort from a$dominal distension and decrease sense of fullness produced $y
pressure of a$dominal contents and ascites on the stomach
Nursing iagnosis
• =istur$ed ?ody Image !elf- steem
&a# 3e related to
• ?iophysical changes altered physical appearance
• ncertainty of prognosis, changes in role function
• 0ersonal vulnera$ility
• !elf-destructive $ehavior 9alcohol-induced disease
Possi3l# eviden!ed 3#
•
Der$ali ation of change restriction in lifestyle
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• Eear of re@ection or reaction $y others
• Negative feelings a$out $ody a$ilities
• Eeelings of helplessness, hopelessness, or powerlessness
esired Out!omes
• Der$ali e understanding of changes and acceptance of self in the present situation(
• Identify feelings and methods for coping with negative perception of self(
Nursing iagnosis
• .is" for acute confusion
Ris< %a!tors ma# in!lude
• Alcohol a$use
• Ina$ility of liver to deto*ify certain en ymes drugs
esired Out!omes• Maintain usual level of mentation reality orientation(
• Initiate $ehaviors lifestyle changes to prevent or minimi e recurrence of pro$lem(