Cholangiocarcinoma is a cancer bile ducts, affecting the intrahepatic, perihilar, distal sections biliary tree. The most common type of cholangiocarcinoma is hilar tumors (56%), less common are intrahepatic cholangiocarcinomas (6–10%).
A hilar tumor, also called a Klatskin tumor (first described by researcher Gerald Klatskin in the 1960s), affects the common hepatic duct at the bifurcation of the right and left hepatic ducts at the hilum of the liver.
- Risk factors for developing the disease
- Clinical picture
- Diagnosis of the disease
- Treatment and prognosis
This tumor accounts for 3% of malignant tumors gastrointestinal tract. It usually occurs between the ages of 50 and 70, but can appear earlier. In most cases, it is detected in patients with primary sclerosing cholangitis and common bile duct cysts.
The incidence rate is slightly higher among men. This tumor grows slowly and metastasizes late. Due to late detection and the impossibility of surgical resection, the disease has high risk lethal outcome.
The prevalence of the disease is up to 2 cases per 100,000 population, its level increases every year, perhaps this is due to improved diagnosis and implementation computed tomography.
A neoplasm develops from intrahepatic and extrahepatic epithelial cells. Some researchers suggest that the development of the disease is associated with a mutation in the tumor suppressor gene.
According to the morphological structure, Klatskin’s tumor is an adenocarcinoma in 90% of cases, and squamous cell carcinoma in 10%. Local metastases are found in the liver, porta hepatis, regional lymph nodes of the pancreaticoduodenal complex and the abdominal cavity.
Risk factors for developing the disease
The etiology of malignant formations of the bile ducts in most cases remains unknown.
It is currently believed that gallstones do not increase the risk of developing cholangiocarcinomas.
Let's consider the main risk factors:
The following symptoms are observed with Klatskin tumor:
The classic triad of symptoms of hepatobiliary and pancreatic cancer is characteristic: cholestasis, abdominal pain, weight loss. 90% of patients develop jaundice, which is often intermittent.
Jaundice is the most common manifestation malignant tumors bile ducts, but with Klatskin’s tumor it manifests itself in more late stages and indicates serious progression of the disease.
Hepatomegaly is observed in every third patient. Lab tests blood show an increase in the level of bilirubin (bilirubin also appears in the urine), alkaline phosphatase. Jaundice is a physical manifestation of hyperbilirubinemia.
Some patients have elevated carcinoembryonic antigen (CEA), but this indicator is not a specific and sensitive marker. The most accurate level is the level of cancer antigen CA 19–9; its value is increased in 80% of patients. A combination of two tests is more indicative of detecting this type of cancer.
Diagnosis of the disease
To diagnose a Klatskin tumor, the following radiographic methods are used:
Treatment and prognosis
If the disease can be resected (there are no metastases in the liver or other systemic organs, The lymph nodes, And blood vessels not affected) surgical intervention is the best option treatment.
The five-year survival rate of patients with this disease without surgery is from 5 to 10%. After surgery, survival rate is 10–30% or higher. Unfortunately, Klatskin tumor is rarely diagnosed on early stages Therefore, it is inoperable in most patients.
The impossibility of tumor resection determines the low average survival rate of patients. The criteria for surgical treatment are based on the assessment of anatomical structures affected by tumor growth.
Radiological research methods are necessary to determine the possibility of surgical resection of the tumor and the choice therapeutic tactics. Klatskin tumor is inoperable in the following cases:
- bilateral damage to the right and left hepatic ducts to the level of branching of the intrahepatic ducts;
- main occlusion portal vein, its proximal bifurcations;
- atrophy of the liver lobe in combination with occlusion of the opposite branch of the portal vein;
- atrophy of the liver lobe with damage to the opposite biliary ducts of the second order;
- Tumor damage to bilateral liver arteries.
Ultimately, the ability to remove the tumor is determined during surgery.
If preoperative CT scan results indicate that surgical removal is not possible, the patient may be eligible for palliative care or palliative surgery (biliary bypass to relieve the obstruction). Bile duct stenting relieves obstruction but increases the risk of cholangitis.
To increase the likelihood of cure, radiation therapy is used, which provides an advantage in case of incomplete resections. Adjuvant and preoperative radiation therapy used to reduce tumor size to resectable size.
At inoperable tumors chemotherapy in combination with radiation therapy can increase survival to 10 months. Some patients with Klatskin tumor require palliative care ( average duration life is 2–8 months).
Partial resection of the hilum of the liver, chemotherapy, radiation therapy, bypass surgery - all these treatment methods are used with varying results.
Liver cirrhosis, unspecified (K74.60), Liver cirrhosis, other (K74.69)
RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2013
Other and unspecified cirrhosis of the liver (K74.6)
Palliative care
general information
Short description
Constipation - decreased stool frequency and difficulty in bowel movements.
I. INTRODUCTORY PART
Protocol name: Palliative care for patients with chronic progressive diseases in the incurable stage, accompanied by constipation
Protocol code:
Disease code according to ICD 10:
B20 - B24, C00-C97, E10-E11, G20, G81-G83, G92-G93, I10-I13, I25, I27, I50, I69, J44, J90- J91, J96, K70.3-K70.4, K71.7, K72, K74, N18-N19, S72.0
Abbreviations used in the protocol:
GPs - doctors general practice
UAC - general analysis blood
OAM - general urine analysis
Gastrointestinal tract - gastrointestinal tract
RK - Republic of Kazakhstan
INN - international nonproprietary name
Date of development of the protocol: year 2013.
Protocol users: GPs in polyclinics, oncologists in hospitals and clinics, palliators in hospital hospice and on-site hospice services.
Diagnostics
II. METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSIS AND TREATMENT
Diagnostic criteria(description reliable signs syndrome)
Complaints and anamnesis:
Complaints about a decrease in the frequency of stool (less than 3 times a week), a feeling of heaviness and bloating, a denser consistency of stool (“sheep feces”), the act of defecation requires muscle effort, even after the act of defecation there is a feeling of insufficient bowel movement.
When collecting anamnesis, they ask in detail about all manifestations of constipation - frequency of stool, character of feces, straining and feeling of satisfaction with the act of defecation, duration of constipation. They also find out whether there is abdominal pain, flatulence, signs of damage to the upper gastrointestinal tract, signs of damage to the urinary tract, whether the patient took laxatives or other medications and for how long.
Physical examination:
palpation and percussion of the abdomen, auscultation, macroscopic examination of stool, indirect objective data.
Laboratory research tests necessary to determine the syndrome, carried out before hospitalization in a palliative care organization: not carried out
Instrumental studies tests necessary to determine the syndrome, carried out before hospitalization in a palliative care organization:
- x-ray examination- if there is a suspicion of partial or complete intestinal obstruction (constipation accompanied by abdominal pain, vomiting, lack of effect from conservative therapy).
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Treatment
Goals of palliative care: normalization of stool
Palliative care tactics
Non-drug treatment(regime, diet, etc.)
Prevention of asthenia, expansion mode motor activity, exercise therapy, cleansing enemas.
Diet - inclusion in the diet of foods containing dietary fiber, sufficient fluids, fruits, fruit juices.
Drug treatment(indicated pharmacological groups, only medicines registered in the Republic of Kazakhstan, INN, course or daily doses, indicating the release form. If there are specific features of the prescription, you must indicate: intravenous administration, insulin pump, etc.):
|
List of main medicines |
||||
| INN/Active substance | Release form | Course dose, 14 days | ||
| Medicines used for diseases of the digestive system | ||||
| Laxatives | ||||
| bisacodyl | Tablet, 5 mg, sup rectal 10 mg, drops |
20 tablets 10 St. |
||
| lactulose | Syrup, suspension for oral administration |
1 bottle - 500 ml |
||
| Senna | tab | 20 tab | ||
|
List of additional medicines |
||||
| Blood products, plasma substitutes and parenteral nutrition products | ||||
| Means that help restore the microecological balance of the intestines | ||||
| Sterile concentrate of intestinal microflora metabolic products | drops for oral administration | 2 bottles | ||
| phosphate enema | 100 ml 1-2 times a day | 5 pieces | ||
Products medical purposes
|
Name products |
Quantity per day |
Duration applications |
| Intravenous infusion system | 1 | 5-10 days |
| Syringe 2 ml, 5 ml, 10 ml, 20 ml | 30 | 14 days |
| Device for infusion into small veins with a butterfly needle for subcutaneous injections | 1 in 3-10 days | 14 days |
| Alcohol wipe | 30 | 14 days |
| diapers | 4 | 14 days |
| Disposable diaper | 4 | 14 days |
| hypoallergenic adhesive plaster | 1pack (2*500 cm) | 14 days |
| Body thermometers | 1 piece per 1 patient | 14 days |
| Blood pressure tonometer | 1 PC | 14 days |
| Esmarch's irrigator | 1 | 1-2 times per course |
Surgical intervention: if there is a suspicion of partial or complete intestinal obstruction (constipation accompanied by abdominal pain, vomiting, lack of effect from conservative therapy).
Further management(patient support on an outpatient basis):
- stool control after 2 days on the 3rd, independent use laxatives at home after adjusting hospital prescriptions.
Indicators of the effectiveness of palliative treatment
Drugs ( active ingredients), used in the treatment
Groups of drugs according to ATC used in treatment
Hospitalization
Indications for hospitalization in a palliative care organization:
- the patient has an oncological or somatic disease in an incurable stage, accompanied by the development of ascites;
- the presence of social and domestic indications (lack of conditions for providing proper care and treatment at home, a situation of psychological discomfort due to the presence in the apartment of a patient with an oncological or somatic disease in an incurable stage, etc.).
Conditions for hospitalization in a palliative care organization:
- the patient has a chronic progressive disease in an incurable stage, confirmed by a medical certificate issued by doctors of a health care organization; (patronage notification, data from histological or cytological examinations or other examinations confirming the diagnosis).
Information
Sources and literature
- Minutes of meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2013
- 1. Doyle, D, G. W. Hanks, and N. eds MacDonald. 1998. Oxford Textbook of Palliative Care. 2nd ed. Oxford/New York/Tokyo: Oxford University Press. 2. ASCO Curriculum on Symptom Management. Dubuque, IA: Kendall|Hunt Publishing; 2001. 3. Weiler K, Garand L. Evidence-based protocol. Advance directives. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core; 1999. 35 p 4. Primer on palliative medicine, ed. Doctor of Medical Sciences Moshoyu D., 2012 120s
Information
III. ORGANIZATIONAL ASPECTS OF PROTOCOL IMPLEMENTATION
List of protocol developers with qualification information:
1. Kasenova Asem Tolegenovna, director of the Pavlodar Hospice, palliator,
2. Okulskaya Elena Viktorovna, psychotherapist of the 1st category, resident doctor at the Hospice of Pavlodar,
3. Smailova G.A., Professor, Doctor of Medical Sciences, Head of the Department of Newly Diagnosed Pulmonary Tuberculosis of the National Center for Tuberculosis of the Republic of Kazakhstan,
4. Izhanova A.K., candidate of medical sciences, associate professor of the department of propaedeutics of internal diseases of the Kazakh National Medical University named after S.D. Asfendiyarova,
5. Kenzhebaeva G.S. - Deputy Chief Physician for organizational and methodological work of the Hospital of Nursing Care, Karaganda,
6. Fedorova A.K., head of the palliative department of the Kostanay regional oncology clinic,
7. Rakhimova M.R. - resident doctor of the palliative care department No. 1 of the City Palliative Care Center, Almaty
Reviewers:
Sirota V.B., Head of the Department of Oncology, KarSMU, Doctor of Medical Sciences, Professor
Indication of no conflict of interest: No.
Indication of the conditions for reviewing the protocol: Once every 3 years or when new proven data appears.
Attached files
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- The choice of medications and their dosage must be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage taking into account the disease and condition of the patient’s body.
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Geriatrics - area clinical medicine, studying diseases of the elderly and old age, developing methods of their treatment and prevention in order to preserve the physical and mental health of a person until old age.
Carrying out doctor's orders related to patient treatment. Setting up jars, mustard plasters, medicinal baths, gastric lavage, enemas, bandaging techniques.
The presentation describes typical problems that arise in bedridden patients, as well as generally accepted measures to prevent these problems.
General patient care procedures. Description, methods of carrying out.
Monitoring a patient - what to pay attention to, basic techniques for monitoring the patient’s condition. Available research methods.
There are now about 30 million elderly people in Russia: 4.3% of them are people over 75 years old. 3-4 million elderly people need constant medical and social assistance, and only 216-220 thousand people live in boarding schools.
Prolonged lying down or immobility of the patient is not as harmless as it seems at first glance. Immobility gives rise to many very serious complications. These complications significantly worsen the outcome of the underlying disease and are themselves serious diseases that contribute to the patient’s disability.
When caring for a sick person, it is necessary to comply with the sanitary and anti-epidemic regime (SER) and remember that if you do not comply with the SER, you can become infected with an infectious disease from the patient or infect him.
The mucous membranes of the skin undergo significant changes with age. They lose elasticity and their fluid content decreases. The protective function of the skin and mucous membranes also weakens, and therefore the frequency of various inflammatory diseases, including fungal ones.
It goes without saying that the course of most diseases in elderly and senile patients has characteristics. The combination of several diseases in a patient creates additional difficulties in treatment and worsens the prognosis for recovery.
General rules ensuring a safe environment for the patient, fire safety issues, use medical equipment. Communication with a mentally ill person.
Along with measures aimed at combating the disease, the patient needs to be provided correct mode, proper care for him (physical regime, sanitary and hygienic conditions, nutrition, assistance with departure physiological needs and conducting various procedures aimed at reducing the manifestations of the disease).
When caring for elderly and senile patients, their psychological characteristics must be taken into account. Some patients, trying not to notice the approaching or onset of old age, continue to lead the same lifestyle as in at a young age while performing significant physical activity. This usually has an adverse effect on the course of diseases, contributing to their progression and the development of complications.
It is always advisable to allocate a separate room for the patient, especially if there is a suspicion of infection, including influenza or acute respiratory disease. If this is not possible, you need to allocate for it the best part room, separating it with a curtain or closet.
Cirrhosis of the liver - chronic illness liver, accompanied by the destruction of normal liver tissue and the proliferation of non-functioning connective tissue, disrupting the structure and function of the liver. Among people aged 45-65 years, liver cirrhosis is the third most common cause of death after heart disease and malignant tumors.
Main risk factors for the development of liver cirrhosis
- chronic hepatitis and other liver diseases;
- abuse of alcohol or its substitutes;
- malnutrition;
- long-term use of some medicines;
- poisoning with chemical toxins.
The main symptoms of liver cirrhosis are
- sometimes there are no symptoms at the beginning of the disease;
- the first symptoms may be weakness, easy fatigue, heaviness in the right hypochondrium, stool irregularity;
jaundice; - itching of the skin;
- with the development of ascites - an enlarged abdomen, a decrease in the amount of urine excreted;
- in advanced cases, bleeding from dilated veins of the esophagus and hemorrhoidal veins is possible, the development of liver failure, accompanied by stupor, inadequate reaction to the environment, confusion and loss of consciousness, and the development of coma
Rules for caring for patients with liver cirrhosis
- control over compliance with the diet (table 5) - mainly dairy-vegetable fortified foods using mainly vegetable fats;
- The consumption of any alcohol is strictly prohibited;
- Spicy, fried and pickled foods are prohibited;
- in weakened patients - bed rest, which provides general care and a comfortable position in bed for the patient;
- limiting physical activity;
- with the development of ascites, it is necessary to limit table salt to 5 g per day and liquid to 1 liter per day;
- if signs of hepatic encephalopathy appear, limit protein foods;
- if bleeding occurs from the dilated veins of the esophagus, hunger is indicated;
- meals are fractional, at least 4-5 times a day;
- monitoring the patient’s diuresis;
- body weight control;
- control over the complete and timely intake of medications prescribed by a doctor;
- in case of dryness, scratching and itching of the skin - skin care;
- control for mental state sick.
Prevention measures
- limiting alcohol consumption;
- balanced diet;
- adequate treatment of liver diseases, incl. acute and chronic hepatitis.
Question answer
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The role of palliative care is difficult to overestimate. Every year there are more and more cancer patients, and almost 10 million new cases of cancer are diagnosed worldwide. Without looking at the application the latest methods diagnostics approximately half of patients come to the doctor already in an advanced stage, therefore, today oncologists are faced with the task of not only using the most effective methods cancer treatment, but also to help patients whose days are numbered.
Patients who can no longer be cured by all available methods modern medicine, need supportive therapy, maximum symptom relief, and creation of the most comfortable living conditions possible in the last stages of life. These conditions are included in the concept of palliative care. The burden of heavy worries and worries falls to a large extent on the patient’s loved ones, who must also be as prepared as possible for the upcoming difficulties.
Achieving an acceptable level of quality of life is the most important task in oncological practice, and if for patients who have successfully completed treatment, it means, to a greater extent, social rehabilitation and a return to labor activity, then in the case of incurable pathology, the creation of adequate living conditions is, perhaps, the only truly feasible goal, which palliative medicine is designed to fulfill.
The last months of the life of a seriously ill person at home pass in a rather difficult environment, when both the person himself and his family already know that the outcome is a foregone conclusion. In such a situation, it is important to skillfully observe all ethical standards in relation to the doomed person and demonstrate respect for his wishes. It is necessary to correctly use the available emotional, mental, and physical resources, because there is less and less time left. During this difficult period, the patient is in great need of a variety of palliative care approaches.
The use of palliative medicine is not limited to oncology practice. Patients of other profiles (heart disease, musculoskeletal system, severe neurological lesions etc.) who have been diagnosed with an incurable disease also need relief from symptoms and improved quality of life.
Stages of palliative care
Palliative care may be needed by cancer patients in the early stages of the disease, then such treatment serves as an addition to the main therapy, but as the pathology progresses, palliative medicine becomes the leading one.
Palliative care for incurable patients can be provided:
- In the hospital using surgical, radiation and chemotherapy approaches;
- In day care departments;
- At home;
- At the hospice.
In an oncology hospital, a patient for whom it is no longer possible to cure the disease, however, can be provided with assistance designed to alleviate severe symptoms and improve your well-being.
an example of an operation that prolongs the life of cancer patients with extensive gastrointestinal tumors
Thus, carrying out partial removal of the tumor, relieving some symptoms(For example, intestinal obstruction for colorectal cancer by placing the outlet on abdominal wall) can significantly improve the patient’s well-being and increase the level of his social adaptation.
Radiation therapy can relieve the patient of severe pain, and palliative chemotherapy can reduce the volume of tumor tissue, contain the progression of cancer and reduce intoxication with tumor metabolic products. Of course, such treatment may also be associated with undesirable side effects, but the successes of modern pharmacotherapy and the emergence of new gentle irradiation techniques make it possible to reduce them to an acceptable level.
For lonely patients or those with limited mobility, it is possible to provide palliative care in day hospital. Visiting specialized departments two to three times a week allows you to receive not only the necessary medical care and advice from a qualified specialist, but also psychological support. For patients who are surrounded by loving and caring relatives, visiting a day hospital can also be useful to get away from “home loneliness”, when both the patient and his family members find themselves, although all together, but at the same time alone with illness.
Most often, palliative treatment is carried out at home, in the most comfortable conditions for the patient. In this case, the participation and support of family members, who must be trained, is of paramount importance. simple rules caring for cancer patients, methods of pain relief, features of cooking. It is important that at all stages of palliative care the patient’s condition is monitored by professionals who know not only the specifics of the use of medications, including narcotic analgesics, but are also able to give the necessary and good advice the patient and his family members.
If symptomatic treatment cannot be carried out at home, the patient may be placed in a hospice - a specialized medical facility that provides care to terminally ill cancer patients at the final stage of their lives. Hospices are free institutions in which specialists from various fields provide care and treatment for seriously ill people. Relatives can also receive all the necessary recommendations and advice at the hospice. It is important to remember, however, that no matter how good hospice care is, most patients still prefer a home environment with family.
Palliative care is not aimed at prolonging life or curing a disease, but it should alleviate the patient’s condition as much as possible, improve the quality of life and provide psychological comfort. Since one of the most important symptoms cancer is considered pain, sometimes unbearable and very painful, then adequate pain relief is one of most important tasks palliative therapy.
Basic principles of palliative care
The most important principles of palliative care are:
- Fighting pain;
- Correction of disorders of the digestive system (nausea, vomiting, constipation);
- Balanced diet;
- Psychological support.
Most patients in advanced stages of cancer experience pain, often intense and very excruciating. Such pain interferes with usual activities, communication, walking, making the patient’s life unbearable, therefore adequate pain relief is the most important stage in providing palliative care. IN medical institution for pain relief can be used, and when the patient is at home - analgesics for oral or injectable form.
Analgesics are used for pain relief, the regimen, dosage and regimen of use of which is established by the doctor based on the patient’s condition and the severity of the pain syndrome. Thus, the drug can be prescribed by the hour at certain intervals, with the next dose taken or administered when the previous one has not yet completed its effect. Thus, a state is achieved where the patient does not have time to experience pain between doses of the drug.
Another scheme for combating pain, recommended by the World Health Organization, is the so-called “pain staircase”, when As the patient's condition worsens, the analgesic changes to a potent or narcotic one. Usually, according to this scheme, they begin to relieve pain with non-narcotic analgesics (paracetamol, ketorol, for example), moving, as the symptoms progress, to weak ones (codeine, tramadol), and then to strong opiates (morphine).
Similar regimens can be prescribed to sick children. Unfortunately, it happens that children also suffer from severe incurable forms of cancer, and the issue of pain relief is more difficult for them than for adults. A child cannot always accurately describe the nature and intensity of pain, and it can be difficult for an adult to correctly evaluate his words and behavior. When prescribing morphine, parents may experience anxiety and even express categorical reluctance to use it in a sick child, so the specialist should explain that it is extremely important to relieve pain, even if this requires prescribing morphine.
Digestive disorders may be big problem for cancer patients. They are associated with general intoxication, a variety of medications taken, and other reasons. Nausea and vomiting may be so distressing that they require the use of antiemetic drugs, similar to symptomatic treatment for all stages of the tumor. In children, it is especially important to warn in advance possible nausea and vomiting, since they can cause mistrust of the child and his parents in the attending physician and complicate further therapy due to the development conditioned reflex for the administration of chemotherapy drugs.
In addition to nausea and vomiting, chemotherapy and pain relief with opioid analgesics can cause constipation, for the correction of which it is very important to prescribe laxatives and optimize the regimen and diet. Children are always prescribed laxatives (lactulose) when using morphine to relieve pain.
Rational nutrition plays an extremely important role in oncology. It is aimed not only at improving the patient’s well-being and mood, but also at correcting the lack of vitamins and microelements, combating progressive weight loss, nausea and vomiting. The nutritional approach for cancer patients within the framework of palliative medicine is no different from that for patients of all stages of cancer, including those in whom treatment was effective.
The basic principles of nutrition can be considered a balanced composition in terms of the amount of protein, fats and carbohydrates, sufficient caloric content of food, a high content of vitamins in foods, etc. For a patient in the terminal stage of the disease, this may be of particular importance appearance and the attractiveness of the dishes, as well as the atmosphere during the meal. Relatives can provide all the conditions for the most comfortable and enjoyable meal, who should be aware of the dietary habits of the sick family member.
Psychological support is important for any patient, faced with a terrible diagnosis of cancer, regardless of stage; however, incurable patients who are aware of the nature of the disease and prognosis need it especially urgently. If necessary, appointed sedatives and consultations with a psychotherapist, but the primary role is still given to relatives, on whom it largely depends on how calm they will be last days the patient's life.
Relatives often wonder: does the patient need to know the whole truth about his illness? The issue, of course, is controversial, but awareness and knowledge contribute to instilling calm and confidence, overcoming the horror of the upcoming outcome. In addition, having a certain period of time, the patient can try to use it as richly as possible, implementing at least part of his plans and resolving many issues, including those of a legal nature. Most patients themselves want to know all the information about their condition in order to manage the measured, albeit short, period of life at their own discretion.
Treatment of cancer is not an easy task, requiring the participation of a wide range of specialists in different fields, and the terminal stages of the disease require help not only medical workers, but also loved ones, whose role becomes almost paramount. It is very important to inform both the patient and his relatives about the main methods of palliative medicine, the possibilities of receiving qualified assistance and consultations, features of home care. To alleviate the suffering of a terminally ill patient is the ethical duty of a doctor, and to support and create the most comfortable living conditions is the task of loved ones.
Video: palliative care in the School of Health program
The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment in this moment they don't turn out to be.
Liver cirrhosis is the scourge of the 21st century. This disease is incurable and sooner or later leads to death. Patients with liver cirrhosis are often in serious condition at the end of the disease.
At the same time, they require careful self-care. AND nursing process in liver cirrhosis is extremely important.
What leads to liver cirrhosis? There are many diseases and conditions that cause this pathology.
These include:
- hepatitis of viral etiologies B, C, D;
- alcoholism;
- damage by toxic substances;
- autoimmune diseases;
- metabolic diseases (disease of accumulation of iron, copper, etc.);
- stetohepatitis (fatty liver disease);
- disruption of the outflow of venous blood from the liver;
- disease of the biliary system.
How does the disease manifest?
At the initial stage of the disease, any clinical manifestations often absent. Diseases can only be suspected based on laboratory data.
However, patients, even at the compensation stage, often note weakness and loss of strength, and loss of appetite.
In the subcompensated stage, the patient may often be bothered by itchy skin, which gets stronger at night. Then jaundice is added.
The patient complains of heaviness in the right side, nagging pain, bitterness in the mouth, nausea and vomiting. The appearance of bruises and spider veins.
Which is the final stage of the disease, complications manifest themselves: ascites, esophageal-gastric bleeding, encephalopathy, peritonitis, renal failure and liver cancer.
At the stage of decompensation, complications that arise make the patient weak and in need of care. Relatives at home often do not have the opportunity to provide proper care.
This is due to lack of time and lack of desire to observe the serious illness of your loved one. In addition, care requires special training, and nursing care is best.
The responsibilities of a nurse include:
- Control over the patient’s diet, namely eating by the hour, assistance in choosing those foods that are allowed and a strict prohibition of foods that can harm their health.
- Providing bed or semi-bed rest. Helping a bedridden patient take care of himself (carrying a bedpan, timely changing of linen, preventing the appearance of bedsores and treating them).
- The nurse independently takes blood from a vein or finger and helps to correctly collect a urine or stool sample.
- Prepares the patient for diagnostic procedures.
- Helps to undergo diagnostic and therapeutic procedures.
- Conducts healing procedures(intramuscular and intravenous injections), controls the timely administration of medications.
- Controls general conditions the patient (his weight, arterial pressure, body temperature).
- Calls the attending or duty doctor at the request of the patient or on his own initiative, if he considers it necessary.
- Must provide first aid in emergency situations.
To provide complete care, the nurse must communicate with the patient daily, ask questions about his condition and his relatives.
It is necessary to follow diet No. 5. Caring for the patient’s nutrition falls directly on nurse, because it is she who notifies the canteen worker about changes in the diet, which can be traced through the medical history.
She also talks about proper nutrition for this disease, and why it is so important to follow a diet. The patient can always seek advice and ask about which food can be eaten and which should not.
The nurse is obliged to prevent any attempts to consume alcoholic beverages within the walls of a medical institution and conduct a conversation about the dangers of alcoholism.
If a patient in serious condition is unable to eat on his own, then nursing staff will help with this.
This is of course ideal. But in reality, one nurse cannot provide such attention to every patient. Then relatives and friends should come to the rescue.
Patients with cirrhosis of the liver are often prescribed bed rest. Or, unfortunately, for health reasons the patient cannot get out of bed at all. Nursing process for liver cirrhosis includes complete care for a bedridden patient.
The nurse will carry out hygiene care: will help you go to the toilet, wash you, comb your hair, treat your eyes, and clean your ears and nose. He will also feed his patient.
It is mandatory to wash in the bathroom or dry your body at least once every three to four days. Bed linen is changed once a week, more often if necessary. The head is washed once a week.
A very important point is the prevention of bedsores. To prevent bedsores from occurring, honey. the worker should help change the position of the patient’s body every 2-3 hours, straighten any wrinkles in clothing and bed linen.
He should also monitor the condition of the skin, examining the areas most susceptible to damage. If you notice redness, inform your doctor about it and treat with special creams and solutions.
You should know that the patient's skin must be completely dry. If the patient is sweating, then you need to wipe him with a soft terry towel; the folds can be treated with talc or powder. After using the toilet, you need to wash your genitals with warm water, wiping all folds dry. Feces, urine, and vomit must be removed immediately, as they irritate the patient’s skin.
Honey. staff must inform relatives about what kind of clothing the patient should wear. Clothes should be comfortable, soft, fit, made of cotton fabric, and not have rough seams, buttons or zippers.
The nurse is also responsible for filling out medical information. patient records, correct keeping of a diary in which basic health indicators are recorded (body temperature, blood pressure), timely attachment of laboratory and instrumental test results, calling specialized specialists for consultation, on the recommendation of the attending physician, filling out a prescription sheet.
The junior nurse and orderly ensures cleanliness and order in the patient’s room. Every day you need to ventilate the room and carry out wet cleaning.
The nurse, first of all, must strictly follow the doctor’s instructions, maintain the accuracy of the dose of medication taken, the order and correct sequence of treatment measures.
The nurse, due to the fact that she communicates with the patient more often and more closely than the doctor, can learn about the patient’s self-administration of medications (taking medications for concomitant diseases, self-prescribing painkillers, etc.). IN in this case she will be required to inform the attending physician about this, since additional medication may have a toxic effect on the liver.
Nursing care for patients with liver cirrhosis is important not only during treatment in a hospital, but also while at home. If the patient remains unable to care for himself, his relatives will do this, but the person providing ongoing care must have a full understanding of proper care for a bedridden patient, a nurse can best tell you about this.
Often relatives cannot be with the patient all the time, then a nurse should be hired. It is better if the chosen nurse has a medical education.
Even at home, treatment must continue and often requires intramuscular or intravenous injections, for this purpose, a polyclinic nurse comes to the house, if the clinic has the ability to do so.
The priority problem in caring for patients with cirrhosis is the lack of qualified nursing personnel.
No, of course there is, but in such small quantities that for one sister there are dozens of seriously ill patients, it is difficult for her to give everyone due attention. Even with all the desire, this, alas, is impossible. This is why the nursing process for liver cirrhosis in our hospitals is far from perfect.
Everyone decides for themselves what to do in this case. But the main thing is that the patient feels loved and needed. The care of loved ones will definitely help fight this disease.
