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NURSING MANAGEMENT TO Mr. S, PATIENT WITH PEDIS EPIDERMOID CARSINOMA AT SURGERY WARD A3 DR KARIADI HOSPITAL BY: Toto Dinar W.

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Presentation on theme: "NURSING MANAGEMENT TO Mr. S, PATIENT WITH PEDIS EPIDERMOID CARSINOMA AT SURGERY WARD A3 DR KARIADI HOSPITAL BY: Toto Dinar W."— Presentation transcript:

1 NURSING MANAGEMENT TO Mr. S, PATIENT WITH PEDIS EPIDERMOID CARSINOMA AT SURGERY WARD A3 DR KARIADI HOSPITAL BY: Toto Dinar W

2 Cancer is diseases characterized by excessive, uncontrolled growth of abnormal cells, which invade and destroy other tissues Cancer usually develops gradually over many years, the result of a complex mix of environmental, nutritional, Life Style, and hereditary factors. According to World Health Organization about 6, 25 million people suffer cancer every year. Epidermoid carsinoma includes the tenth of most common cancer In Indonesia. In Dr. Karyadi hospital there are seven cases of epidermoid cancer. Psychologycal aspect, family and Nurse support

3 Epidermoid carcinoma is a cista caused by epidermoid cell which invades and grows to the subcutis tissues because of severe trauma (Mansjoer, 2000). Squamous cell carcinoma is malignant neoplasma of the keratinocytic shaped from more differentiated epidermis cells (Anugrah, 1995) Squamous cell carcinoma is keratinocytic tumor affected the skin and mucous membranes, with variated malignancy degree (Harahap, 2000).

4 Sunlight Chemical Carsinogen Heredity ras Chronic ulcer Imunosuppressive Therapy

5 Chronic exposure of sunlight, chemical carsinogen, trauma, heredity disorder, Imunosuppressive Therapy can damage epidermis cell via RNA chain breaking. RNA chain breaking will make epidermis cells be poorly differentiated. These poorly diferentiated cell become uncontrolled growth and hyperplasia which invade and destroy surroundings tissues. Function of the skin regeneration become to be disturbed. If this conditions is so long, it can damage the tissues and may be skin ulcer and damage lower layers.

6 poorly differentiated moderately differentiated well differentiated

7 1.Colored nodul like normal skin, smooth surface without crusta or ulcer with clearer limited side. 2.redness nodul with popilomatosa or verukosa like cabbage flower 3.Ulcer with crusta on the side surface rise and less redness 4.Squamouse cell carcinoma of the normal skin often more quickly invade and metastases, than lesion appeared by actinic keratoses.

8 Early detection and treatment are the keys to survival Surgical operation. Radiotherapy

9 1.Pain related to periphery nerve tissues destruction 2.Anxiety related to threatening or altered health status, situation crisis. 3.Risk for infection related to transmission microorganism secondary to wound. 4.Impaired Skin integrity related to inflammation between dermis and epidermis secondary cancer cell. 5.Ineffective individual coping related to lack of family support system.

10 Assesment was on July Mr. S, 6O years old, moeslem, Javanese race, farmer, address: sembung, kedonan district, Blora. The client admitted on July 5 th 2005, at 3 p.m. with medical diagnosis Pedis Epidermoid Carcinoma. The Chief complaint is pain in the left leg because of his ulcer. About 2 months ago there were tumor in the left leg, the client felt itchiness and then it rounded up. The ulcer became putrid. The client said that he could not have activated because of pain and fear with his bleeding wound. The client said his disease as a Gods punishment.

11 There were ulcer about 6 cm on the sinistra pedis, unflat wound, bleeding, unpleasant odor, wound penetrated reach the leg bone. Hb, 11, 00 gr/dl, Ht 33, 5 %, Leucocyte /mikro L, Trombocyte: /mikro L Therapy programme Amoxycillin 3 x 500 mg, mefenamat acid 3 x 500 mg.

12 1.Pain related to periphery nerve tissues destruction secondary cancer cell. Subjective data the client complain pain on the left leg. Objective data there were ulcer about 6 cm. on the lef leg. 2. Risk for infection related to transmission microorganism secondary to wound Subjective data client said that his ulcer have not yet recovered. Objective data there were ulcer about 6 cm. on the lef leg, dirty wound unpleasant odor, leucocyte /mikro.

13 3. Risk for hipovolemic shock related to disorder of trombocyte cell secondary cancer cell. Subjective data client said wound bleeding Objective data blood leak around the wound, wound easy to bleed, blood pressure 100/60 mmHg, Trombocyte /mikro 4. Anxiety related to deficit of knowledge about disease process, medicine,and other therapy. Subjective data the client said that he has not known about medicine procedures. Objective data The client appeared be upset, asked about therapy programe. 5. Ineffective individual coping related to lack of family support system. Subjective data the client said his illness as God punishment. Objective data The client had a daydream.

14 1.Pain related to periphery nerve tissues destruction secondary cancer cells. Acute pain is condition in which an individual experience and report their terrific uncomfortable for six month or less (Carpenito, 2001). Pain appeared because of invading of cancer cells to the dermis which have blood vessel and nerve tissues. It will stimulate norciceptor to send impuls to the cortex cerebry. The main priority in this implementation are to teach distraction and relaxation. After doing nursing care the problem can be solved.

15 According to carpenito Risk for infection can be related to decrease body immune system secondary to cancer. Risk for infection appeared because cancer cells have destroyed lymph tissues in homolateral, so T sitotoxic lymphocytes damaged by cancer cell. The main priority in this implementation is to take care wound. After doing nursing care, a part of the problem can be solved. 2. Risk for infection related to transmission microorganism secondary to wound. Risk for infection is the state in which an individual has an increased susceptibility for invation by pathogenic or opportunistic organism.

16 3. Risk of hipovolemic shock related to cell disorder of trombocyte secondary cancer cell. Hipovolemic shock is imbalance between blood volume with vascular cavity which can be caused loss of intravascular fluid for the example bleeding. The writer takes this diagnosis because of thrombositosis and it will cause bleeding to patient. The main priority in this implementation are to give motivation the patient to drink a lot of water and take blood sample. After doing nursing care the problem can be solved.

17 4. Anxiety related to deficit of knowledge about disease process, medicine, and other therapy. Anxiety is the state in which an individual or group experience worried and activate the autonomy nerve system in responding to unclear threatening. The writer takes this diagnosis because patient with carcinoma often feel powerlessness and scare to be dead. The main priority in this implementation is to give information about his disease and therapy programme, and to do ECG examination. After doing nursing care the problem can be solved.

18 5. Ineffective individual coping related to lack of family support system. Ineffective individual coping is impairment of adaptive behaviors and problem solving abilities of person in meeting lifes demand and role. The writer takes this diagnosis because Ineffective individual coping mechanism can appears if family support decrease. The main priority in this implementation is to give health education about factors which can make quickly in healing. After doing nursing care the problem can be solved.

19 In nursing management patient with pedis epidermoid carcinoma have to include bio, phsyco, sosio, cultural. The writer took five diagnosis namely pain, risk for infection, risk for hipovolemic shock, anxiety, ineffective individual coping. Four diagnosis can be solved and one diagnosis be solved a part. Using sun block Washing hand Take care the wound in aseptic and antiseptic tehnicque Using therapeutic communication Involving family.

20 SKIN ANATOMY

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