At present, surgery remains the primary means of treatment of breast cancer. But the basic and clinical studies have confirmed the clinical diagnosis of breast cancer, when 50% ~ 60% had micro-metastasis exists, a simple surgery can not cure breast cancer. Therefore, as a systemic chemotherapy treatment increasingly taken seriously. Preoperative chemotherapy can contribute to breast tumors and metastases in local shrink, expand the scope of surgical indications and narrow surgical; also reduces the activity of cancer cells to prevent intraoperative spread of tumor cells, the control is not found in the clinical micro-metastasis, to reduce breast cancer metastasis; and tips used in cancer chemotherapy for the sensitivity. Practice confirmed that preoperative chemotherapy has reduced the advantages of staging. They wanted the smooth progress of chemotherapy, nursing care is essential.
1. Nursing problem
1.1 Fear 100% of the patients have a fear. Fear of patients mainly from two aspects, first, by the community “cancer = death” erroneous understanding of the impact. Most people mistakenly believe that cancer is an incurable disease, cancer would be tantamount to a death sentence or a reprieve, which the fear of cancer, mainly from the fear of death. The second is the fear of adverse reactions to chemotherapy. Because chemotherapy can cause vomiting, hair loss, partial skin necrosis and other serious adverse reactions, most patients have the misconception that chemotherapy is a kind of poison, such fear, mainly from the lack of understanding of the chemotherapy drugs, chemotherapy, and lack of knowledge of the After chemotherapy, self-image concerns.
1.2 anxiety comes mainly from the patient’s anxiety and lack of knowledge. Since the majority of patients mistakenly believed that surgery is the only way to cure diseases, surgery as quickly as possible, while the pre-operative chemotherapy to prolonged waiting times for surgery, the patient anxiety will increase.
1.3 depressive conditions such sentiments come from his family more difficult patients. The concerns raised on the family economy and strong sense of responsibility, may make the patient cause for concern. Because preoperative chemotherapy to prolonged waiting times for surgery, hospitalization costs would increase anxiety in patients with anxiety also increase, while the negative sentiment on the prognosis would have adverse effects.
2. Nursing
2.1 Psychological Care
2.1.1 Elimination of the fear of cancer in patients with frank answers to questions about the patient, patiently explain to patients of cancer related knowledge, to tell the patient of cancer is not incurable, with the development of medical science, there are many cancers can be cured, and some even that can cure and resume a normal life; based on the patient’s understanding and capacity of the proper interpretation of illness, tell the patient bad mood on the impact of disease and prognosis to patients about the success of previous cases, the patient to eliminate fear, establish confidence in disease-fighting and actively cooperate with treatment. In addition the patient death should be an appropriate education to reduce the fear of death of patients.
2.1.2 Elimination of anxiety in patients with patience and meticulous pre-operative chemotherapy to patients to explain the meaning and the need to tell patients surgery is not the only methods of treatment to enable patients to understand the feelings of staff and patient mood is the same, doctor will make every effort to work out the best treatment programs be cured, so happy for treatment.
2.1.3 Elimination of adverse reactions to chemotherapy in patients with fear based on the patient’s understanding and tolerance of chemotherapy drugs to patients to explain the role of the mechanism and possible adverse reactions. Should pay attention to talk art, multi-chat with the patient and patiently listening to patients Qing Shu, raised questions about the patient, do patient and meticulous explanations. Tell the patient, application of chemotherapy drugs would have some discomfort, but the application of chemotherapy drugs before the drugs and preventive measures will be applied if there is discomfort, medical staff would think of ways to provide treatment so that patients eliminate ideological concerns, it is necessary psychological preparation, actively cooperate with the treatment.
2.2 Chemotherapy Care
2.2.1 medical information ready before chemotherapy, patients should be measured height, weight, ready for routine blood test, electrocardiogram, liver function, kidney function and other testing materials, a full understanding of the toxic side effects of chemotherapy drugs in order to make adverse reaction time corresponding treatment.
2.2.2 master skilled operating skills to protect the small veins of the operation of skilled technical and painless injection technique reduce the fear of chemotherapy patients. Nurses should understand that the skilled operation techniques and a wealth of business knowledge in a planned way use ipsilateral limb superficial vein. Due to breast cancer patients should avoid ipsilateral upper extremity intravenous infusion, it can only be contralateral after infusion carried out to protect the contralateral vein, preoperative chemotherapy should choose the ipsilateral upper extremity superficial veins.
2.2.3 pay attention to oral hygiene and diet since the beginning chemotherapy, two times a day oral care, maintenance of oral hygiene. To encourage the patient to nutritious food, more water and potassium-rich fresh fruit juice, to help patients to develop a reasonable diet.
2.3 Prevention of chemotherapy and treatment of adverse reactions
2.3.1 in patients with gastrointestinal reactions are the most serious and most readme worried about side effects of chemotherapy [3], can lead to malnutrition and the impact of treatment effect, therefore, should make full preparations. To create a good therapeutic environment to eliminate the room odor, guiding patients with a reasonable diet and after a meal, or fasting, when in the line of chemotherapy, and 2 ~ 3h after a meal the best chemotherapy drugs; diet should Shaoliangduocan, fullness, and during chemotherapy inedible too greasy food. Intramuscularly 30min before chemotherapy phenergan 25mg, metoclopramide 20mg, or static push Kytril, vomiting will stop, ressaix down, such as ondansetron antiemetic drugs. Qin chemotherapy ward visits, multi-patient conversation distracts, conditional, could listening to music, watching TV in the receiving chemotherapy. To maintain smooth stool, if necessary, can laxatives; chemotherapy nausea and vomiting should be promptly dealt with vomiting and severe cases, should be given intravenous nutrition.
2.3.2 Bone marrow suppression is the most common side effects of chemotherapy drugs. Doctor’s orders, while chemotherapy should be given to l white blood drugs, periodic review hemogram, leukocytes less than 1.0 × 10 9 / L, prophylactic antibiotics should be prescribed by a doctor to implement isolation and treatment and care, restrictions on visits, in order to avoid cross-infection.
2.3.3 alopecia due to hair loss caused by a “special image of the chemotherapy,” is a serious problem affecting patients with self-esteem, therefore, before chemotherapy should be informed of this problem may occur in patients so that adequate preparations for it. Wear in the course of chemotherapy in ice caps or in the hairline, under the scalp with the rubber band tightly enclosed be prevented.
2.3.4 the prevention of chemotherapy extravasation extravasation of chemotherapeutic drugs can cause local tissue necrosis, once the development of skin ulcers, prolonged unhealed, the lack of effective treatments, therefore, focus on prevention. The preparation of chemotherapy drugs which should be required first in order to puncture the liquid non-chemotherapy blood vessel puncture to be successful, do not change after the liquid leakage of liquid containing chemotherapy. Intravenous injection, they would first withdraw sword, see pushed back only after the blood injection. Push injection process, repeatedly withdraw sword observation, injection speed should not be pushed too fast, and is not too slow, so as to avoid leakage and phlebitis, push injection time 10 ~ 15min is appropriate. Intravenous drip should be observed regularly tour. Chemotherapy drugs after bolus injection or bit by bit, and then replaced with non-chemotherapy intravenous fluid flushing path.
2.3.5 treatment of chemotherapy extravasation event of extravasation of chemotherapeutic drugs, should immediately cease injection bolus 5mg dexamethasone after needle injection, 24h a sustained ice, 24h is still swelling after local who painted cortisone acetate ointment, or dexamethasone wet packing, pain, those with lidocaine and hydrocortisone sodium succinate-line partial closure of dexamethasone and gentamicin alternating wet compress. Local has been a marked necrosis, ulcers who need to deal with surgical debridement.
