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MindMap Gallery 50. Nursing care of patients with bone tumors
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50. Nursing care of patients with bone tumors
This is a mind map about the care of 50. bone tumor patients. Bone tumors: tumors that occur within the bone or originate from various bone tissue components, as well as tumors that have malignant tumors of other organs that metastasize to the bone, are collectively referred to as bone. Tumor.
Edited at 2023-11-22 20:30:09
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50. Nursing care of patients with bone tumors
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Nursing Care of Bone Tumor Patients
Overview
Bone tumors: Tumors that occur within the bone or originate from various bone tissue components, as well as tumors that metastasize to the bone from malignant tumors of other organs, are collectively referred to as bone tumors.
(1) Incidence of disease
Bone tumors can be divided into two categories: primary and secondary.
Primary bone tumors account for 2 to 3% of systemic tumors, and benign tumors are more common.
Among benign tumors, osteochondroma has the highest incidence rate
Among malignant tumors, osteosarcoma has the highest incidence rate.
The cause of bone tumors is unknown, and the incidence is slightly higher in men than in women.
The onset of bone tumors is characterized by age and anatomic location:
Osteosarcoma is more common in children and adolescents;
Giant cell tumor of bone is more common in adults;
Myeloma is more common in the elderly.
Many tumors are more common in the metaphysis of long bones, such as the lower end of the femur, the tibia, and the upper end of the humerus.
(2) Pathological classification
Classified according to the degree of malignancy: benign, intermediate, malignant
Classification according to the primary site of the tumor: Primary: benign and common; secondary
(3) Surgical staging
Adopt G.T.M surgical grading system
G (grade) indicates pathological grade: Go benign, G low malignant, G high malignant
T (territory) refers to the relationship between the tumor and the anatomical compartment: TO intracapsular, T | extracapsular interior, T2 exterior Compartments are natural barriers to the spread of small tumors, such as: in long bones, they refer to the bone cortex and articular cartilage; in soft tissues, they are the fascial compartments and the starting points of tendons.
M (metastasis) indicates distant metastasis: Mo has no distant metastasis, M1 has distant metastasis
1. Staging of benign tumors
Represented by Arabic numerals 123
1. Quiescent tumors with complete cysts
2. Active growth, still located in the cyst or blocked by natural barriers
3. Invasive
2. Malignant tumor staging
Indicated by Roman numerals I, II, III. Each period is divided into two types: A (indoor room) and B (outdoor room).
·IA, IB: low-grade malignancy;
·ⅡA, ⅡB: highly malignant;
IIIA, IIIB: metastasis
(4) Clinical manifestations
1. Pain and tenderness: Pain is the main symptom of malignant tumors. The pain gradually becomes severe, obvious at night, and has local tenderness: benign tumors grow slowly and often have no pain symptoms or mild pain.
2. Lumps and swelling:
Malignant: fast growth, superficial venous distension visible on the surface, high local skin temperature
Benign: Slow growth, long course, often discovered accidentally.
3. Symptoms of dysfunction and compression: Bone tumors located in the metaphysis of long bones, often adjacent to joints, can cause joint dysfunction due to pain, swelling and deformity. When the mass is huge, it causes compression symptoms.
4. Pathological fracture: It is the first symptom of some bone tumors and a common complication.
5. Metastasis and recurrence: Malignant bone tumors can metastasize to distant places through blood (most common) and lymph, such as lung metastasis.
6. Others: Cachexia occurs in the late stage of malignant bone tumors: such as anemia, weight loss, loss of appetite, weight loss, low-grade fever, etc.
(5) Auxiliary inspection
1. Imaging examination
x-ray
Plain film: of great value for diagnosis. It can display the basic lesions of bone tissue and determine whether the bone tumor is benign or malignant. Benign: clear boundaries and uniform density; malignant: unclear boundaries and uneven density.
Angiography: Angiography can show the blood supply of the tumor and can be used for blood vessel embolization and chemotherapy.
CT: shows the location, size, scope of the lesion and its relationship with the surroundings
MRI: shows the specific location and size of the lesion, as well as bone destruction or absorption
2. Laboratory examination shows osteolytic destruction: increased blood calcium and blood phosphorus: such as giant cell tumor of bone and osteosarcoma; increased alkaline phosphatase is helpful in the diagnosis of osteosarcoma.
3. Pathological examination: Puncture biopsy: It is the only reliable examination to diagnose bone tumors.
4. Modern biotechnology detection and immunohistochemistry technology: It can better understand the degree of differentiation, benign and malignant tumors, and judge the efficacy and prognosis.
(6) Processing principles
Different treatment methods are adopted according to the nature of the tumor, the location of the lesion, the extent of invasion and the presence of metastasis.
1. Benign bone tumors
Mainly surgical resection
Curettage and bone grafting: Completely scrape off the diseased tissue, use drugs or cautery to kill residual tumor cells, and place filling materials in the scraped cavity.
Exophytic bone tumor resection: The tumor is removed from the normal bone at the base to prevent recurrence. Such as osteochondroma resection.
2. Malignant bone tumors
Comprehensive treatment methods, mainly surgical treatment, are usually used.
Limb salvage surgery: Limb salvage surgery is often used.
Amputation: suitable for advanced and highly malignant tumors with extensive lesions and ineffective adjuvant treatment.
Chemotherapy: Greatly improves survival and limb salvage rates.
Radiotherapy: Inhibits the proliferation of malignant tumor cells, controls the development of lesions, relieves pain and postoperative recurrence.
Other therapies: such as vascular embolization and local arterial catheterization chemotherapy.
osteochondroma
Overview
It is a common benign bone tumor derived from osteocartilage. It mostly occurs in adolescents aged 10 to 20 years old, more often in males than females, and is more common in the metaphysis of long bones, such as the lower end of the femur, the upper end of the tibia and the humerus.
There are two types: single and multiple.
Solitary warts are more common and are also called exostoses.
Multiple is rare, also known as hereditary multiple osteochondroma. Most of them have a genetic history, and the chance of malignant transformation is higher than that of solitary osteochondroma.
clinical manifestations
The vast majority of patients have no conscious symptoms and often seek medical attention due to the inadvertent discovery of lumps.
Masses commonly occur on the distal femur, tibia, and proximal humerus, ilium, and spine.
The enlarged mass may compress surrounding tissues, causing corresponding compression symptoms, or secondary bursitis and pathological fractures.
Multiple osteochondromas can hinder the growth and development of bones, resulting in shortening and bending deformity of the affected limbs.
If the pain worsens and the mass grows rapidly, the possibility of malignant transformation into chondrosarcoma may be considered.
Auxiliary inspection
X-ray examination: The metaphysis has pedicle-shaped, antler-shaped or hilly bony protrusions, and its cortex and cancellous bone are connected to the normal bone, and the medullary cavity is connected to them. The cartilage cap and bursa are mostly not visible, and sometimes they may appear irregular. Regular calcifications.
Processing principles
Those who belong to GoMoTo and are asymptomatic generally do not need treatment and should be closely observed and followed up.
Surgical resection: The tumor is too large, grows rapidly, has symptoms of compression, affects function, or is suspected of malignant transformation.
Strict resection scope: starting from the normal bone tissue around the base of the tumor, including fibrous membrane or bursa, cartilage cap, etc., to avoid recurrence.
Nursing diagnosis
1. Anxiety or fear: related to limb dysfunction and worry about the prognosis of the disease.
2. Body movement disorder: related to pain and impairment of limb function.
3. Potential complications: pathological fractures and malignant transformation.
Nursing measures
1. Reduce anxiety and fear
2. Relieve pain
3. Prevent pathological fractures: Use walking aids correctly to avoid weight bearing on the limbs.
4. Provide health education: raise the affected limb after surgery to prevent swelling. Pay attention to the incision. Sensation and movement of the operated limb.
giant cell tumor of bone
Overview
It is a common primary bone tumor and is a potentially malignant or low-grade malignant tumor.
The age of onset is more common in 20-40 years old, and women are more common than men.
It most commonly occurs at the lower end of the femur and the upper end of the tibia.
clinical manifestations
There is local pain and swelling, and the pain is aggravated by intratumoral hemorrhage or pathological fracture.
The degree of pain is related to the growth rate of the tumor.
If it invades articular cartilage, it can affect joint function.
There may be mild tenderness and increased skin temperature in the localized lesion.
Local masses may be palpable and pathological fractures may occur.
Auxiliary inspection
X-ray manifestations: The lesion is located at the end of the bone, showing eccentric osteolytic destruction. The bone cortex in the lesion area expands and becomes thinner, showing a "soap bubble-like" change.
Angiography showed that the tumor was rich in blood vessels and had arteries and veins.
Processing principles
Surgical treatment: Mainly surgical treatment
1) Curettage and bone grafting.
2) Tumor segment resection: tumor segments are removed and prostheses are implanted.
3) Amputation: For malignant patients without metastasis, wide radical resection or osteotomy is used.
Chemotherapy: Insensitive
Radiotherapy: It has a certain effect on those who have difficulty in surgical removal, but a small number of patients may develop sarcomatosis after radiation.
Nursing diagnosis
1. Anxiety or fear: related to loss of limb function and worry about the prognosis of the disease.
2. Physical mobility disorder: related to pain and impairment of limb function.
3. Pain: related to the tumor compressing surrounding tissues.
4. Potential complications: pathological fracture.
Nursing measures
Preoperative care
1) Reduce anxiety and fear
2) Pain relief: For mild pain, use relaxation therapy, physical therapy, etc.; for severe pain: analgesia: fentanyl, pethidine and other drugs; operate gently and steadily, and try to avoid moving.
3) Prevent pathological fractures: If the bone is seriously damaged, a small splint or plaster should be used for fixation; if the distal femoral bone is seriously damaged, in addition to fixation, traction should be used to avoid joint deformity. Bed-ridden patients should be gentle and steady when turning and moving.
Postoperative care
Promote joint function recovery
1) Position: The postoperative position is determined according to the location and nature of the surgery. Such as after artificial hip replacement? After knee replacement?
2) Condition observation: Observe the blood supply of the wound and affected limb; raise the affected limb, keep the drainage tube unobstructed, and observe and record the drainage situation.
3) Functional exercise
Encourage patients to perform functional exercises to prevent muscle atrophy and joint stiffness
Once the mood is stable, you can start isometric contraction of the muscles of the affected limb and activities of the toes; start joint activities 1 to 2 weeks after the operation; practice abduction exercises after artificial hip replacement, and use crutches to move on the ground and train to stand 2 weeks after the operation. Weight-bearing; practice extension and flexion exercises after artificial knee replacement.
For allograft bone and joint transplant recipients, the amount of activity should be gradually increased based on the degree of healing to prevent allograft bone fractures.
Prevention and care of complications of radiotherapy
1. Psychological care: the necessity of radiotherapy and possible reactions.
2. Radiation dermatitis: Pay attention to protect the skin of the irradiated area. Avoid stimulation by physical and chemical factors and direct sunlight. If there is skin ulceration, treat it in time.
3. Bone marrow suppression: Pay attention to weekly blood tests; prevent infection, conduct protective isolation, and transfuse blood products if necessary to increase resistance; if white blood cells are too low, chemotherapy should be suspended.
Osteosarcoma
Overview
The most common primary malignant bone tumor.
The degree of malignancy is high and the prognosis is poor.
The most common age of onset is 10-20 years old.
It mostly occurs in the metaphysis of long bones.
70% are in the lower end of the femur, the upper end of the tibia and the upper humerus.
Characteristics: malignant tumor cells directly form osteoid tissue or immature bone.
Advances in treatment have greatly increased the 5-year survival rate.
clinical manifestations
Symptoms: The main symptoms are: pain and local swelling. In the early stage, it is local intermittent dull pain, which may occur before the lump appears. It gradually turns into persistent severe pain, which worsens at night and affects sleep.
Signs: A mass can be seen near the joint at the bone end, local skin temperature increases, venous distention, and tenderness. The enlarged mass can accumulate in adjacent joints, causing limited joint movement. May be accompanied by pathological fractures. The incidence of pulmonary metastasis is higher.
Auxiliary inspection
X-ray mainly shows osteoblastic, osteolytic, and mixed bone destruction.
If the malignant tumor grows rapidly and exceeds the scope of the bone cortex, blood vessels will grow in at the same time, and the tumor bone and reactive bone will be deposited along the radial blood vessel direction, showing a "sunray ray" shape.
Processing principles
Comprehensive treatment, mainly surgical treatment, is adopted.
Adjuvant chemotherapy should be performed promptly to eliminate micro-metastasis.
Again, radical tumor segmentectomy or limb-salvage surgery with prosthesis implantation is performed;
If limb salvage is not possible, amputation is performed.
High-dose chemotherapy was continued after surgery.
Nursing diagnosis
Fear: Related to concerns about loss of limb function and prognosis.
Pain: related to tumor compression, pathological fractures, surgical trauma, etc.
Physical mobility disorders: related to pain, limited joint function, and immobility.
Disturbed self-image: associated with side effects of surgery and chemotherapy.
Potential complications: pathological fracture.
Lack of knowledge: Lack of knowledge about disease and self-care.
nursing assessment
health history
normal information
Past history: history of trauma and fractures, cachexia, and pain
family history
Physical conditions
Local: pain, local manifestations, presence or absence of metastasis
Systemic: Cachexia manifestations, other organ functions, ability to tolerate radiotherapy and chemotherapy.
Auxiliary examination results: biochemical examination, X-ray examination, pathological examination, and function of each organ.
Psychological and social support status
The patient's cognitive level and psychological endurance.
Knowledge of surgical treatment.
economic status.
Nursing measures
psychological care
1. Communicate with patients and their families, understand the impact of the disease on them, and understand the patient's emotional response.
2. Introduce current treatment methods and encourage active cooperation with treatment.
3. Introduce successful cases and increase confidence in defeating the disease.
4. Provide explanations for preoperative examinations to coordinate with preoperative preparations.
5. Provide psychological support to patients undergoing amputation so that they can be mentally prepared for the operation.
control pain
①Non-drug pain relief: avoid triggering factors and choose a comfortable position
②Application of analgesics: Three-step analgesic therapy can be applied: Level 1 analgesic Non-opioid anti-inflammatory analgesics. Secondary analgesia Weak opioids: strong analgesia, codeine. Third-level analgesia Strong opioid: morphine and pethidine. Pay attention to administering medication on time, in steps, and on an individual basis until the pain disappears. If possible, apply it before the next time it hurts.
③Use an analgesic pump
Chemotherapy patient care
① Strengthen psychological support
② Dietary guidance: Apply antiemetics 30 minutes before chemotherapy. Eat a light diet 24 hours before and 72 hours after chemotherapy.
③Observe drug toxic reactions
④ Medication precautions: a. Nurses should protect themselves. b. Standardize and accurately use medication: prepare it now and use it at intervals. C. Vascular protection: start from the distal end to prevent extravasation of the drug solution
Postoperative care
Promote joint function recovery
Elevate the affected limb to prevent swelling.
Maintain the functional position of the limbs: 10 degrees of flexion of the knee joint after surgery; neutral position of abduction of the hip joint after surgery to prevent joint deformity.
Bed rest in the early postoperative period, and then move according to the recovery situation. Teach patients the correct use of crutches and wheelchairs to assist activities.
Provide knowledge about rehabilitation
2 weeks before surgery, instruct lower limb surgery patients to do isometric contraction exercises of the quadriceps muscles.
Start doing muscle isometric exercises 48 hours after surgery to promote blood circulation and prevent joint adhesion.
After artificial joint replacement, functional exercises of the joints can be started 2 to 3 weeks later.
Joint activities of the affected limb can be carried out 3 weeks after surgery, and the range of motion can be increased 6 weeks after surgery.
Assisted with physical therapy and activities using equipment.
Prevent pathological fractures
·Be gentle and steady when moving
· Assistance when turning over
·Be careful to protect the affected limb after surgery
·Functional exercises should be done step by step to prevent falls.
·If there is a fracture, treat it as a fracture
Care of patients after amputation
psychological care
Amputation is a great trauma to the patient's body and mind, and everyone reacts differently.
The affected limb should be elevated 24-48 hours after surgery to prevent postural swelling. People with lower limb amputations should lie prone for 30 minutes every 3 to 4 hours, with the residual limb supported by pillows.
Observation and care of complications
Prevent heavy bleeding from the stump
Pay attention to the bleeding situation of the limb stump, the nature and amount of wound drainage. If there is excessive bleeding, apply pressure bandage.
·Keep a tourniquet or sandbag at the bedside to prevent bleeding from ruptured blood vessels.
2) Postoperative wound infection: closely observe whether there is any infection and adjust the dosage of antibiotics in a timely manner
Phantom limb pain care
Preoperative explanation: The pain is mostly persistent, especially at night, with different characteristics and degrees.
Stare at the stump and accept reality.
Relaxation therapy to eliminate phantom limb sensation.
Gently tapping the stump, physical therapy, etc. can eliminate phantom limb pain.
If necessary, use physiological saline suggestion therapy or sedative and analgesic drugs alternately.
Residual limb functional exercise
Generally, functional exercises can be started 2 weeks after the operation, after the wound has healed. Prone position: practice thigh adduction and extension; shoulder joint adduction, abduction and rotation.
Evenly compress the stump to promote soft tissue contraction.
Use an elastic bandage to wrap it repeatedly every day, and perform massage, patting and stepping on the stump to increase the weight-bearing capacity of the stump.
Promote stump maturation and prepare for prosthetic limb installation.
health education
Stay healthy physically and mentally. Improve quality of life. Stick to functional exercises. Use your walking aid correctly. Regular follow-up visits and chemotherapy on time