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19 Oncological Nursing Care

205

 

 

Take time for the patient and their next of kin, convey commitment and care, answer questions comprehensively, and respond to wishes and concerns

Develop an empathetic relationship toward patient and family based on mutual trust. Without trust and understanding, good communication cannot take place

Be informed about the disease and understand its consequences for everyone involved

Information needs to be adequate in quantity and quality regarding requirements of the child and their entire family, their age, physical and psychological state, their mental resilience, and their familial situation

Accept that parents are the prime persons of reference as far as a social network is existent, therefore, involve the parents in the nursing care and collaborate with them

Remember to pay a compliment to the parents from time to time

Take note of needs and wishes as part of the nursing process (collecting information), accordingly formulating the respective goal, as well as planning and revising measures taken

Where there is a poor prognosis, accompany the patient, giving them support, guidance, or advice, since hope can give rise to strength, courage, and regeneration

Information needs to be shared (a nurse should also be present during family– patient conversations with the physician)

19.1.2Nursing Care

Nursing care activity is scientifically supported by means of nursing care research. Professional handling is encouraged through systematic scientific methods:

Cost-effectiveness is shown

Research in the field of oncology nursing leads to improvements in quality and facilitates working with nursing care standards (e.g., Nursing Care Standards in Oncology by Suzan Tucker, 1998)

19.2Side Effects of Treatment

19.2.1Nausea and Vomiting

Nausea and vomiting are two of the burdensome side effects of chemotherapy; they vary greatly in their individual extent and depend on the type of chemotherapeutic drugs

Vomiting and nausea can occur separately or in combination

There are potent drugs capable of preventing, alleviating, or almost fully suppressing these side effects

19.2.1.1 Cause

Nausea and emesis are usually caused by irritation of certain centers of the brain. Chemotherapeutic agents activate the vomiting center of the brain. In addition, serotonin is released from intestinal cells, which further activates the vomiting center.

206 F. Oeschger-Schürch and C. Verdan

19.2.1.2 Forms of Nausea and Vomiting

Acute vomiting: within the first 24 h of chemotherapy

Delayed vomiting: symptoms occur more than 24 h after cessation of chemotherapy, potentially over the course of several days

Anticipatory vomiting: occurs before treatment or at the very thought of it, for example, the sight of the hospital, an i.v., bottle, the color or smell of the hospital, or a nurse

19.2.1.3 Symptoms

Nausea is a subjective sensation of sickness in the throat and/or stomach, with or without vomiting. Nausea may be accompanied by sweating, drooling, pallor, and tachycardia

Emesis is a forceful emission of stomach contents and/or bile fluid out of the mouth. So-called dry vomiting describes a vomiting act without ejection of stomach contents

19.2.1.4 Prophylactic Care

Immediately before and after treatment, the patient ought to eat with restraint, have frequent, small meals, and avoid sweets and fat. Better tolerated is food such as mashed potato, apple puree, ice cream, crisp bread, toast, curd cheese, or bananas

Plenty of fluids (but no fizzy drinks; apple juice, tea, lemonade, and chilled drinks are better tolerated)

The patient should avoid strong smells (this is difficult in hospital)

Distract the patient through music, video games, conversations, board games, magazines, or TV

Relaxation, for example massage

Occasionally the patient’s mouth should be rinsed with diluted lemon water or their teeth brushed

Sugar-free sweets alleviate bad tastes in the mouth

Go for walks with the patient in the fresh air

Personal motivation and a positive attitude of the patient toward the treatment have a major impact on the course of events

19.2.1.5Treatment

Administer drugs to prevent nausea and emesis according to the doctor’s prescription

Prophylaxis of nausea and emesis: do not give medication once the patient is vomiting

In case of anticipatory vomiting: aid with anxiolytic drugs or general preventative measures against anxiety

Create an antiemetic plan, adjusting and amending the plan to the individual response and needs of the patient

Enquire about side effects of antiemetic drugs, keeping protocol

Where treatment lasts several days, daily assessment is necessary

The patient should try their best to eat and tolerate food during chemotherapy

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