Nursing Care Plan for Hepatoma

Nursing Care Plan for Hepatoma

NCP for Hepatoma

Hepatoma
A hepatoma is a cancer that starts in the liver. It is the most common type of cancer originating in the liver.
Symptoms

The first signs of the disease may include :

• Abdominal pain
• Weight loss
• Large mass that can be felt in the upper right section of the abdomen

People who have had cirrhosis for a long time may also experience :

• Sudden feeling of illness
• Fever
• Sudden abdominal pain and shock (very low blood pressure) caused by a rupture or bleeding of the tumor

Causes and Risk Factors
Risk factors for hepatoma include :

• Long-standing cases of cirrhosis (severe scarring of the liver)
• Chronic infection with hepatitis B
• Chronic infection with hepatitis C
• Certain food fungi

Diagnosis
At first, symptoms may not offer clues that the disease is present. When the person has had cirrhosis for a long time and a tumor can be felt in the abdomen, the doctor will suspect hepatoma.
Other ways to detect the disease include :

• Ultrasound
• Computed tomography (CT) scans
• Magnetic resonance imaging (MRI)scans
• Liver biopsy. For this, a small sample of tissue is taken for examination under a microscope.

Treatment
The survival rate for people with hepatoma is poor. This is because the tumor is usually discovered at a later stage.
Treatment options include :

• Surgery, if the tumor is small
• Chemotherapy. This can slow the growth of the tumor but not cure the cancer.

Source : www.cedars-sinai.edu

Nursing Care Plan for Hepatoma

Nursing Assessment
On physical examination can be obtained :

• Ascites
• Jaundice
• Hypoalbuminemia
• Splenomegaly, spider nevi, palmar eritoma, edema.

In general, nursing assessment in patients with hepatoma, including :

• Metabolic disorders
• Bleeding
• Ascites
• Edema
• Hipoproteinemia
• Jaundice / icterus
• Endocrine Complications
• Activities were disrupted by treatment.

Nursing Diagnosis for Hepatoma
Based on the above assessment, the nursing diagnoses that often arises is :

1. Malnutrition: Weight loss related to anorexia, nausea, impaired absorption, metabolism of vitamins.
2. Ineffectiveness of breathing related to the existence of ascites and emphasis diapragma.
3. Pain related to abdominal wall tension
4. Lack of fluids and electrolytes related to excessive ascites, bleeding, and edema
5. The risk of infection related to a deficiency of white blood cells
6. The risk of skin integrity problems related to pruritus, edema, and ascites
7. Sexual dysfunction related to hormonal dysfunction and decreased libido
8. Anxiety related to hospitalization
9. Lack of knowledge about the disease process and its causes
10. Social isolation related to the risk of spreading infection.

ineffective Airway Clearance - Evaluation, Interventions, Documentation

Desired Outcomes/Evaluation
Criteria—Client Will:
• Maintain airway patency.
• Expectorate/clear secretions readily.
• Demonstrate absence/reduction of congestion with breath sounds clear, respirations noiseless, improved oxygen exchange (e.g., absence of cyanosis, ABG results within client norms).
• Verbalize understanding of cause(s) and therapeutic management regimen.
• Demonstrate behaviors to improve or maintain clear airway.
• Identify potential complications and how to initiate appropriate preventive or corrective actions.

Actions/Interventions
NURSING PRIORITY NO. 1. To maintain adequate, patent airway:
• Position head midline with flexion appropriate for age/condition to open or maintain open airway in at-rest or compromised individual.
• Assist with appropriate testing (e.g., pulmonary function/ sleep studies) to identify causative/precipitating factors.
• Suction naso/tracheal/oral prn to clear airway when secretions are blocking airway.
• Elevate head of the bed/change position every 2 hours and prn to take advantage of gravity decreasing pressure on the diaphragm and enhancing drainage of/ventilation to different lung segments (pulmonary toilet).
• Monitor infant/child for feeding intolerance, abdominal distention, and emotional stressors that may compromise
airway.
• Insert oral airway as appropriate to maintain anatomic position of tongue and natural airway.
• Assist with procedures (e.g., bronchoscopy, tracheostomy) to clear/maintain open airway.
• Keep environment allergen free (e.g., dust, feather pillows, smoke) according to individual situation.

NURSING PRIORITY NO. 2. To mobilize secretions:
• Encourage deep-breathing and coughing exercises; splint chest/incision to maximize effort.
• Administer analgesics to improve cough when pain is inhibiting effort. (Caution: Overmedication can depress respirations and cough effort.)
• Give expectorants/bronchodilators as ordered.
• Increase fluid intake to at least 2000 mL/day within level of cardiac tolerance (may require IV) to help liquefy secretions. Monitor for signs/symptoms of congestive heart failure (crackles, edema, weight gain).
• Encourage/provide warm versus cold liquids as appropriate.
• Provide supplemental humidification, if needed (ultrasonic nebulizer, room humidifier).
• Perform/assist client with postural drainage and percussion as indicated if not contraindicated by condition, such as asthma.
• Assist with respiratory treatments (intermittent positivepressure breathing—IPPB, incentive spirometer).
• Support reduction/cessation of smoking to improve lung function.
• Discourage use of oil-based products around nose to prevent aspiration into lungs.

NURSING PRIORITY NO. 3. To assess changes, note complications:
• Auscultate breath sounds and assess air movement to ascertain status and note progress.
• Monitor vital signs, noting blood pressure/pulse changes.
• Observe for signs of respiratory distress (increased rate, restlessness/anxiety, use of accessory muscles for breathing).
• Evaluate changes in sleep pattern, noting insomnia or daytime somnolence.
• Document response to drug therapy and/or development of adverse side effects or interactions with antimicrobials,
steroids, expectorants, bronchodilators.
• Observe for signs/symptoms of infection (e.g., increased dyspnea with onset of fever, change in sputum color, amount, or character) to identify infectious process/promote timely intervention.
• Obtain sputum specimen, preferably before antimicrobial therapy is initiated, to verify appropriateness of therapy.
• Monitor/document serial chest x-rays/ABGs/pulse oximetry readings.
• Observe for improvement in symptoms.

NURSING PRIORITY NO. 4. To promote wellness (Teaching/
Discharge Considerations):
• Assess client’s knowledge of contributing causes, treatment plan, specific medications, and therapeutic procedures.
• Provide information about the necessity of raising and expectorating secretions versus swallowing them, to examine and report changes in color and amount.
• Demonstrate pursed-lip or diaphragmatic breathing techniques, if indicated.
• Review breathing exercises, effective cough, use of adjunct devices (e.g., IPPB or incentive spirometer) in preoperative teaching.

• Encourage/provide opportunities for rest; limit activities to level of respiratory tolerance. (Prevents/lessens fatigue.)
• Refer to appropriate support groups (e.g., stop-smoking clinic, COPD exercise group, weight reduction).
• Instruct in use of nocturnal positive pressure air flow for treatment of sleep apnea. (Refer to NDs disturbed Sleep
Pattern; Sleep Deprivation.)

Documentation Focus
ASSESSMENT/REASSESSMENT
• Related Factors for individual client.
• Breath sounds, presence/character of secretions, use of accessory muscles for breathing.
• Character of cough/sputum.
PLANNING
• Plan of care and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Client’s response to interventions/teaching and actions
performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Long-term needs and who is responsible for actions to be taken.
• Specific referrals made.