{"id":1152,"date":"2010-01-29T17:35:41","date_gmt":"2010-01-29T16:35:41","guid":{"rendered":"http:\/\/www.zdravstvena.info\/vsznj\/?p=1152"},"modified":"2010-05-16T16:03:10","modified_gmt":"2010-05-16T15:03:10","slug":"zn-onkoloskega-bolnika-zadnji-izpit","status":"publish","type":"post","link":"https:\/\/www.zdravstvena.info\/vsznj\/zn-onkoloskega-bolnika-zadnji-izpit\/","title":{"rendered":"ZN onkolo\u0161kega bolnika zadnji izpit"},"content":{"rendered":"

\"rak-pljuc\"Zna\u010dilnosti maligne bolezni?<\/strong><\/p>\n

a)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ozdravljiva<\/p>\n

b)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kroni\u010dna bolezen<\/p>\n

c)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Invazivnost (Tumor vra\u0161\u010da v sosednje organe, tkiva, jih uni\u010duje in nadome\u0161\u010da s svojo rastjo. Meje malignega tu so neostre, nepravilne, kar je potrebno upo\u0161tevati pri kirur\u0161ki odstranitvi tumorja. Zaradi nepopolno odstranjenega tu lahko pride do nastanka novega tumorja \/ recidiva.)<\/p>\n

d)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sistemska bolezen<\/p>\n

e)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nebole\u010d:\u00a0 sam tumor, bole\u010dina se razvije, ko tu prizadene periferno \u017eiv\u010devje<\/p>\n

f)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Funkcionalni u\u010dinki: zaradi hitre rasti deli tumorja niso dovolj prekrvavljeni, ti propadejo, nekrotizirajo<\/p>\n

<\/p>\n

g)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Simptomi in znaki prizadetega organa<\/p>\n

h)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zasevanje\/metastaziranje: POTEK: stopenjski: posamezne celice v primarnem tumorju se sprostijo in se po limfni, krvni poti ali po telesnih teko\u010dinah raz\u0161irijo v oddaljene organe in tkiva. V mikrocirkulaciji organov in tkiv se ustavijo in nastopi proces ekstravazacije (izstopa iz \u017eile) ter infiltracija v tkivo teh organov. Celice za\u010dnejo rasti ter ustvarjajo novo kolonijo malignih celic – metastazo.<\/p>\n

Metastaza:<\/strong> od primarnega \u017eari\u0161\u010da oddaljeno \u017eari\u0161\u010de z enakimi ali podobnimi zna\u010dilnostmi.<\/p>\n

Hematogen, limfogen ali transcelomi\u010dni razsoj<\/strong><\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 KARCINOMI so maligni tumorji, ki zrastejo iz epitelnih celic (celic vrhnjice), ki gradijo ve\u010dino telesnih organov. V kategorijo karcinomov uvr\u0161\u010damo okrog 80 % vseh rakov.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 SARKOMI so maligni tumorji, ki zrastejo iz celic opornih tkiv in se pojavljajo zlasti v vezivu, ma\u0161\u010devju, kosteh in hrustancu.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 LEVKEMIJE so rakaste bolezni krvi in krvotvornih organov. V nasprotju z ve\u010dino drugih rakov se navadno ne pojavljajo v obliki bul ali zatrdlin.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 LIMFOMI so rakaste bolezni limfati\u010dnega sistema, ki ga v telesu tvori omre\u017eje mezgovnic in bezgavk. Limfati\u010dni sistem deluje kot nekak\u0161en filter, ki prepre\u010duje, da bi telesu nevarne snovi (npr. mikroorganizmi) vdrle v krvni obtok.<\/p>\n

Kaj je fatigue in ZN?<\/strong><\/p>\n

KRONI\u010cNA UTRUJENOST \u2013 FATIGUE = stalen subjektivni ob\u010dutek utrujenosti v povezavi z rakavo boleznijo ali zdravljenjem raka, ki moti normalno \u017eivljenje (definicija NCCN).<\/p>\n

\uf02d\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Telesna iz\u010drpanost<\/p>\n

\uf02d\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Du\u0161evna iz\u010drpanost<\/p>\n

\uf02d\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u010custvena iz\u010drpanost<\/p>\n

Vzroki:<\/p>\n

\uf02d\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 bolezen<\/p>\n

\uf02d\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 specifi\u010dno zdravljenje<\/p>\n

\uf02d\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 spremljajo\u010da stanja (slabokrvnost, izsu\u0161enost, metabolne motnje, podhranjenost, zdravila,psihi\u010dni razlogi\u2026..)<\/p>\n

Zdravstvena vzgoja ob pojavu kroni\u010dne utrujenosti<\/strong><\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bolnik naj dovolj po\u010diva hkrati pa skrbi tudi za telesno aktivnost. \u010cez dan naj ima ve\u010d kraj\u0161ih po\u010ditkov.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Omeji naj dejavnosti in opravila le na najpomembnej\u0161a.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Skrbi naj za ohranjanje energije: predmete mu postavite bli\u017eje, da jih bo la\u017eje dosegel…<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vsak dan si naj bele\u017ei stopnjo utrujenosti, kar bo pomagalo ugotoviti kdaj in zakaj je bolj ali manj utrujen.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 U\u017eiva naj energijsko in hranilno bogato hrano, ki vklju\u010duje beljakovinska \u017eivila (mleko, meso, jajca, stro\u010dnice).<\/p>\n

<\/strong><\/p>\n

Kaj je extravazacija?<\/strong><\/p>\n

Lokalni zaplet sistemske intravenozne terapije.<\/p>\n

Nedavne \u0161tudije so raziskovale interakcije med tumornimi celicami in trombociti v detajlih, potekajo pa na ve\u010d nivojih: intravazalna distribucija, adhezija na endotelijske celice , invazija in ekstravazacija. Trombociti se ve\u017eejo direktno na tumorne celice, ob spro\u0161\u010danju razli\u010dnih faktorjev kot npr. trombocitni faktor 4, trombospondin, trombin in gelatinaza A, ki olaj\u0161ajo tromboti\u010dno formacijo.<\/p>\n

<\/strong><\/p>\n

Venska valvula?<\/strong><\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Indikacije:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 v primeru na\u010drtovanega dolgotrajnega sistemskega zdravljenja maligne bolezni in komplikacij<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 v primeru iztro\u0161enih ali slabo dostopnih perifernih ven, pri bolniku pri katerem potrebujemo centralni venski kanal v dalj\u0161em \u010dasu<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Uporaba:<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 kontinuirana infuzija citostatikov ali aplikacija citostatikov, ki so vezikanti<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 aplikacija antimikrobnih zdravil<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 aplikacija krvi in krvnih derivatov<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 aplikacija paranteralne prehrane<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 paranteralna hidracija<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 paranteralna aplikacija analgetikov<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 odvzemi krvi za laboratorijske preiskave<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Osnovna sestava<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 komora valjaste oblike<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 silikonski septum<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 kateter, priklju\u010den na komoro<\/p>\n

Zakaj podko\u017ena aplikacija infuzije?<\/strong><\/p>\n

Vnos zdravila v infuzijski obliki preko kanile, ki jo namestimo v podko\u017eje bolnika<\/p>\n

Indikacije<\/p>\n

– bolnik ni zmo\u017een zau\u017eiti zdravila<\/p>\n

zaradi:<\/p>\n

– slabosti<\/p>\n

– bruhanja<\/p>\n

– intestinalne obstrukcije<\/p>\n

– motenj pri po\u017eiranju<\/p>\n

– pri motnjah malabsorbcije<\/p>\n

– zdravljenju nevropatske bole\u010dine ( kjer terapija skozi usta ni u\u010dinkovita)<\/p>\n

Prednosti<\/p>\n

–\u00a0 stalna koncentracija zdravila v krvi (stalen dotok omogo\u010da stalno koncentracijo zdravila v krvi brez ve\u010djih nihanj in s tem manj str. u\u010dinkov v primerjavi z bolusno apliikacijo zdravil.)<\/p>\n

– izognemo se pogostemu zbadanju<\/p>\n

– omogo\u010da aplikacijo kombinacije ve\u010dih zdravil<\/p>\n

– omogo\u010da zdravljenje na domu<\/p>\n

– pove\u010da bolnikovo mobilnost, samostojnost in neodvisnost<\/p>\n

– zmanj\u0161a \u0161t. obiskov zdravstvenega osebja na domu<\/p>\n

– enostaven nadzor<\/p>\n

– u\u010dinkovita metoda odpravljanja in prepre\u010devanja dolo\u010denih simptomov<\/p>\n

Kontraindikacije<\/p>\n

– hude trombocitopenije, anasarka, bolnikovo zavra\u010danje metode<\/p>\n

<\/strong><\/p>\n

Plju\u010dni rak?<\/strong><\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Bolezen je najpogostej\u0161a: 45. – 70. letom.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010d kot 90% mo\u0161kih in 70% \u017eensk s plju\u010dnim rakom kadi.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Razvoj – po\u010dasen. \u0160tudije so pokazale, da lahko prete\u010de do 10 let od prvih sprememb celic respiratornega epitelija do razvoja rakavih celic.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Znaki in simptomi bolezni na za\u010detku nezna\u010dilni, 2\/3 pacientov s plju\u010dnim rakom pride k zdravniku prepozno.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ve\u010dina bolnikov ob odkritju bolezni znake in simptome posledica napredovale bolezni .<\/p>\n

<\/strong><\/p>\n

DEJAVNIKI TVEGANJA<\/strong><\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 KAJENJE<\/p>\n

– Kajenje ni le razvada, pa\u010d pa oblika odvisnosti.<\/p>\n

– Kadilci desetkrat pogosteje zbolijo kot nekadilci. Ve\u010d kot 90% mo\u0161kih in 70% \u017eensk s plju\u010dnim rakom kadi. Hudi kadilci, ki so pri\u010deli kaditi v zgodnji mladosti, pokadijo veliko cigaret dnevno in pri tem globoko vdihujejo cigaretni dim, umirajo za plju\u010dnim rakom do dvajset krat pogosteje kot nekadilci.<\/p>\n

– Pri ljudeh z dolgotrajno izpostavljenostjo kajenju – tveganje za razvoj plju\u010dnega raka pove\u010dano za 20-30 odstotkov. Zaradi pasivnega kajenja zboli veliko \u0161tevilo ljudi, predvsem \u017eensk. Nekadilke imajo 24% ve\u010dje tveganje, da bodo zbolele za plju\u010dnim rakom, \u010de \u017eivijo s kadilcem.<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 OSTALI DEJAVNIKI TVEGANJA<\/p>\n

– dru\u017einsko obremenjenost z 2 do 5 krat ve\u010djo pogostostjo<\/p>\n

– obstruktivno bolezen bronhijev s 4 krat ve\u010djo pogostostjo<\/p>\n

– izpostavljenost azbestu s 5 krat ve\u010djo pogostostjo<\/p>\n

– sevanje radona s 3 krat ve\u010djo pogostostjo<\/p>\n

– \u017ee preboleli rak dihal I ( pojav novega raka plju\u010d pri 1-3% pacientov letno)<\/p>\n

– radioaktivno sevanje iz kakr\u0161nega koli vira<\/p>\n

– nekoliko vi\u0161je tveganje predstavlja tudi onesna\u017een zrak v mestih<\/p>\n

SIMPTOMI, ZNAKI<\/strong><\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ka\u0161elj<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 huj\u0161anje<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 dispneja<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 bole\u010dina v prsnem ko\u0161u<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 hemoptize (krvav izpljunek)<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 bole\u010dine v kosteh<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 beti\u010dasti prsti<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 vro\u010dina<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 oslabelost<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 sindrom zg. votle vene<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 motnje po\u017eiranja<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 stridor<\/p>\n

<\/strong><\/p>\n

VRSTE<\/strong><\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Plo\u0161\u010datoceli\u010dni (epidermoidni) karcinom<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Drobnoceli\u010dni (mikrocelularni) karcinom<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u017dlezni rak (adenokarcinom )<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Velikoceli\u010dni (makrocelularni) karcinom<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Adenoskvamozni karcinom<\/p>\n

<\/strong><\/p>\n

Najpogostej\u0161i raki pri mo\u0161kem<\/strong><\/p>\n

Mo\u0161ki: plju\u010dni, prostata, ko\u017ea, \u0161iroko \u010drevo in danka<\/p>\n

ZN pacienta z obsevanjem prsnega ko\u0161a?<\/strong><\/p>\n

V prsnem ko\u0161u obsevamo plju\u010da, po\u017eiralnik, sapnik in bezgavke, ki le\u017eijo med obema plju\u010dnima kriloma. To obsevanje bolniki obi\u010dajno dobro prena\u0161ajo. Upo\u0161tevati morajo splo\u0161na navodila glede nege ko\u017ee, glede prehrane<\/p>\n

(ne smejo u\u017eivati vro\u010de in za\u010dinjene hrane, piti morajo \u010dim ve\u010d bogato kalori\u010dnih teko\u010din) in glede kajenja (odsvetujemo kajenje, ker dra\u017ei sapnik oziroma plju\u010da). Kako izrazite so reakcije organizma na obsevanje, je<\/p>\n

odvisno od raz\u0161irjenosti bolezni, psihofizi\u010dne kondicije bolnika in od radikalnosti obsevanja. Pomen obsevanja raka plju\u010d je predvsem v olaj\u0161anju bolnikovih te\u017eav.<\/p>\n

<\/p>\n

Te\u017eave, ki lahko nastopijo so splo\u0161ne:<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 slabo po\u010dutje, utrujenost, navsea, izguba apetita, nerazpolo\u017eenje, nespe\u010dnost (obsevalni ma\u010dek)<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 padec odpornosti zaradi supresije kostnega mozga (padec levkocitov, trombocitov, anemije)<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 lokalne:<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 radioezofagitis (bole\u010dina med po\u017eiranjem, peko\u010da bole\u010dina za prsnico in v \u017erelu)<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 iradiacijski pnevmonitis (te\u017eko dihanje, dra\u017ee\u010d ka\u0161elj, zvi\u0161ana temperatura, ti\u0161\u010danje\u00a0 za prsnico)<\/p>\n

Negovalne diagnoze pri obsevanju prsnega ko\u0161a<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 po\u0161kodba sluznice po\u017eiralnika zaradi obsevanja<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 zvi\u0161ana mo\u017enost infekcije zaradi supresije kostnega mozga in slab\u0161e prehranjenosti organizma<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 neu\u010dinkovito dihanje zaradi radio-pnevmonitisa in\/ali fibroze plju\u010d<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 prestra\u0161enost in tesnoba zardi ob\u010dutka pomanjkanja zraka<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 moteno spanje in po\u010ditek zaradi dra\u017ee\u010dega ka\u0161lja in bole\u010dine v prsih<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 zaskrbljenost v zvezi z boleznijo<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 utrujenost zaradi neu\u010dinkovitega dihanja ob fizi\u010dni aktivnosti<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 motnje po\u010ditka in spanja zaradi bole\u010dine in ka\u0161lja<\/p>\n

\u2022\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 zmanj\u0161ana sposobnost gibanja in samooskrbe zaradi splo\u0161ne prizadetosti<\/p>\n

Na\u0161tej oblike sistemskega zdravljenja raka + lokalno zdravljenje?<\/strong><\/p>\n

Sistemsko zdravljenje<\/strong> je usmerjeno predvsem v prepre\u010devanje\u00a0 delitve rakastih celic, prepre\u010devanje njihovega prodiranje v druga tkiva in metastaziranje.<\/p>\n

Primerno zdravilo za sistemsko zdravljenje =\u00a0 u\u010dinkovina, ki kar najbolj zavira delitev rakastih celic, a le minimalno vpliva na zdrave celice.<\/p>\n

Preoperativno (neoadjuvantno) sistemsko zdravljenje<\/strong><\/p>\n

Namen je zmanj\u0161ati tumor in omogo\u010diti \u010dim manj\u0161i kirur\u0161ki poseg in bolj\u0161o kvaliteto \u017eivljenja, ob enakih mo\u017enostih ozdravitve.<\/p>\n

Pri preoperativni ST moramo biti pozorni, \u010de se tumor ob th. ne manj\u0161a ali celo raste, v tem primeru moramo takoj uporabiti radikalno kirur\u0161ko zdravljenje.<\/p>\n

Dopolnilno (adjuvantno) sistemsko zdravljenje<\/strong><\/p>\n

Po radikalni kirur\u0161ki odstranitvi prvotnega tumorja. Namen je delovati na nevidne mikrozasevke in tako pove\u010dati mo\u017enosti ozdravitve.<\/p>\n

Zdravljenje napredujo\u010de bolezni<\/strong><\/p>\n

Pogosto kombinirano z obsevanjem, v\u010dasih tudi kirur\u0161ko odstranitvijo posameznih tumorskih mas, ki bolniku povzro\u010dajo huj\u0161e te\u017eave.<\/p>\n

Velikokrat edini na\u010din zdravljenja napredovale bolezni (levkemije, visoko maligni limfomi, Hodkinova bolezen, germinalni tumorji\u2026), lahko ozdravi ve\u010d kot 2\/3 teh bolnikov.<\/p>\n

ZDRAVLJENJE RAKA Z RADIOTERAPIJO<\/strong><\/p>\n

Radioterapija opredeljuje razli\u010dne na\u010dine zdravljenja, pri katerih uporabljamo ionizirajo\u010de sevanje.<\/p>\n

Osnovni odkritji, ki sta omogo\u010dili uporabo ionizirajo\u010dega sevanja v medicini sta odkritji: rentgenskih \u017earkov (X \u017earki) leta 1896 in odkritje naravnega sevanja (\u017earki alfa, beta in gama) leta 1897 \u2192 velik napredek v diagnostiki in zdravljenju uporablja za lokalno zdravljenje.<\/p>\n

Stopnje stomatitisa in rizi\u010dni dejavniki?<\/strong><\/p>\n

Stopnja 1 \u2013 rahla rde\u010dina in oteklina ustne sluznice, bolnik \u010duti rahlo peko\u010do bole\u010dino, ima ob\u010dutek nelagodja<\/p>\n

Stopnja 2 – rde\u010dina in oteklina s posameznimi razjedami sluznice, bolnik \u010duti peko\u010do bole\u010dino, ima te\u017eave pri \u017eve\u010denju in po\u017eiranju hrane, rizi\u010dni dejavniki, ki lahko vplivajo na intenzivnost pojava stomatitisa<\/p>\n

Stopnja 3 – huda rde\u010dina z oteklino, z obse\u017enimi razjedami, ki zajemajo do 50% ustne sluznice, bolnik ima hude bole\u010dine, ne more \u017eve\u010diti, po\u017eiranje je mo\u010dno ote\u017eko\u010deno, s te\u017eavo govori<\/p>\n

Stopnja 4 – huda rde\u010dina z oteklino, z obse\u017enimi globokimi, krvave\u010dimi razjedami, ki zajemajo ve\u010d kot 50% ustne sluznice, bolnik ima zelo hude bole\u010dine, ne more se hraniti, ne more govoriti<\/p>\n

Dejavniki vezani na na\u010din zdravljenja in lokalizacije bolezni (vrsta in odmerek citostatika, nevtropenija, prisotnost rakave bolezni v sami sluznici, lokalno radioterapevtsko zdravljenje \u2013 sluznica v obsevalnem polju, drugo sistemsko zdravljenje \u2013 steroidi.<\/p>\n

Dejavniki vezani na \u017eivljenjski stil (neustrezna ustna higiena, nezadostno u\u017eivanje teko\u010din, neurejeno zobovje, uporaba kemi\u010dnih iritantov \u2013 alkohol, tobak, ustne vode, uporaba fizi\u010dnih iritantov \u2013 vro\u010da, groba in mo\u010dno za\u010dinjena hrana.<\/p>\n","protected":false},"excerpt":{"rendered":"

Zna\u010dilnosti maligne bolezni? a)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ozdravljiva b)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kroni\u010dna bolezen c)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Invazivnost (Tumor vra\u0161\u010da v sosednje organe, tkiva, jih uni\u010duje in nadome\u0161\u010da s svojo rastjo. Meje malignega tu so neostre, nepravilne, kar je potrebno upo\u0161tevati pri kirur\u0161ki odstranitvi tumorja. Zaradi nepopolno odstranjenega tu lahko pride do nastanka novega tumorja \/ recidiva.) d)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sistemska bolezen e)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Nebole\u010d:\u00a0 sam … Preberi ve\u010d o ZN onkolo\u0161kega bolnika zadnji izpit<\/span><\/a><\/p>\n","protected":false},"author":336,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1284],"tags":[1310,1309,3675,1308],"class_list":["post-1152","post","type-post","status-publish","format-standard","hentry","category-3-letnik-zdravstvena-nega-onkoloskega-bolnika-z-onkologijo-in-s-paliativno-oskrbo","tag-izpit-zdravstvena-nega-onkoloskega-bolnika","tag-zdravstvena-nega-onkoloskega-bolnika","tag-3-letnik-zdravstvena-nega-onkoloskega-bolnika-z-onkologijo-in-s-paliativno-oskrbo","tag-zn-onkoloskega-bolnika"],"_links":{"self":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/1152","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/users\/336"}],"replies":[{"embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/comments?post=1152"}],"version-history":[{"count":0,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/posts\/1152\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/media?parent=1152"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/categories?post=1152"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.zdravstvena.info\/vsznj\/wp-json\/wp\/v2\/tags?post=1152"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}