238
Unit 3
Applying concepts from the nursing process
have on quality of life. Providing the patient and family with
opportunities to discuss these issues is imperative. The needs
of the individual must be accurately assessed and validated in
each situation for any type of reconstructive surgery.
Nursing management in cancer surgery
Patients undergoing surgery for cancer require general peri
operative nursing care, as described in Unit 4, along with
specific care related to the patient’s age, organ impair-
ment, nutritional deficits, disorders of coagulation and altered
immunity that may increase the risk for postoperative com-
plications. Combining other treatment methods, such as
radiation and chemotherapy, with surgery also contributes
to postoperative complications, such as infection, impaired
wound healing, altered pulmonary or renal function, and the
development of deep vein thrombosis. In these situations, the
nurse completes a thorough preoperative assessment for all
factors that may affect patients undergoing surgical procedures.
The patient undergoing surgery for the diagnosis or treat-
ment of cancer is often anxious about the surgical procedure,
possible findings, postoperative limitations, changes in normal
body functions and prognosis. The patient and family require
time and assistance to deal with the possible changes and
outcomes resulting from the surgery.
The nurse provides education and emotional support by
assessing patient and family needs and exploring with the
patient and family their fears and coping mechanisms, encour-
aging them to take an active role in decision making when
possible. When the patient or family asks about the results of
diagnostic testing and surgical procedures, the nurse’s response
is guided by the information the doctor previously conveyed to
them. The patient and family may also ask the nurse to explain
and clarify information that the doctor initially provided but
that they did not grasp because they were anxious at the time.
It is important for the nurse to communicate frequently with
the doctor and other healthcare team members to be certain
that the information provided is consistent.
After surgery, the nurse assesses the patient’s responses
to the surgery and monitors for possible complications such
as infection, bleeding, thrombophlebitis, wound dehiscence,
fluid and electrolyte imbalance, and organ dysfunction. The
nurse also provides for patient comfort. Postoperative teaching
addresses wound care, activity, nutrition and medication
information.
Plans for discharge, follow-up and home care, and treat-
ment are initiated as early as possible to ensure continuity of
care from hospital to home or from a cancer referral centre to
the patient’s local hospital and healthcare provider. Patients
and families are also encouraged to use community resources
such as the Australian Cancer Council and the New Zealand
Cancer Society and local support groups.
Radiation therapy
In
radiation therapy
, ionising radiation is used to interrupt
cellular growth. More than half of patients with cancer receive
a form of radiation therapy at some point during treatment.
Radiation may be used to cure the cancer, as in Hodgkin’s
disease, testicular seminomas, thyroid carcinomas, localised
cancers of the head and neck, and cancers of the uterine
cervix. Radiation therapy may also be used to control malig-
nant disease when a tumour cannot be removed surgically
or when local nodal metastasis is present, or it can be used
for prophylactic surgical procedures. For example, a strong
family history of breast cancer, positive
BRCA-1
or
BRCA-2
findings, an abnormal physical finding on breast examination
such as progressive nodularity and cystic disease, a proven
history of breast cancer in the opposite breast, abnormal mam-
mography findings and abnormal biopsy results may be factors
considered in making the decision to proceed with a prophy
lactic mastectomy (Calhourn & Anderson, 2006).
Prophylactic surgery is offered selectively to patients and
discussed thoroughly with the patient and family because
the long-term physiological and psychological effects are
unknown. Preoperative teaching and counselling, as well as
long-term follow-up, are provided.
Palliative surgery
When cure is not possible, the goals of treatment are to make
the patient as comfortable as possible and to promote a satis-
fying and productive life for as long as possible. Whether the
period is extremely brief or lengthy, the major goal is a high
quality of life—with quality defined by the patient and family.
Honest and informative communication with the patient and
family about the goal of surgery is essential to avoid false hope
and disappointment.
Palliative surgery is performed in an attempt to relieve
complications of cancer, such as ulcerations, obstructions,
haemorrhage, pain and malignant effusions. It may include
the insertion of central venous access devices, feeding tubes,
stabilisation of bones, stenting and bypassing procedures, or
tumour debulking (Table 11-6).
Reconstructive surgery
Reconstructive surgery may follow curative or radical surgery
and is carried out in an attempt to improve function or
obtain a more desirable cosmetic effect. It may be performed
in one operation or in stages. Patients are informed about
possible reconstructive surgical options before the primary
surgery by the surgeon who will perform the reconstruction.
Reconstructive surgery may be indicated for breast, head and
neck, and skin cancers.
The nurse must recognise the patient’s needs and the
impact that altered functioning and altered body image may
Table 11-6 Indications for Palliative
Surgical Procedures
Procedure
Indications
Pleural drainage tube placement
Pleural effusion
Peritoneal drainage tube placement
Ascites
(Tenckoff catheter)
Abdominal shunt placement
Ascites
(Levine shunt)
Pericardial drainage tube placement
Pericardial effusion
Colostomy or ileostomy
Bowel obstruction
Gastrostomy, jejunostomy tube
Upper gastrointestinal
placement
tract obstruction
Biliary stent placement
Biliary obstruction
Ureteral stent placement
Ureteral obstruction
Nerve block
Pain
Cordotomy
Pain
Venous access device placement (for
Pain
administering parenteral analgesics)
Epidural catheter placement (for
Pain
administering epidural analgesics)
Hormone manipulation (removal of
Tumours that depend on
ovaries, testes, adrenals, pituitary)
hormones for growth
