Breast cancer in the clinical diagnosis, many patients have been in the presence of a small number of metastatic lesions, surgery can easily lead to the spread of tumor cells, so pure surgical treatment has been unable to completely achieve the purpose of breast cancer, chemotherapy is an important part of the comprehensive treatment of breast cancer. In the chemical drugs to kill tumor cells at the same time, its normal body tissues also have damage, there have been a series of clinical symptoms, that is, chemotherapy adverse reactions.
Breast cancer patients during chemotherapy to give them high quality care, can reduce the adverse reactions of chemotherapy, to ensure the effectiveness of treatment, but also to improve the quality of life of patients.
1 materials and methods
1.1 general information
Randomly selected 128 cases of 2010-06-2011-06 months in the First Affiliated Hospital of Bengbu Medical College for breast cancer modified radical mastectomy or radical mastectomy, 64 cases were randomly divided into experimental group and control group of 64 cases, the experimental group were treated with routine nursing intervention, the control group was treated with routine nursing.
Two patients were alive without spouse, depression, anxiety and other mental illness. There was no significant difference in age, culture, disease and treatment between the two groups (P>0.05).
1.2 method
1.2.1 determination method
Using "Chinese cancer patients quality of life (QOL) questionnaire" (Chinese Academy of Medical Sciences, Sun Yan, Professor of Medical Science in 1990), involving 12 indicators of physical function, mental activity and social activities. Each indicator is equipped with 5 scores, all "1" points that patients with the worst condition, all of the "5" points that patients with functional and state best, to inform patients to choose the most appropriate answer, the index score and the total score of [1].
1.2.2 life quality classification standard of QOL score of 60 points, is divided into five grades: score < 20 divided into range; score 21-30 is poor; score of 31 to 40 divided into general; score of 41 points, better; score greater than or equal to 51 points as well.
1.3 nursing intervention
1.3.1 before chemotherapy nursing intervention
To evaluate the physiological and psychological status of patients, and to understand the history of each case, living habits, to take positive individual nursing. In front of the patients treated with primary chemotherapy, with its talk exchanges, in the exchange to have a preliminary understanding and the understanding of breast cancer. After the recognition of patients with postoperative chemotherapy is necessary, and then focus on the common adverse reactions and chemotherapy in the treatment of attention, reduce the patient's psychological negative effects caused by the stress, and the clinical effect of the treatment of patients with mild clinical efficacy of good. Do psychological counseling, to improve the treatment of confidence, reduce the patient's tension and fear of chemotherapy, so that it is willing to accept and actively cooperate with chemotherapy [2].
Nursing intervention in the treatment of patients with breast cancer after breast cancer patients with upper limb lymph node dissection led to the upper limb of the patients with lymph edema, venous return is slower, so the side of the side of the vein puncture chemotherapy, but also because of venous sinus, blood flow velocity and lower limb vein blood vessels are generally not the first choice for the treatment of breast cancer. To ensure the success rate of venous access trocar first puncture, fixing method reasonable properly, tissue necrosis, pain, infection and other complications caused by chemotherapeutic drugs extravasation injury puncture point in the vicinity of the soft tissue can be avoided. It is emphasized that the protection of the upper limb vein blood vessels can be placed in the PICC, and it can relieve the injury of venous blood vessel. Observation and nursing intervention of adverse reaction of II: chemotherapy infusion of the drug to be more inspection, drug use sequence, timely adjustment of infusion rate, close observation of patients with adverse reactions of chemotherapy, timely and relevant nursing intervention, such as nausea and vomiting is a common chemotherapy adverse reactions, patients were encouraged to eat much food less, eat easy digest, the delicate, high calorie, high fiber diet, patients were encouraged to drink as much as possible, in order to promote the metabolism of chemotherapeutic drugs, reduce the toxic and side effects, for chemotherapy in gastrointestinal tract reaction in heavier patients can be in before chemotherapy given intramuscular injection of gastric metoclopramide 10 mg, in order to reduce the gastrointestinal tract reaction. Third, drug leakage and phlebitis nursing intervention: if you find extravasation of chemotherapeutic drugs, infusion is stopped in time, around the injection site play closed, can relieve the pain of chemotherapy drugs on local tissue and nerve damage caused by, and can prevent due to vasospasm or damage caused by local tissue necrosis, and if there is any phlebitis, stop drug instantly, local hot compress, magnesium sulfate wet compress or physiotherapy, massage point of puncture side upper limb vascular gently guiding patients after chemotherapy, increase local blood circulation and improve blood vessel elasticity. Nursing intervention of bone marrow suppression: chemotherapy drugs more or less can inhibit bone marrow hematopoietic, especially the white blood cell reduction of the most common, combination in effect increases, inhibition of bone marrow hematopoietic are also more obvious, bone marrow suppression cause leucocyte reduce greatly, which enable patients and severe infection. Close observation of bone marrow suppression to signs, blood routine, chemotherapy weekly check blood picture 2~3 before chemotherapy. White blood cells less than 3 x 109/L should stop chemotherapy, give rise to the drug and increase the intake of nutrients, do a good job disinfection and isolation, strict aseptic operation, to avoid external infection, monitoring body temperature changes. White blood cells are less than 2 x 109/L, which need to be transferred to the intensive care unit for the treatment of isolation. Daily inspection notice were due to thrombocytopenia caused by petechia and ecchymosis, gingival bleeding epistaxis and other coagulation function abnormal phenomenon. Maintain indoor humidity and temperature, on the one hand to the patient with a comfortable environment, so that it has a good mood. On the one hand, the patient's nasal mucosa, mouth to keep moist, reduce the bleeding caused by drying, mucosal damage, infection, etc.. Nursing intervention of the hair loss: chemotherapy drugs on hair follicle damage, before the start of chemotherapy inform patients and their families. During chemotherapy can be shaved by a wig until after the end of chemotherapy hair back to normal again, to eliminate the unnecessary worries.
Nursing intervention after 1.3.3 chemotherapy
Health education for life: inform the note after discharge, light diet, avoid spicy, greasy, tea, coffee and other irritating food, eat more fresh vegetables, fruit. Using a soft bristle toothbrush, avoid gingival mucosa bleeding, try to avoid upper limb lifting weights, strengthen suffering from moderate side upper limb functional exercise. To reduce the chance of going out in the first half of the chemotherapy, to avoid the activities of public places and reduce the risk of infection.
Mental health education: to maintain a positive, optimistic attitude. Professor Yi's method of wearing the breast, reduce the psychological burden caused by lack of breast. Create a good family atmosphere, to make patients feel relatives to take care of and derive a strong spiritual support, to establish the confidence to overcome the disease.
1.4 statistical methods
Using SPSS 11 software for statistical analysis, t test, P<0.05 for the difference was significant.
2 Results
In two groups of patients with postoperative chemotherapy, according to the above methods and principles, close observation, careful nursing and timely treatment, the two groups of patients before and after chemotherapy, the quality of life of the QOL influence is seen in Table 1
3 discussion
Breast cancer is a common cancer in women, with the popularization of health examination, most breast cancer found earlier, due to the implementation of the concept of comprehensive treatment of tumor, the more ideal, the 5 year survival rate is higher. Surgical treatment of breast cancer in the first place, postoperative chemotherapy more and more attention. But the chemotherapy process is longer, there are many adverse reactions, some adverse reactions may eventually cause the patient can not continue treatment, resulting in a low mood, the patient can also have a negative effect on the patient's immune system, which affects the overall prognosis of patients. Strengthen basic care for patients, to do a good job of psychological care is particularly important. The survey found that there was a more significant impact on the quality of life of patients with different nursing interventions, the value of [5-6]. chemotherapy before and after the intervention, the value of [7] chemotherapy, the care intervention can reduce the patient's fear and psychological pressure, enhance the patient's fear and psychological pressure, enhance the treatment confidence, and enhance the treatment confidence, so as to better cooperate with the doctor to develop chemotherapy regimen; chemotherapy; chemotherapy; nursing intervention, not only reduce the body discomfort and influence, but also help patients. Establish confidence in life, better adjust the patient's physiological and mental state, and lay a good foundation for patients to receive a new round of chemotherapy.
Reference
[1] Sun Yan, Luo Jian, Zhou Sheng yu. China cancer patients with chemical biological treatment quality of life table of the preparation of [J]. Chinese Journal of cancer, 199719 (6): 437-440.
[2] Luo Yuqiao, Wang Chunyan, Li Zhenglian. Investigation of postoperative psychological problems in patients with breast cancer and nursing care of [J]. Chinese medicine, 2009,7 (1): 61-62.
[3] Zheng Dongmei, Zheng Xueqing. The clinical nursing of in the treatment of advanced breast cancer with [J]. Chinese medicine, 2011,9 (4): 648-649.