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Submitted By DarjaKosak3
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6. zdravstvena nega žensk z obolenjem dojk

1. Uvod

- CA DOJKE JE DRUGI NAJPOGOSTEJšI VZROK SMRTI ZARADI RAKA - JE NAJPOGOSTEJšI MED »GINEKOLOšKIMI RAKI« - ZGODNJE ODKRIVANJE JE IZJEMNEGA POMENA ZA OHRANITEV žIVLJENJA

- ZGRADBA DOJKE (INFORMATIVNO IN OSVEžITEV ZNANJA; PARNA žLEZA, TUBULARNO-ALVEOLARNA ZGRADBA, REžNJI, ACINUSI, MLEKOVOD- DUKTUS LACTIFERUS, AREOLA MAMMAE,…)

- RAZVOJ DOJKE - POSAMEZNA žIVLJENJSKA OBDOBJA- SPREMEMBA VELIKOSTI IN OBLIKE : - EMBRIONALNA ZASNOVA- MLEčNA GUBA, MLEčNI VOZLIčI - PET PUBERTETNIH STADIJEV V RAZVOJU DOJKE, - SPREMEMBE V čASU NOSEčNOSTI, - SPREMEMBE V OBDOBJU DOJENJA, - SPREMEMBE V PO-MENOPAVZALNEM OBDOBJU.

2. NEPRAVILNOSTI IN BOLEZNI DOJK
6.2.1 RAZVOJNE NEPRAVILNOSTI - AMASTIA - ODSOTNOST DOJKE - ATHELIO - ODSOTNOST BRADAVICE - POLYMASTIA – NADšTEVILNE DOJKE - POLYTHELIO – NADšTEVILNE BRADAVICE - MIKROMASTIA – MAJHNE OZ. PREMAJHNE DOJKE - MAKROMASTIA – PREVELIKE DOJKE

6.2.2 POšKODBE DOJK - TRAVMATSKA MAščOBNA NEKROZA - HEMATOM

6.2.3 NAZADUJOČI PROCESI DOJK - ATROFIJA

6.2.4 VNETJA DOJK - GLEDE NA POTEK: AKUTNO, SUBAKUTNO, KRONIčNO - GLEDE NA LOKACIJO: THELITIS, MASTITIS,.. - GLEDE NA POT OKUžBE: EKSOGENO, ENDOGENO

6.2.5 NAPREDUJOčI PROCESI
- FIBROCISTIčNA BOLEZEN
- TUMORJI DOJKE: - BENIGNI (FIBROADENOMI, LIPOMI, MIOMI, HONDROMI,..)

- MALIGNI – CA DOJKE

3. EPIDEMIOLOGIJA CA DOJK - RAZLIKE MED RAZVITIM IN NERAZVITIMI DEžELAMI, ETNIčNI FAKTOR JE POMEMBEN - POGOSTOST V SLOVENIJI (CCA 21% VSEH RAKOV PRI žENSKAH) - INCIDENCA NARAščA PO 35. LETU, NAJVEčJA INCIDENCA JE PRI STAROSTI 60- 65 LET

4. RIZIčNI DEJAVNIKI ZA CA DOJKE - DEDNA OBREMENJENOST - REPRODUKTIVNA ZGODOVINA - ZGODNJA MENARHA (11LET) - KASNA MENOPAVZA (PO 55.LETU) - NULIPARNOST - KASNORODNOST - šT.PORODOV NIMA VPLIVA - STAROST - BENIGNA PROLIFERATIVNA BOLEZEN DOJK - UPORABA ORALNIH KONTRACEPTIVOV (NASPROTUJOčA MNENJA) - PREKOMERNA TELESNA TEžA (VEč KOT 40% NAD IDEALNO) - DEJAVNIKI ZA OSTALE RAKE - KAJENJE - IZPOSTAVLJENOST SEVANJU - UžIVANJE ALKOHOLA

5. šTADIJI CA DOJK IN PREžIVETJE IZHODIščE ZA PRIMERJAVO JE TNM KLASIFIKACIJA: T- VELIKOST TUMORJA,RAZšIRITEV (T0, T1, T2, T3, T4 ) N- PRIZADETOST REGIONALNIH BEZGAVK (N0, N1, N2, N3, N4) M- PRISOTNOST/ODSOTNOST ODDALJENE METASTAZE (M0, M1)

STOPNJA | T | N | M |5-LETNO PREŽIVETJE | | I. |MANJ KOT 2 CM | N0 | M0 | 80 - 90 % | | II. |2 – 5 CM | N0 ALI + | M0 | 40 – 50 % | | III. |VEč KOT 5 CM, INVAZIJA | N +
V KLAVIK.P | M0 | DO 10% | | IV. |KATEREKOLI VELIKOSTI | N + ALI N0 | M1 | 0% | | Opažen in situ (intraepitelijski) je preživetje več kot 95% .

6.6 ZNAKI CA DOJK IN ODKRIVANJE
6.6.1 ZNAKI - ZGODNJI :- ZATRDLINA (NEBOLEčA OSTRO OMEJENA, NAJVEčKRAT V ZGORNJEM KVADRANTU DOJKE); - IZCEDEK IZ BRADAVICE (SPONTAN, KRVAVKAST); - RDEčINA (SINDROM POMARANčNE LUPINE); - TRDOVRATNI EKCEM BRADAVICE

- POZNI: - UGREZNINA KOžE; - UGREZNJENA BRADAVICA; - POVEčANE BEZGAVKE ( V PAZDUHI IN SUPRACL. L., LIMFOGENI RAZSOJ)

1. NAJPOGOSTEJŠA LOKALIZACIJA
LATERALNO MEDIALNO
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POZNANE DIAGNOSTIčNE METODE
NOBENA DIAGNOSTIčNA METODA NI 100%, UPORABLJA SE KOMBINACIJA VEč DIAGN. METOD.

LE 10% VSEH ODKRITIH RAKOV JE V ZGODNJI FAZI.

ČIMBOLJ ZGODAJ ODKRITI RAKA !

- SAMOPREGLEDOVANJE
(NATANčEN OPIS, VIDEO, SKICE, MODELI-DEMONSTRACIJA,VAJA)
DOJKE SI JE POTREBNO PREGLEDATI 1X MESEčNO; V RODNEM OBDOBJU MED 10-16 DNEM MENSTRUALNGA CIKLUSA, OSTALE PA KADARKOLI.
ZNAčILNOSTI METODE: - JE NAJCENEJšA MED VSEMI - PREPROSTA - DOSTOPNA VSAK TRENUTEK - NEINVAZIVNA - NEšKODLJIVA
ŽENSKE SI NE PREGLEDUJEJO DOJK V ZADOSTNI MERI KER: - SE NE ZNAJO SAMOPREGLEDOVATI; - NE ZAUPAJO SVOJIM ROKAM; - SO ZDRAVSTVENO NEVZGOJENE; - JIH JE STRAH PRED »ZATIPANJEM«; - MISLIJO , DA SO PREMLADE;

POLOžAJI PRI SAMOPREGLEDOVANJU:
- PRED OGLEDALOM : A) OPAZOVANJE OBLIKE, VELIKOSTI, POLOžAJA, SPREMEMB NA KOžI IN BRADAVICI, IZCEDKA, GIBANJA DOJK B) TIPANJE NEžNO V SMERI URINEGA KAZALCA KROžNO DRSI S PRSTI PO DOJKI

- LEžEčI POLOžAJ : A) PODLOžI SI RAME NA STRANI KJER TIPA DOJKO B) V MISLIH RAZDELI DOJKO NA 4 KVADRANTE C) TIPA NAJPREJ ZGORNJI NOTRANJI KVADRANT OD VIDEO PRSNICE PROTI BRADAVICI, NADALJUJE S SPODNJIM NOTRANJIM,SPODNJIM ZUNANJIM IN ZAKLJUčI Z ZGORNJIM ZUNANJIM.

SAMOPREGLED ZAKLJUčI, KO OTIPLJE PODROčNE BEZGAVKE- VRATNE, NAD IN PODKLJUčNIčNE IN PAZDUšNE)

ISTO PONOVI NA DRUGI DOJKI

- POD TUšEM: PRINCIP JE ISTI KOT V LEžEčEM POLOžAJU. PRIPOROčA SE PREGLED Z NAMILJENIMI ROKAMI.

MODELI-PRIKAZ

- ANAMNEZA
- UGOTOVITI ALI IMA žENSKA RIZIčNE DEJAVNIKE ZA NASTANEK RAKA DOJKE
- VKLJUčEVANJE SIMPTOMOV, KI SO ZNAčILNI ZA BOLEZEN

- KLINIČNI PREGLED
- JE NAJBOLJ OSNOVNA METODA (OB VSAKEM GINEKOLOšKEM PREGLEDU!)
- POSTOPEK JE PODOBEN KOT PRI SAMOPREGLEDU.
- POMEMBNO JE, DA JE ZAGOTOVLJEN NATANčEN PREGLED DOJK IN REGIONALNIH BEZGAVK NEODVISNO OD UPORABLJENE TEHNIKE

- MAMOGRAFIJA
- RENTGENSKO SLIKANJE DOJK PRI NAVIDEZNO ZDRAVIH žENSKAH
- OSNOVNI MAMOGRAM ( PRED 50.LETOM, )
- POGOSTOST MAMORAFIJ (žENSKE Z DEJAVNIKI TVEGANJA, OSTALE)
- ODKRIJE TUMOR VELIKOSTI ½ CM

- GALAKTOGRAFIJA
- RENTGENSKO SLIKANJE, MLEčNA IZVODILA NAPOLNIJO S KONTRAST.

- BIOPSIJA
- ASPIRACIJSKA (CITOLOGIJA, HISTOLOGIJA)
- EKSCIZIJSKA

- TERMOGRAFIJA
VNETNO TKIVO JE DOBRO PREKRVLJENO IN TOPLEJšE OD OKOLNEGA.
SE OPUščA, MAJHNA ZANESLJIVOST.

- ULTRAZVOK
- DOPOLNILNA METODA KLINIčNEMU PREGLEDU IN MAMOGRAFIJI
- NE ODKRIJE ZGODNJIH STADIJEV,UPORABEN ZA DOLOčITEV STADIJA

- MAGNETNA RESONANCA
- SODOBNA METODA, NI IZPOSTAVLJENOSTI SEVANJU,
- DRAGA, DOLGOTRAJAJOčA PREISKAVA,
- LOčI FIBROZE OD CA,
- NAJVEč SE UPORABLJA PRI BOLNICAH PO OP, KI IMAJO OHRANJENO DOJKO
- PRIčAKUJE SE RAZVOJ TE TEHNIKE V SMISLU LOčEVANJA BENIGNIH OD MALIGNIH TUMORJEV DOJKE

6. ZDRAVLJENJE IN REHABILITACIJA
ODVISNO JE OD RAZšIRJENOSTI BOLEZNI. - NAčINI ZDRAVLJENAJA - KIRURšKO – MASTEKTOMIJA, LUMPEKTOMIJA - Z OBSEVANJEM (RADIOTERAPIJA) - S CITOSTATIKI (KEMOTERAPIJA) - S HORMONI - Z MODULATORJI IMUNSKEGA SISTEMA (IMUNOTER.)
OBIčAJNO JE ZDRAVLJENJE KOMBINIRANO.

- REHABILITACIJA (KOT SESTAVNI DEL ZDRAVLJENJA) - REKONSTRUKCJIA DOJKE – IZBOLJšATI KVALITETO žIVLJENJA (NAčINI REKONSTRUKCIJE) - LOGOTERAPIJA (SE UPORABLJA V SKUPINAH ZA SAMOPOMOč, POT K OKREVANJU) - VKLJUčEVANJE PROSTOVOLJK (DRUšTVO ONKOLOšKIH BOLNIKOV SLOVENIJE)

EUROPA DONNA - EVROPSKA ZVEZA (1992) ZA BOJ PROTI RAKU - SLOVENSKO NACIONALNO ZDRUžENJE (1997)

DESET CILJEV: -

Florentinska izjava (1998 v Firencah) 1.konferenca, kjer so sodelovali strokovnjaki in znanstveniki s predstavnicami žensk. Sprejeli so sklepe znane pod imenom Florence statement- Florentinska izjava.

[pic]

državni program dora
- program presejanja za raka dojk (Onkološki inštitut, Ministrstvo za zdravje, Zavod za zdravstveno zavarovanje)
- Vabijo ženske med 45 in 69 letom starosti na RTG dojke.

6.8. AKTIVNOSTI MEDICINSKE SETRE: - POGOSTI NEGOVALNI PROBLEMI - nezmožnost zadovoljevanja pos. Ž.A - spremenjena samopodoba, zaradi odstranitve dojke, - pomanjkanje samooskrbe zaradi delne imobilnosti zgornje okončine, - občutek neudobja zaradi bolečine, preiskovalnih postopkov, - možnost seksualne disfunkcije zaradi izgube dela telesa in partnerjevo reakcijo na to izgubo - strah pred diagnozo,…

- NEGOVALNE INTERVENCIJE - pomoč pri izvajanju življenjskih aktivnost (izhod. Teoretični model V. Henderson , R-L-T, in D. Orem) - psihična podpora ženskam z Ca dojke

- POMEMBNA NAVODILA BOLNICAM - TEžKIH BREMEN NAJ NE NOSIJO IN NE DVIGUJEJO - PRIPOROčLJIVO JE OB VRNITVI DOMOV OPRAVLJATI OBIčAJNA VSAKODNEVNA OPRAVILA VENDAR JE POTREBNA PREVIDNOST (ZAščITNE ROKAVICE ZA DELO NA VRTU, NAPRSTNIK PRI šIVANJU, ZAščITA PRED PIKI INSEKTOV, - POTREBNO SI JE ORGANIZIRATI POčITEK - PRIMERNOST BIVANJA V TOPLICAH - SAMO-PREGLEDOVANJE DRUGE DOJKE - SKRBETI ZA SVOJO ZUNANJOST - NE REZATI KOžICE NA NOHTIH - PAZLJIVO OSKRBETI OPEKLINE, ODRGNINE - KOžO NA OPERIRANEM DELU JE POTREBO VAROVATI PRED DRAžENJEM, PRETIRANIM SONčENJEM, MASAžO - ODVZEM KRVI IN APLIKACIJA TERAPIJE NAJ BO (čE JE LE MOžNO) NA NEPRIZADETI ROKI, PRAV TAKO MERJENJE RR - IZOGIBATI SE TESNIH PASOV, ZAPESTNIC, ROčNIH UR IPD. - PAZITI NA TELESNO TEžO

-----------------------
- Ugotavljanje psihosocialnega stanja bolnic mora biti sestavni del zdravljenja vseh bolnic, ne le tistih, ki so vključene v klinične raziskovalne študije.
- Vsi, ki skrbijo za organizacijo in financiranje zdravljenja raka dojk morajo vsem bolnicam zagotoviti zdravljenje v ustrezno opremljenih centrih z multidisciplinarno in multi profesionalno obravnavo.
- Kakovost zdravljenja odločilno poteka na potek bolezni, zato morajo programi za ugotavljanje kakovosti dela postati obvezni.
- Klinične študije so potrebne, zato naj bo vanje vključenih čim več bolnic. Vse bolnice morajo biti podrobno poučene o namenih študij.
- Raziskavam o raku dojk je potrebno nameniti več sredstev.
- Genetski testi se naj opravljajo le v okviru kliničnih raziskav.

-

1. Pospeševati širjenje in izmenjavo informacij o raku dojke povsod po Evropi. 2. Krepiti zavedanje o obolenju dojk. 3. Poudarjati potrebo o ustreznem pregledovanju dojk in zgodnjem odkrivanju bolezni. 4. Propagirati dostopnost optimalnega zdravljenja za vse bolnice. 5. Zagotoviti dostopnost kakovostne celostne oskrbe med zdravljenjem in po njem. 6. Zagovarjati ustrezno izobraževanje zdravstvenih strokovnjakov. 7. Poudarjati kakovostno strokovno obravnavo in pospeševati njen razvoj. 8. Zahtevati redno kakovostno dopolnjevanje medicinske opreme. 9. Zagotoviti, da ženske popolnoma razumejo vse predlagane možnosti zdravljenja, kot tudi vključitev v klinične študije in da imajo pravico poiskati še drugo strokovno mnenje. 10. Podpirati napredek raziskav na področju raka dojke.

57% 15%

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