1. 1 standard adopts the grading standard formulated by the National Cancer Institute of the United States: Grade I: tendon reflex disappears or numbness is felt, but the function is not affected; Grade II: loss of sensation or numbness, affecting function but not daily activities; Grade III: loss of sensation or numbness, affecting daily activities; Grade ⅳ: long-term sensory loss, affecting function.
1.2 drug reactions Common chemotherapy drugs such as paclitaxel can show many different effects at different concentrations. The clinical reactions are numbness of limbs, burning sensation, walking sensation of gloves and socks, disappearance of deep tendon reflex, rapid onset of muscle and joint pain caused by paclitaxel, and further development may lead to motor nerve injury; The clinical symptoms of platinum drugs include numbness of limbs, abnormal sensation of temperature and pain, disappearance of tendon reflex, decreased sensitivity of fine touch and proprioception, ataxia, and decreased high-pitched hearing. Oxaliplatin is the third generation platinum derivative. One is the acute reaction that occurs 24-48h after administration, mainly manifested as sensory disturbance and numbness of limbs, acute sensory disturbance of throat, and aggravation of symptoms after cold. The other is chronic cumulative reaction, and its clinical symptoms are similar to those caused by cisplatin. The more cumulative dose, the longer the duration of sensory disturbance [2]. The typical manifestations of vincristine are muscle weakness, abnormal symmetrical sensation of limbs, numbness or tingling from fingertips to heart, mandibular pain and disappearance of deep tendon reflex, which can cause abdominal pain, constipation, urinary retention and postural hypotension caused by intestinal paralysis. The main clinical manifestation of adriamycin is reversible severe alopecia.
2 drug therapy In the drug therapy of anti-tumor drug toxicity, some antioxidants or cell membrane protectants have been clinically proven to have certain curative effects, such as amifostine, reduced glutathione, vitamin E, lithium salt and so on. [3]. To understand the characteristics of different chemotherapeutic drugs, paclitaxel combined with platinum is the most widely used chemotherapy scheme for postoperative chemotherapy of various malignant tumors. Paclitaxel can produce rapid and common adverse reactions, especially when used in large doses. Generally, symptoms appear 2-3 days after taking the medicine, and can be relieved or disappeared by themselves 5-6 days after taking the medicine. With the increase of chemotherapy course and individual differences, the time for symptom relief or disappearance will be prolonged. Nurses should explain the normal reaction of drugs to patients, eliminate their ideological concerns, and apply analgesics to relieve pain and improve mental state and sleep in severe cases. Patients applying oxaliplatin chemotherapy should be forbidden to touch cold objects and drink cold water, and should be instructed to wear gloves from the day of chemotherapy to avoid aggravating limb numbness in case of cold. Warm water is used for washing. If the drug extravasates during oxaliplatin chemotherapy, it should not be iced as usual, but should be partially closed. For those with severe limb numbness, nursing measures such as massage and hot compress can be taken to relieve symptoms, and to assist daily life and prevent falls. When using vincristine, we should pay attention to the evaluation of autonomic nerve injury such as abdominal pain, constipation and urination, encourage people to eat more vegetables, fruits and crude fiber, keep physical activity as much as possible, guide patients to develop the habit of defecation regularly, apply laxatives or enema when necessary, strengthen nursing and prevent collapse.
3. Clinical nursing should evaluate the dynamic nerve injury in different stages of chemotherapy. Nurses should carefully observe the condition, talk and communicate with patients, pay attention to patients' chief complaints, find out whether patients have symptoms such as numbness, paresthesia and muscle joint pain, and make an accurate classification. If there are serious reaction symptoms, you should promptly notify the doctor to give corresponding treatment, suspend chemotherapy or replace chemotherapy drugs.
3. 1 oral care before radiotherapy, carefully check the oral teeth, first remove the false teeth and gold teeth, and reduce the oral mucosal reaction. Dental caries cannot be repaired before radiotherapy, and teeth or residual roots need to be extracted. Instruct patients to drink more than 250ml of water every day to keep the oral mucosa moist. In addition, in order to keep your mouth clean, you can rinse your mouth with light salt water. Brush your teeth with a soft brush and fluoride toothpaste after meals, rinse your mouth with Dobbin solution for at least 65,438 0 min each time, and rinse your mouth alternately with cheek bulging and sucking for 65,438 0 min or 2 min to remove food residues; Other measures include: giving atomized inhalation; Spray ulcers with two melon cream sprays. The pain of oral ulcer affects the eater. Gargling with mouthwash containing lidocaine and dexamethasone 30 minutes before meals can relieve pain, increase appetite and greatly reduce or delay the occurrence of radiation stomatitis.
3.2 Diet Nursing During radiotherapy, patients suffer from dry mouth, decreased taste, congestion and pain in the posterior pharyngeal wall, and dare not eat, which may easily lead to decreased body resistance and leukopenia. At this time, it is necessary to do more ideological work for patients, encourage patients to eat more high-calorie, high-protein and multi-vitamin diets, such as fish, eggs, poultry, bean products, milk, fresh vegetables and fruits, etc., and it is appropriate to eat soft food, warm food or cold food to avoid spicy stimulation and fried food; Avoid being too sweet, too sour and too salty, and avoid aggravating the irritation to oral mucosa. High egg F 1, high vitamin digestible diet; Intravenous infusion of antibiotics and nutrients such as amino acids, glucose and vitamins as appropriate.
3.3 Strengthen basic nursing. If you feel pain or sweat for a long time, you should change clothes and bedding in time, keep the environment clean and quiet, and create a warm rest environment for patients. Do a good job of skin care in the radiation area. During storage, the skin in the radiation area may have different degrees of desquamation, itching, local infiltration and other adverse reactions. Tell patients not to scratch, scratch or scratch with their hands when storing the shooting area, do not apply soap and irritating drugs, and do not stick adhesive tape to prevent skin rupture from causing infection.
The patient was intubated subcutaneously, intravenously or intraspinal canal, and a small amount of analgesic pump was continued. To understand the patient's reaction after taking the medicine, adjust the dose in time according to the doctor's advice. Keep the catheter unobstructed to prevent slippage. Pay attention to aseptic operation to prevent infection.
Guide patients and their families to strengthen their awareness of protection and prevent injuries. If you feel that your limbs are extremely light, you should keep them clean and wear gloves and socks for protection. Those who feel unusually heavy should avoid stress and cold and hot stimulation. It is forbidden to use hot water bottles to keep warm directly in winter to prevent burns. Pay attention to wear warm clothes when going out, especially to protect your fingers and toes. Instruct patients to massage the parts with abnormal sensation, exercise moderately, go up and down stairs and be accompanied by a special person when going out to prevent accidental injuries and improve the quality of life of patients.
Psychological nursing radiation reaction and behavioral symptoms often make patients feel anxious and fearful. After the blow of surgical treatment, patients with malignant tumor have to bear the pain caused by chemotherapy again in a short time after operation, which brings great mental pressure to patients and is very important for their psychological nursing. Always communicate with patients, understand their psychological state, and help them overcome anxiety, fear and other bad psychology. Explain to patients, encourage them to establish confidence in overcoming diseases, reduce psychological burden, and actively cooperate with treatment with a good attitude. At the same time, it is very important for patients to successfully complete chemotherapy and get the cooperation of their families and care for patients.
5 Health education Cancer pain is not only a patient's physical problem, but also a psychological problem, a family and social problem. The harmonious relationship between patients and their families is conducive to the improvement of cancer pain. Family members' concerns about pain treatment are related to patients' concerns. We attach importance to the role of family members in pain treatment, from the original "patient-centered" to "family-centered". Through the simultaneous implementation of cancer pain-related knowledge education for the family members of cancer patients, a personalized nursing education program is formulated for the patients and their families, so that the family members can participate in the nursing of cancer pain of patients and cooperate with patients to appropriately use non-drug analgesia methods to relieve pain. The active participation of family members can improve the therapeutic effect of patients.
In a word, the successful evaluation and control of pain depends on a good nurse-patient relationship, the foundation is to gain the trust of patients, and the key is to let patients and their families participate in the management of pain. Strictly abide by the guiding principles of effective pain control, master the correct evaluation methods, implement effective analgesic measures and perfect nursing, and truly alleviate the pain of patients. Therefore, the care of cancer patients is the care of pain, which requires nurses to have all kinds of knowledge to deal with cancer pain, master correct evaluation methods, treatment techniques and appropriate nursing methods, adopt comprehensive nursing methods of drug and non-drug analgesia for cancer patients, and educate patients and their families about cancer pain, so that cancer patients can not only relieve pain, but also improve their quality of life.